Rabbi Yosef SprungThe first portion of this essay[1] covered General Guidelines (including how a Choleh may gauge in advance whether he can fast, why the treating physician’s judgment carries special weight, and how to understand a patient’s claim that he “needs” to eat or drink) and Shiurim (the caution required in eating or drinking less than the halachic measure).
C. The food a Choleh should be instructed to eat
The reason we do not instruct a Choleh to spoil his food
A Choleh sheYesh Bo Sakana who is permitted to eat and drink on Yom Kippur (whether Shiurim or regularly, with the guidance of a competent halachic authority and his physician) should not deliberately spoil his food and drink,[2] but should consume them as they are.[3] Although eating sheLo k’Derech Achila is not Asur Min haTorah, whereas eating Shiurim is (though without the Chiyuv Kares), nevertheless, the Poskim do not insist that a Choleh spoil his food. This is likely due to the concern that he will not consume an adequate quantity of food and thus endanger his life. However, if a patient is confident that he will eat sufficiently, he should spoil his food. This is not a ruling for the public at large.
Moreover, in the case of a Choleh sheYesh Bo Sakana, part of the purpose of eating is to restore his peace of mind – l’Yisuvei Da’atei. Eating and drinking sheLo k’Derech is unlikely to achieve this. Additionally, if the food is spoiled, there is a concern that he may vomit and thereby worsen his condition.
Foods and drink with high nutritional value
One who must eat or drink should consume foods and drinks with high nutritional value and high caloric content. These will strengthen him and allow him to avoid excessive eating and drinking.[4]
Dry bread versus fatty meat
A Choleh should not be instructed to eat food he will not enjoy, such as dry bread or bland soup, instead of fatty meat. The guiding principle is that he should eat what will sufficiently satisfy, nourish, and settle his mind so that he may minimize further eating (Minchas Asher Moadim, Yom Kippur 17).[5]
Bitter Water
Some Poskim are inclined to say that a Choleh who is not currently in danger but must drink to prevent himself from becoming endangered should make his drinks bitter. However, Halacha does not strictly require this.
D. Artificial Feeding
Is artificial feeding on Yom Kippur an Issur d’Rabbanan?
Other Issurei Torah depend on Hana’as Grono (benefit of the oral cavity and throat) rather than Hana’as Me’av (benefit of the intestines). Thus, if one eats half a Kezayis, vomits it up, and then eats another half Kezayis, the amounts combine to form a complete measure.
Regarding Yom Kippur, some Acharonim contend that the Issur depends on Hana’as Me’av, since Inuy depends on whether the stomach is satisfied, not the throat. This has ramifications in several cases, such as where food with a volume of a Koseves (a large date) was eaten but some remained stuck in the teeth, so that the oral cavity enjoyed a Koseves but not the stomach (see Chasam Sofer O.C. 127), or if a person ate and then vomited his food (Minchas Chinuch 313:2). See also Or Sameach, Shevisas Asor 2:4.
Nevertheless, the Achiezer (3:61) rules that a person is certainly not liable for Hana’as Me’av achieved via a feeding tube because one is not liable if the Hana’ah does not come via the throat. (There is even less reason for liability here than in the case of eating something wrapped, even though the food still passes through the throat inside the tube.) The Minchas Chinuch (313) also rules that one is exempt for ingesting food wrapped in paper, etc. This is also the opinion of the Maharsham (1:124).
However, it seems that in all such cases – intravenous infusions, gastrostomies, nasal feeding tubes, rectal suppositories, and the like – since the food is not swallowed, they do not constitute acts of eating; it would not even be an Issur d’Rabbanan.
Intravenous fluids for a Choleh who needs to eat
A Choleh whose condition requires him to eat or drink is permitted to eat or drink as necessary; he is not obligated to receive nourishment or fluids intravenously.[6]
Some Poskim contend that there is a possible Issur to administer an IV to nourish a patient who is exempt from fasting.[7] Others hold that if the patient wishes to act stringently and receive an IV to avoid eating and drinking, he is permitted to do so.[8]
However, this is clearly an extreme act of Midas Chasidus. Its appropriateness depends entirely on the individual and the situation. When an ordinary person, who is not particular about pious practices in any other area, asks to be fed via IV, it is considered pretentious (“Yuhara”) and is not appropriate. The halachic requirement is only to preserve one’s life in the regular manner.
One who is hospitalized and will need fluids on Yom Kippur should not be advised to request IV placement before Yom Kippur instead of on Yom Kippur itself, since this increases a [theoretical] risk of infection. (R’ Asher Weiss.)
E. Specific conditions
Insulin-dependent diabetes
A patient with Type 1 diabetes who is treated with injections or an insulin pump: Several of the Gedolei haPoskim rule that he should eat and drink as usual throughout the day without any change to his normal routine, due to the risk of hypoglycemia or hyperglycemia.
However, many patients with Type 1 diabetes can fast on Yom Kippur. Therefore, it is recommended to experiment on other fast days, such as Shiva Asar b’Tammuz and Tisha b’Av, to see how the body responds to fasting and how much insulin is needed under fasting conditions. If they fasted on these days, monitored their blood glucose closely under a physician’s supervision, and did so without adverse events or complications, they should fast on Yom Kippur.
However, no general rule can be laid down in this matter. Not all patients with Type 1 diabetes are required to fast, nor are all of them prohibited from fasting. Rather, each patient should act in accordance with the judgment of a qualified specialist physician who is well acquainted with the patient’s specific condition.
Repeated fingersticks on Yom Kippur
One should not perform repeated fingersticks during Yom Kippur to test blood sugar if this is necessary to allow fasting, since this may involve an Issur d’Oraisa. In such a case, the patient should eat Shiurim if that reduces the number of tests needed.
However, if the tests can be performed with a Shinui, or by a non-Jew, or in any manner that involves only an Issur d’Rabbanan, frequent blood glucose testing is preferred over eating Shiurim, which is an Issur d’Oraisa. Since no general rules can be established in this area, each person in this situation must ask a Rav. (R’ Asher Weiss.)
In today’s more common case of patients using continuous glucose monitors (CGMs) instead of fingersticks, the display may be activated via Shinui, and the need for frequent glucose monitoring is not a factor in the discussion of fasting or eating.
Miscarriage
The Biur Halacha, quoting the Sdei Chemed, rules that a woman who miscarries has the same status as a woman who has given birth.[9]
However, in my humble opinion, there is an important distinction: if the miscarriage occurs toward the end of pregnancy, in which case the woman experiences labor-like contractions induced by medication, and the process is essentially identical to natural childbirth, her status is that of a woman who has given birth. If, however, it is an early miscarriage without contractions or other signs or manifestations of labor, her status is that of an ordinary Choleh, and she may drink only if a physician says that fasting would endanger her.
Preventing a cesarean section
Regarding a near-term pregnant woman whose fetus is in breech presentation: if her doctors say that fasting is likely to trigger early labor and require a cesarean section, while not fasting may allow delivery at term, by which point the fetus may turn on its own and surgery may be avoided, she should nevertheless not eat or drink on Yom Kippur, even Shiurim. This is because neither outcome is certain, and nowadays a cesarean section is not considered especially dangerous compared with a regular birth.
Postponing surgery
Regarding a Choleh with a malignant disease who is scheduled for surgery the day after Yom Kippur for which pre-surgical fasting is required, and he would be at risk if he were also to fast on Yom Kippur: Halacha regards surgery of this sort as a matter of Pikuach Nefesh, and it may not be postponed (even though doctors sometimes postpone these procedures to allow a patient to attend a Simcha, etc.). If, with the doctors’ approval, it is possible to provide him with a few hours of nutrition on the night following Yom Kippur without harming him or interfering with the surgery preparation – that is preferable. But if not, the patient should eat and drink Shiurim.
Fasting after surgery
Regarding a patient who has undergone major surgery (e.g., intracranial, intrathoracic, or intra-abdominal surgery): During the first three days post-surgery, he should eat in accordance with the Halacha of a Yoledes. Though this ruling is not found in Chaza”l or the Poskim, that is only because in their time major surgeries were not performed.[10]
Therefore, it seems self-evident that since surgery is no less traumatic than childbirth, one should be lenient in every respect during the first days following the surgery if there is any concern of Pikuach Nefesh. Though we do not find this ruling explicitly in the Poskim, and it is difficult to establish a firm Psak where they did not, it appears to be justified.
Drinking on Yom Kippur to assist medical tests
A Choleh sheYesh Bo Sakana who is scheduled for imaging or another medical test after Yom Kippur may drink Shiurim on Yom Kippur if the test requires advance hydration. Although the drinking is needed for the test rather than for the illness itself, timely testing and diagnosis for a Choleh sheYesh Bo Sakana are themselves considered Pikuach Nefesh; therefore, the test should not be delayed merely to enable fasting.
Mental illness
A patient who takes psychiatric medications regularly should continue taking his medication on Yom Kippur as usual. In the event of a psychotic episode, the Choleh should be permitted to eat and drink to settle his mind, since any stress, distress, or anxiety can negatively affect his mental state and cause real danger either to himself or others.
Unlike psychotic illness, conditions like depression or bipolar disorder generally do not, by themselves, place a patient’s life in danger. Therefore, although such a patient may take his regular medication on Yom Kippur, as noted above, eating or drinking is generally not permitted. However, in cases of severe depression, where there is concern that the patient may become suicidal or harm himself, if the treating physicians determine that his life is in danger and the patient feels a need to eat or drink, this may be permitted to settle his mind.
To be continued…
[1] https://medicalhalacha.org/2025/10/01/piskei-halacha-of-maran-rav-asher-weiss-shlita-yom-kippur-for-cholim/
[2] By contrast, this should be done for a Choleh she’Ein Bo Sakana who can only swallow medication with liquid.
[3] Minchas Shlomo, 2:58:26; Chut Shani, Yom Kippur 9, p165 et al.
[4] Nishmas Avraham 612:6, citing R’ Yehoshua Neuwirth.
[5] This is in line with the Or Sameach’s position (Ma’achalos Asuros 14:14) as well as the other Poskim who did not specify such a requirement. The Amudei Or (30 and 64) dissents. R’ Asher explained that the enjoyment derived from the taste of the food is not considered prohibited benefit; the primary benefit is the satiety that the food brings. (The reason Halacha sometimes insists that food be rendered tasteless or bitter is to make it sheLo k’Derech Achila, not because the taste itself is inherently forbidden.)
[6] Igros Moshe (O.C. 3:90; 4:121), Minchas Shlomo (2:58:26 and 69:2), Nishmas Avraham (Mahadura Basra, 1, p716) in the name of R‘ Shlomo Zalman Auerbach zt”l, all rule that there is no obligation to use an intravenous infusion. The reason is that contrived methods could lead to Sakana: people may mistakenly think that there is a halachic obligation to use them, and then, when these options are not available, they may refrain from eating and drinking.
However, a person who understands that Halacha does not require it but chooses to use this therapy rather than eat is praiseworthy (see the following footnote).
The Shu”t Yisa Yosef (O.C. 2:149) likewise quotes R’ Elyashiv zt”l, who ruled that a patient who is already in a state of Pikuach Nefesh may eat normally and there is no need to feed him intravenously. (However, this does not apply to a patient who is not yet in danger, but there is concern that he might become endangered.)
R’ Shmuel Wosner zt”l (Shevet haLevi 10:91) likewise rules that we do not have the authority to instruct a patient to receive an infusion instead of eating, given that Chaza”l specifically permitted him to eat. He explains that eating also provides Yishuv Da’as, which an infusion does not.
R’ Moshe Sternbuch shlit”a also rulesthat in cases where eating is permitted, there is no obligation to eat in an unusual manner (Shu”t Teshuvos v’Hanhagos 2:287, 290).
[7] Rav Moshe Feinstein zt”l (Igros Moshe, O.C. 3:90) discusses whether there is an Issur in using intravenous fluids on Yom Kippur instead of eating, as it might be considered contravening the will of Hashem Who desires that this individual should not fast. In addition, there is a concern that it might not actually help the patient. Furthermore, inserting the catheter constitutes an act of Chavala, which is forbidden when not for medical purposes. There is also the possibility that the administered fluids could cause other harm (this risk is permitted only for the sake of Refua). However, R’ Asher Weiss contends that it is almost certain that R’ Moshe Feinstein’s ruling, written many decades ago, no longer applies in our times.
Shulchan Shlomo (Refua, 1, p168, footnote 29), records that R’ Shlomo Zalman Auerbach zt”l once ruled that even someone who is willing and able to receive IV fluids – with the catheter inserted before Yom Kippur and with a physicians’ consent – should not do so, so that people will not come to say that a sick person is forbidden to drink on Yom Kippur except in this artificial manner even in a case of Sakana.
[8] Shevet haLevi 11:145.
[9] Biur Halacha 617 s.v. ”Yoledes” citing the Sdei Chemed (Erev Yom Kippur 3:1) in the name of several Acharonim. See also Yabia Omer 7 O.C. 53 s.v. ”haMuram”.
[10] There are some sources indicating that people in earlier times were skilled in surgical techniques – for example, the soldiers of the House of David haMelech had their spleens removed (Sanhedrin 21a), and the cows of Alexandria had their uteruses removed (ibid. 33a). However, internal surgery with anesthesia was obviously not performed.
Rabbi Yosef Sprung
