Rabbi Yosef SprungThe earlier parts of this essay discussed general guidelines, Shiurim, suitable foods for a Choleh when fasting is forbidden, artificial feeding, and several specific conditions.
F. Patients with very advanced age or dementia
People of very advanced age
Adults at the extreme of age often experience complex medical situations. Although they may not always be classified as Cholim Mesukanim, they should generally be permitted to eat and drink Shiurim, since even minor disruptions to their fragile health may pose serious risk. When necessary, one may even permit them to eat and drink without the restrictions of Shiurim, if there is concern that otherwise they will not consume enough.[1]
Patients prone to falls
This concern is especially true for individuals who have difficulty walking and rely on a walker or cane, and who do not always have an aide or companion. Fasting may impair their balance and thereby increase the risk of a fall, with the attendant danger of serious fractures. This constitutes a concrete health risk, and they should be permitted to eat and drink Shiurim. In some cases, one may even permit eating and drinking without the restrictions of Shiurim, depending on the situation.[2]
Eating with an elderly patient to persuade him to eat
If an elderly patient classified as a Choleh sheYesh Bo Sakana, whose age and frailty have left his mind less than entirely clear, refuses to eat on Yom Kippur and the only way to persuade him is to tell him that today is not Yom Kippur – and even then he will eat only if someone joins him – this may be permitted as a last resort, on the grounds of Pikuach Nefesh. Nevertheless, one must make every effort to employ subterfuge or to minimize the prohibition. For example, one may place food in his own mouth while pretending to eat with the patient, then discreetly spit it out when the patient is not looking, or make the food unfit to eat so it is not considered Derech Achila.
Alzheimer’s disease
A patient with Alzheimer’s disease is, in principle, obligated to fast. However, if he has already attained the halachic status of Shoteh, he is exempt. If he does not request food or drink, one should not provide it. If he does request food or drink, it should be given by a non-Jew or a child if possible; if that is not possible, it should be placed before him so that he may take it himself.
That said, it is important to note that if his cognitive capacity is very limited and he is not aware of Yom Kippur, he may be driven to genuine anguish, and sometimes even intense anger, if denied food and drink. In that case, denying his wishes would be outright cruelty. Therefore, if he demands food, this constitutes the highest form of Sha‘as haDechak. If no non-Jew or child is available, one may feed him directly.
A patient in early stages of Alzheimer’s disease who experiences only forgetfulness but otherwise has a clear mind and normal comprehension is not defined as a Shoteh and is obligated to fast. If he forgets it is Yom Kippur and begins to eat as usual, he should be reminded of the fast.
It is advisable for family members to remain near these patients throughout Yom Kippur to ensure they do not eat when they are fit to fast, and to ensure that they do not eat more than the permitted halachic measure when they are meant to eat Shiurim. However, relatives are not obligated to remain with the patient for the duration of the fast.
G. Medications
Medications that must be taken at fixed times
One who began taking a regular medication (conventional – i.e., not vitamins, supplements, homeopathic remedies, etc.) before Yom Kippur, for whom a single day’s interruption could compromise the efficacy of the treatment,[3] may continue to do so on Yom Kippur.[4]
One who requires medication but cannot swallow it without water
If a Choleh cannot take medication without liquid, he should make the water unpalatable, such as by adding strong tea extract, oil, or salt water. The taste should be unpleasant enough that he would not ordinarily drink it, though it need not contain so much salt or other additives that it might cause nausea or vomiting. Ideally, the mixture should be prepared on Erev Yom Kippur so he can taste it before the fast.
Pain relievers
One who develops a headache or dizziness – to the degree that he becomes bedridden – from fasting, or who knows from experience that his current pain typically progresses to a level that will confine him to bed, is permitted to take pain-relieving medications.[5]
Lip balms
Regarding the use of ointments and creams, there is a concern of the Issur d’Rabbanan of Refua (due to Gezeras Shechikas Samemanim) and Meleches Memare’ach (spreading a substance). However, one who suffers from dry lips and is accustomed to pulling off peeling skin on weekdays may be permitted to use Vaseline to avoid doing so on Shabbos or Yom Kippur. He must be careful not to smear the ointment on his lips, but just to place it on them. He should not intentionally spread it by rubbing his lips together, but he need not be concerned if, in the course of regular lip movements (such as speaking, etc.), the ointment spreads on its own.[6] Alternatively, he may spread the ointment with a Shinui, for example, with the back of his finger (R’ Asher Weiss).
Dry mouth
A patient who suffers from extreme dryness of the mouth, to the point that he is unable to open his mouth to speak or even to move his tongue until he rinses with water, may moisten his mouth with water mixed with enough mouthwash to render it unfit for regular drinking.
H. Other Afflictions of the Day
Leather shoes
A person who underwent lower extremity surgery and is unable to stand or walk except with special leather shoes may wear them as needed, including to walk to shul and to stand during Tefila, since the shoes are necessary for mobility and to prevent pain, not for comfort or enjoyment. When seated with his legs elevated, he is not required to remove the shoes. Since the prohibition on Yom Kippur concerns the pleasure derived from wearing leather shoes, wearing them while neither walking nor standing does not constitute the forbidden form of enjoyment.
Washing and creams or ointments
Cholim sheEin Bahem Sakana (such as a Yoledes) are permitted to wash themselves or apply creams and oils to their skin (Sicha) if necessary. A non-Jew may be asked to heat the water if it is too cold for washing (as is the Halacha of a Choleh sheEin Bo Sakana).
A Shli’ach Tzibur who is not fasting
An esteemed and well-accepted Ba’al Tefila who regularly leads the Tefilos on Yamim Nora’im, but has fallen ill and must eat on Yom Kippur, may serve as the Shli’ach Tzibur on Yom Kippur.[7]
[1] Kisvei yad of Rav Asher Weiss shlit”a
[2] Ibid.
[3] The same applies to someone who must take medication at a certain hour of the day, or within a day of the previous dose.
[4] The basis for this is stated in Sefer haChaim (328) in the name of R’ Shlomo Kluger who asserts that the general Minhag is to be lenient. It is also stated in the name of the Chazon Ish in Orchos Rabbenu (1, Shabbos 214), cited by R’ Gedalya Nadel; in Imrey Yosher (by R’ Meir Karelitz Shlit”a, Kuntrus Pesakim of the Chazon Ish, appendix, No. 97); and in Dinim v’Hanhagos of the Chazon Ish 16:1.
[5] This is like any Choleh sheEin bo Sakana who may take medication, as ruled by the Shulchan Aruch ibid. The Chut Shani (Yom Kippur p165) draws the same conclusion.
[6] See Shemiras Shabbos Kehilchasa 33:14 and footnote 70.
[7] The Shulchan Aruch 566:5 rules that one who is not fasting cannot serve as Shli’ach Tzibur because he cannot say the Tefila of Aneinu (as evident from the Tur and Avudraham, in the name of Rabbeinu Noson). This implies that on Yom Kippur, when Aneinu is not recited, he may serve as Shli’ach Tzibur. Therefore, if his health requires him to eat, he may continue to serve as Shli’ach Tzibur, especially if he is an eminent person and well accepted by the Tzibur. If he eats Shiurim, he may certainly serve as Shli’ach Tzibur, since eating this amount does not invalidate one’s fast (Shulchan Aruch 568:1, see the Magen Avraham ibid. 2).
Rabbi Yosef Sprung
