It is one of those things that no one really learns, almost like that invisible elephant in the room that we don’t want to talk about. Perhaps it is because it reminds us of our own mortality. But it is a set of halachos that we should be familiar with, because people become dangerously ill all the time. So what are the parameters of feeding a dangerously sick person on Yom Kippur?
It is important to know that the Torah does not want us to endanger ourselves by being overly stringent in matters of fasting. If it is determined that a patient must not fast, then it is a mitzvah to eat. A serious punishment is exacted upon people who refuse to eat when it is medically mandated (See MB 618:5).
Experience, however, tells us that when people get very ill or very old, they often do not think logically when it comes to their own health. It is often excruciatingly painful for old and sick people to eat—even though they must. As a consequence, they will often use their lifelong strict adherence to halachah as an excuse not to eat even when instructed to do so.
Family members should patiently and lovingly say that their mitzvah now is to eat, just like there is a mitzvah to eat on erev Yom Kippur. Often the best manner to approach it is to divert their attention with other matters or questions when one feeds them. Sometimes switching the feeder, or laying guilt trips can work too. [This is all referring to situations when there is no feeding tube or parenteral nutrition port.]
There are other situations when a generally healthy person may have recently just taken ill. It is therefore important to be familiar with the definitions and parameters found below.
‘Below the Threshold’ Prohibition
There are actually two different prohibitions that are violated when a regular person eats on Yom Kippur. The less commonly known prohibition is called “below the threshold prohibition” or the “chatzi shiur prohibition.” Although this prohibition is a Torah one, it does not invoke the serious punishment of kareis. It is also set aside whenever there is anyone who is dangerously ill.
But what about the regular “above-the-food-threshold” prohibition? May a dangerously ill person violate this regular prohibition if he can be eating “below the threshold?” Although this issue is actually a debate, the consensus of opinion is that if it is completely feasible from a medical perspective, such a person should just eat and drink “below the threshold.”
The parameters involve both time and food amounts. The “food amounts” are volume measures, not weight measures. And guess what? Food and drink are different.
Food Amounts. The food measurement is a constant—two-thirds of a medium egg (see SA OC 618:7)—understood as one fluid ounce. The liquid measure varies according to each person. If it is determined that the patient should be fasting on Yom Kippur, then, if feasible, the maximum quantity of food that may be eaten at one eating session is one fluid ounce—or 30 milliliters (cc). It is a good idea to prepare these amounts in schnapps cups in advance. Proteins are more filling than starches.
Liquid Amounts. The amount for liquids varies depending upon the person’s individual cheek volume. Remember, it is not a mouthful, but rather a cheekful—one side of the mouth. For the average person, one can figure 35 milliliters. For a small person it could be 30 milliliters.
Time Amounts. What is considered an eating or drinking session? Ideally, one should try to space them every nine minutes. The view of Rav Chaim Na-eh for food is eight minutes (see Shiurei Torah 3:15). Rav Moshe Feinstein, zt’l, writes (Igros Moshe OC IV #41) that b’dieved, in a case of need, they should have a gap of four minutes between them. In regard to liquids, one should shoot for a nine-minute gap, but if not, a four-minute gap. If this is not possible, then, for liquids, one should try to fulfill the view of the Chasam Sofer (Responsa Volume VI #23) of a gap of at least two minutes. These are the main views.
All this refers to regular water. However, a few years before his passing (before Yom Kippur of 5769), Rav Elyashiv, zt’l, ruled that a person could actually use a different option — consuming water that has a pagum (unnatural) taste that is not normally consumed because of its negative taste. The rationale for this ruling (based upon a Rema) is that such drinking does not constitute a normal form of drinking and is thus only forbidden by rabbinic ruling. The rabbis, however, never made such enactments for people who are dangerously ill.
But what should be the recipe for such water? It should be distasteful enough that a normal person would not drink the water, yet not so distasteful as to cause the drinker to get sick or to violate the prohibition of bal teshaktzu — doing something disgusting.
One should always check with one’s doctor, but this author has experimented with various concoctions to create the pagum water. [Do not take the pagum water if your doctor does not advise it for you.] The recipe that best fits the bill, in this author’s opinion, is a room-temperature 16.9-oz. bottle of water mixed with a half-teaspoon of granulated onion powder and three shakes of salt. [The onion powder should first be dissolved in a small amount of hot water before Yom Kippur if possible. This will keep it as pagum but will help reduce possible stomach unrest later.] If there is a negative reaction to the pagum water, one can always go back to the “below the threshold” method.
Experiments conducted by this author have revealed the following revelation: The colder the water, the more onion powder and salt one can tolerate.
Some people have some life-threatening illnesses that require the consumption of a potent antibiotic. These antibiotics must be consumed with a significant amount of water. Because of this, the pagum water suggestion of Rav Elyashiv, zt’l, would be the most appropriate approach to this dilemma.
It is this author’s opinion that the material under discussion should be more widespread and made more available to others. Whenever there is a doubt as to whether one is dangerously ill and there is no doctor or knowledgeable rabbi that is present or available, one should feed the patient. We should all know the 1-oz. food figure and then a nine-minute-gap formula (and the four-minute gap if this is not possible). It may also be worthwhile to have prefilled 1-oz. food containers available for emergency situations.
May Hashem, the Healer of all illness, grant us all a year of health, parnassah, and nachas from our families and ourselves.
Rabbi Hoffman can be reached at Yairhoffman2@gmail.com.