Yom Kippur
SUKKOTH
262. A patient, even if only suffering from discomfort (such as a mild headache or irritation in the eye), and his attendants, are exempt from the mitzvah of sukkah even on the first night[432] if sitting in the sukkah will cause him added discomfort[433]. If later, on the first night, he recovers from his illness, but was unable to eat in the sukkah before midnight, he must recite kiddush after midnight, but does not recite the blessing "לישב בסוכה" unless he eats more than 54gm of bread[434].
263. A hospitalized patient is exempt from the mitzvah of sukkah unless there is a sukkah on the premises, and eating there in no way affects his well-being[435].
264. The blessing of "לישב בסוכה" is recited on the first night (until midnight) even for 27gm of bread (eaten within 2-4 minutes), but preferably for 54gm bread. Throughout the remaining days of the Festival one may only eat less than 54gm of bread outside the sukkah (unless illness prevents him from eating there)[436].
265. The mitzvah of sukkah is not complied with on the first night by consuming cake; bread is required[437].
266. A woman is exempt from the mitzvah of sukkah[438].
267. One may not eat until he has performed the mitzvah of lulav[439]. However, if a lulav becomes available only later in the day and the patient finds it difficult to fast until then, he may eat after having recited the shacharith prayer, or at least the blessings of the Torah, the first paragraph of the shema and, on the Festival day, kiddush[440].
268. If the patient was unable to hear or recite kiddush the first night and also did not recite the shehecheyanu blessing, or forgot to do so, he recites the blessing – in Israel – whenever he can, even during chol hamoed; and in the Diaspora – during the first day. If he did not recite the blessing on the second night (in the Diaspora) it should be recited whenever he can afterwards, even during chol hamoed[441].
[432] Orach Chayyim 640:3.
[433] Mishnah Berurah 640:9. See Kaf ha-Chayyim 640:15.
[434] Mishnah Berurah 639:26.
[435] Orach Chayyim 640:3. See Mishnah Berurah 640:11.
[436] Mishnah Berurah 639:22.
[437] Mishnah Berurah 639:21.
[438] Orach Chayyim 640:1. Regarding the blessing "leisheiv ba-sukkah," see the details in Mishnah Berurah 640:1 and Shemirat Shabbat Kehilchata 48:8.
[439] Magen Avraham 692:7; Mishnah Berurah 692:15.
[440] See Shemirat Shabbat Kehilchata 40:45.
[441] Mishnah Berurah 673:1.
b>Eating & Drinking.
234. Every instance in which a patient has to eat on Yom Kippur must be accompanied by a medical decision as to whether it suffices for the patient to eat or drink "by measure" or as usual; whether liquids alone will suffice or whether solid food is also essential. Even if the patient is permitted to eat a usual quantity once, nevertheless if the second time eating "by measure" were to suffice and the patient ate more, this is a serious desecration of Yom Kippur[390]. One must ascertain from the doctor what the total quantity of food and liquid is required for the patient during Yom Kippur, and whether he is to eat "by measure" or in normal quantities[391].
235. A "measure" is defined as the quantity of food and not its nutritious quality[392]. Therefore, a patient who eats or drinks on doctor's orders (after consultation with a Halachic authority), should eat and drink food and liquids that are rich in caloric content thus possibly requiring to eat or drink fewer times during the day. A patient who only needs to drink, should preferably take milk with sugar, fresh juice (prepared before the commencement of Yom Kippur) or other substantial liquids rather than water[393].
Eating.
236. A "measure" of food is defined as 30gm[394].
237. Eating less than this quantity is also a Torah violation of Yom Kippur, if not necessary to save or maintain life[395].
238. The "measure" of food should be eaten during 9 minutes. In addition, the patient should wait 9 minutes between finishing one "measure" and starting the next. If in the doctor's opinion the patient needs to eat more often, the space of time between the end of one "measure" and the start of the next may be shortened as necessary, to a minimum of two minutes[396].
239. A patient who may not fast the whole day, should preferably start eating "by measure" in the morning rather than wait till later and then eat normal larger quantities, since this may be sufficient to prevent a deterioration in his condition later[397].
240. A seriously ill patient who will be eating normally is forbidden to eat candy (sweets) between meals if taken for pleasure and not for its calorie content[398].
Drinking.
241. A "measure" of liquid is defined as 40-45cc (ml)[399]. The doctor should be asked prior to Yom Kippur what the total quantity of liquid a patient is likely to need during the day. If the patient is unable to measure out the 40-45cc (ml), he should completely fill his mouth with water and take half of this quantity as the permissible "measure" of liquid[400].
242. One should preferably measure these quantities of both solid food and liquid prior to Yom Kippur[401].
243. As in the case of eating, the patient should wait 9 minutes between each "measure" of drink. If a larger quantity of liquid is essential, the waiting time between "measures" may be shortened, or the liquid taken, teaspoonful after teaspoonful as necessary[402].
244. A "measure" of solid food may be followed immediately by a "measure" of liquid since the two are not additive[403]. However "measures" are additive if solid food (such as bread) is dipped or soaked in liquid[404].
245. A competent Halachic authority should be consulted if there is a question as to whether a particular substance is defined as a solid food or as a liquid[405].
Blessings.
246. A patient should wash his hands as usual (that is up to the wrist) before partaking of bread. If he intends to eat 54gm or more of bread, the blessing al netilath yadayim is recited[406]. However if he will eat "by measure" the blessing al netilath yadayim should not be recited even though he eats a total of 54gm or more[407].
247. A blessing is recited before eating or drinking. However if the patient eats or drinks "by measures" a blessing is not pronounced each additional time food or fluids are taken. Once he has decided that he has finished eating (or drinking) for now, if later he needs to eat or drink again, a blessing is again recited[408].
248. Kiddush is not made (neither on wine or bread[409]), nor is there an obligation to take two loaves of bread (lechem mishneh)[410], even if Yom Kippur were on the Sabbath[411].
249. A patient who ate at least 30gm within 3-4 minutes is obligated afterwards to recite the appropriate blessing; if bread were eaten in this way birkath hamazon is recited with the addition of yaaleh veyavo and on the Sabbath retseh as well. However if these were forgotten and the third blessing already pronounced, birkath hamazon is not repeated[412].
250. The blessing after eating or drinking is not recited by a patient who ate or drank "by measures"[413].
Pregnancy, childbirth and the nursing mother.
Pregnancy
251. A pregnant woman or nursing mother should fast on Yom Kippur[414]. A woman is obligated to fast at all stages of pregnancy, so long as she is healthy, even if this means that she has to stay at home or in bed the whole day[415]. As soon as she has regular labor pains she may start to drink "by measure" so as not to go into labor while dehydrated; if she has already fasted many hours, she should drink normal quantities to avoid this possibility[416].
252. A woman who is pregnant following in-vitro fertilization should drink "by measure" during the first weeks of pregnancy (and should stay at home the entire day) since such a pregnancy has a higher likelihood of resulting in abortion in the early weeks than a normal pregnancy, and this may be aggravated by the dehydration caused by fasting[417].
Childbirth.
253. For the first 72 hours following delivery a woman may not fast. The quantities she must eat depend on the following: If she asks to eat, or if her doctor says she must (even if she disagrees), she must eat as usual. However, if both she and her doctor agree that she does not need to eat, then she must nevertheless eat but "by measure"[418].
254. After the first 72 hours and until the end of seven full days after delivery the following rules apply: If she asks to eat or her doctor says she must (even if she disagrees), she is to eat as usual. On the other hand, if she asks to eat and her doctor says that she does not need to, or she does not ask to eat and there is no one who says she should, she eats "by measure". If she says that she does not need to eat and there is no one medically competent who contradicts her, she may fast as long as there is no possibility of affecting the state of a nursing baby (see paragraph 258 below)[419].
255. Once the full seven days have passed since delivery and until the end of a total of thirty days since the birth, the woman is in the category of a non-seriously ill patient and should fast[420]. However, if she is weak as a result of the childbirth and either she or the doctor says that she requires to eat or drink, she should do so as necessary[421].
256. The change over from one of the above time periods to another is determined by the hour of birth and may take place in the middle of Yom Kippur. Thus, for example, a woman who gave birth the day after Rosh Hashanah at 10.00AM, will enter her seventh day at 10.00AM on Yom Kippur, and will have to fast the rest of the day (see previous paragraph)[422].
257. There is no difference in the laws mentioned previously between a woman who gave birth to a live or dead child or to one who aborted 40 days or more after conception[423].
The nursing mother.
258. A nursing mother who, as a result of fasting, does not produce sufficient milk to sustain her baby who is entirely dependent on her milk, thus resulting in a possible danger to his life, may drink "by measure". If this is insufficient, she may drink as necessary[424].
Prayer and confession.
259. A patient who is too ill to pray with a minyan, or even alone, should at least try to recite the blessings of the Torah, the first paragraph of the shema[425] and the short vidui (confession of sins)[426]:
"חטאנו עוינו פשענו – "
"We have sinned in ignorance, we have sinned knowingly, being unable to resist temptation and we have sinned against You rebelliously."
If he is able to continue he should say the following[427]:
"אנא השם, חטאתי, עויתי, פשעתי לפניך ועשיתי כך וכך, הרי נחמתי ובושתי במעשי ולעולם איני חוזר לדבר זה -"
"Help me, Oh God, for I have sinned in ignorance, I have sinned knowingly, being unable to resist temptation and I have sinned against You rebelliously (specify here the sins). I regret this and am ashamed of my sinful deeds and will not repeat them."
If he is capable of further prayer, he should recite the blessings of the Torah, the shema and at least one shemoneh esreh prayer, with the full vidui (or at least the short vidui as above) if possible.
Reading of the Torah.
260. A patient who has to eat on Yom Kippur, may be called up to reading of the Torah during the morning service, and if it is also the Sabbath, during the afternoon service[428]. If he only ate "by measure" he may also be called up during the afternoon service when Yom Kippur is on a weekday[429]. If called up during the morning service, it is preferable not to do so for the reading of the last sections or for maftir[430].
Havdalah
261. A patient who was unable to recite havdalah at the end of Yom Kippur or to hear it recited by someone else, should make it as soon as possible until sunset the following day. The blessing over light is only said if havdalah is recited during the night following Yom Kippur. When Yom Kippur occurs on the Sabbath, havdalah may be recited until sunset on Tuesday evening (without the blessings for spices or for the light of a flame), if there was no possibility of doing so before[431].
[376] Shemirat Shabbat Kehilchata 39:1.
[377] Orach Chayyim 618:1 and Mishnah Berurah 618:1. See Be’ur Halachah s.v. holeh regarding a physician who does not observe the Shabbat. See also Shemirat Shabbat Kehilchata 39, note 15.
[378] Ran on Yuma 82a s.v. chuts; Resp. Radbaz 885 (3:444); Mishnah Berurah 618:5.
[379] Resp. Hatam Sofer 6:23.
[380] R. Sh.Z. Auerbach in Shemirat Shabbat Kehilchata 39, note 94.
[381] Resp. Chelkat Yaakov 3:68. According to Nishmat Avraham Pt. 1, Orach Chayyim 612:7 (end), since non-standard methods of alimentation are not considered eating, it follows that it is not prohibited.
[382] Resp. Maharsham 1:123; Resp. Tsits Eliezer Pt. 10, 25:21; Resp. Iggerot Moshe Orach Chayyim 3:90; Sedei Chemed, Maarechet Yom ha-Kippurim 1:18; see also Resp. Chelkat Yaakov 2:55.
[383] Written communication from R. Y.Y. Neuwirth.
[384] Shemirat Shabbat Kehilchata 39:8.
[385] Oral communication from R. Y.Y. Neuwirth.
[386] Shemirat Shabbat Kehilchata 39:8.
[387] Written communication from R. Y.Y. Neuwirth: This restriction as to amount applies wherever possible. If impossible, there is no restriction because the taste has been spoiled.
[388] Written communication from R. Sh.Z. Auerbach; oral communication from R. Y.Sh. Eliashiv.
[389] Resp. Iggerot Moshe Orach Chayyim 3:91.
[390] The penalty is extirpation (karet). See Be’ur Halachah 618:7, s.v ve-im.
[391] Shemirat Shabbat Kehilchata 39:6.
[392] Tractate Yoma 80b.
[393] R. Sh.Z. Auerbach in Nishmat Avraham Pt. 4, Orach Chayyim 618:1 (page 80).
[394] Shemirat Shabbat Kehilchata 39:18. See Nishmat Avraham Pt. 5, Orach Chayyim 618:1 regarding the measure of 30 grams. See also Nishmat Avraham Pt. 4, Orach Chayyim 475:1 (page 70) for measuring by weight instead of volume.
[395] Mishnah Berurah 618:3.
[396] Shemirat Shabbat Kehilchata 39:18 and note 67.
[397] R. Sh.Z. Auerbach in Shemirat Shabbat Kehilchata 39, note 69, and R. Ts.P. Frank in Mikra'ei Kodesh, Ha-Yamim ha-Nora'im, Pt. 1, sect. 39 in Harerei Kodesh.
[398] Oral communication from R. Sh.Z. Auerbach. See Nishmat Avraham Pt. 5, 621:1.
[399] Shemirat Shabbat Kehilchata 39:20.
[400] R. Sh.Z. Auerbach in Nishmat Avraham Pt. 1, Orach Chayyim 612:9 (page 303).
[401] Shemirat Shabbat Kehilchata 39:19.
[402] Shemirat Shabbat Kehilchata 39:20.
[403] Orach Chayyim 618:2.
[404] Mishnah Berurah 618:4.
[405] See Nishmat Avraham Pt. 1, 612:6 (page 300).
[406] Orach Chayyim 158:2.
[407] Written communication from R. Y.Y. Neuwirth.
[408] Shemirat Shabbat Kehilchata 39:21.
[409] Mishnah Berurah 618:29.
[410] Magen Avraham 618:10; Matteh Efrayyim 17, and see also ibid., Ketseh ha-Matteh 16; Shulchan Aruch ha-Rav 618:18; Chayyei Adam 155:32; Resp. Har Tsevi, Orach Chayyim 1:155.
[411] Shemirat Shabbat Kehilchata 39:31.
[412] Mishnah Berurah 618:29; Shemirat Shabbat Kehilchata 39:31, and see the details. Regarding a special blessing, see Mishnah Berurah 188:19 and Kaf ha-Chayyim 188:28.
[413] Written communication from R. Sh.Z. Auerbach in Lev Avraham Pt. 1, page 18. Similarly: Shemirat Shabbat Kehilchata 39:21. Contrary opinion: R. O. Yosef in Nishmat Avraham Pt. 1, oh, page 336, par. 16.
[414] Orach Chayyim 618:1.
[415] Oral communication from R. Sh.Z. Auerbach. According to an Oral communication from R. Y.Y. Neuwirth, R. Sh.Z. Auerbach did not agree with the leniency of physicians who recommend that all pregnant women eat or drink measured amounts.
[416] Written communication from R. Y.Y. Neuwirth.
[417] Oral communication from R. Sh.Z. Auerbach. See Nishmat Avraham Pt. 5. Orach Chayyim 617:1.
[418] Orach Chayyim 617:4; Mishnah Berurah 617:9 and 617:13; Shemirat Shabbat Kehilchata 39:12.
[419] Orach Chayyim 617:4; Shemirat Shabbat Kehilchata 39:13.
[420] Orach Chayyim 617:4.
[421] Mishnah Berurah 617:12.
[422] Shemirat Shabbat Kehilchata 39:15; Similarly, according to Resp. Yabbia Omer Pt. 7, 53:7, the days are counted in 24 hour intervals. See Nishmat Avraham Pt. 5, Orach Chayyim 617:2.
[423] Shemirat Shabbat Kehilchata 39:16.
[424] Shemirat Shabbat Kehilchata 39:17.
[425] Shemirat Shabbat Kehilchata 40:45.
[426] Rema 607:3; Mishnah Berurah 607:12.
[427] Rambam, Hilchot Teshuvah 1:1.
[428] Shemirat Shabbat Kehilchata 39:36.
[429] Shemirat Shabbat Kehilchata 39, note 115 in the name of R. Sh.Z. Auerbach. But see Shemirat Shabbat Kehilchata Pt. 3, where R. Auerbach is in doubt on this issue.
[430] Shemirat Shabbat Kehilchata 39:36; Matteh Efrayyim 618; Elef ha-Magen 618:53.
[431] Shemirat Shabbat Kehilchata 58:20.