General rules

271. A non-seriously ill patient may not eat any chametz during Pesach, even if it is only Rabbinically prohibited, no matter how small the quantity[443].

272. Pleasant-tasting medicine, such as syrup or lozenges, may not be taken during Pesach if they contain chametz, no matter how small the quantity, unless by a seriously ill patient[444]. Unpalatable medication containing chametz may, however, be taken even by a non-seriously ill patient[445].

Seder night

273. A patient who is unable fully to take part in the seder service because of his ill health should act as follows:

(a) The bare minimum is at least to recite kiddush, drink the first cup of wine (or grape juice), and then say the paragraph "עבדים היינו", followed, if possible by the paragraph "רבן גמליאל היה אומר"[446]. If he can, he should recite the blessing "אשר גאלנו" and drink the second cup of wine. He should then wash his hands, recite the blessing for this, followed by the blessings "המוציא" and "על אכילת מצה" on 3 matzoth eating a total of 2 olives' bulk of matzah (27x2=54gm), each within 2-4 minutes[447], one for the mitzvah of matzah and one for the afikoman[448]. He should at least eat one olive's bulk[449] but then not recite the blessing for washing hands unless he eats at least 2 olive's bulk[450]. Birkath hamazon should be recited in any case[451].

At the time of eating the matzah he should mentally make a condition (referred to as "condition" hereafter) that should he wish to continue his meal before midnight he may do so, and that the afikoman that he has just eaten will represent just a piece of matzah as part of the meal and the afikoman will then be eaten at the end of the meal as usual. On the other hand if he should not be able to eat before midnight, he has already fulfilled the mitzvah of afikoman before then[452].

(b) If he is able to do more, he should eat an olive's bulk of maror (27gm) within 2-4 minutes, recite :he blessing "על אכילת מרור" but not the blessing "בורא פרי האדמה"[453]. If he can, a further olive's bulk (and preferably two[454]) of matzah for afikoman should be eaten[455] (see "condition" in (a) above). The Birkath hamazon is recited, and if possible, followed by the third cup of wine.

(c) If he recovers sufficiently before midnight to continue, the rest of the Haggadah should be recited. If time becomes available only after midnight, he should recite the blessing "אשר גאלנו", and drink a second cup with the blessing "בורא פרי הגפן" (even if he is a Sephardi[456]). Regarding the continuation of his meal, if he still has not recited Birkath hamazon and had intentions of continuing his meal on recovery, he may return to his meal (see "condition" in (a) above)[457]. However, if he has already recited Birkath hamazon, or if he had no thought of continuing with his meal, he should wash his hands again with the blessing and recite "המוציא" on two matzoth, as for any Festival meal[458]. At the end of the meal he should again eat matzah for afikoman (see "condition" in (a) above) and then recite Birkath hamazon. If he has not yet drunk the third cup of wine, he should now do so and complete the seder as usual.

(d) A patient who was unable to carry out any part of the seder before midnight, but recovers sufficiently to do so after midnight, should carry out a seder after midnight. However, the blessings "על אכילת מצה" and "על אכילת מרור" are not recited and the blessing "בורא פרי הגפן" is recited only for the first and third cups of wine[459]. The final blessing after the last cup of wine, "על הגפן ועל פרי הגפן" is recited. The blessing "אשר גאלנו" is recited without God's name. Regarding the blessing of "יהללוך", if he is an Ashkenazi the blessing is pronounced[460], but not if he is a Sephardi[461].

274. If a patient was too ill to take part in the seder service, it may not be arranged after sunrise[462].

275. All the above rules regarding the seder apply also to the second seder night of the Diaspora[463].

276. The rules governing the seder apply equally to a woman as they do to a man[464].

277. If the patient was unable to perform the seder the first night, including reciting the shehecheyanu blessing, he recites the blessing - in Israel -whenever he can, even during chol hamoed or on the last day of the Festival; and in the Diaspora – during the first day only. If he did not recite the shehecheyanu blessing on the second night (in the Diaspora), it is recited during the Festival, even during chol hamoed or on the last days of the Festival[465].

278. A patient or an elderly person who has difficulty in eating the required quantity of matzah on the seder night may crush it[466]. If he is unable to eat it dry, it may be taken with a gulp of water[467] or softened beforehand by immersion[468] in tepid water[469]. If this is insufficient, he may dip it in juice and if absolutely necessary, it may be immersed in the juice[470].

279. Every effort should be made to drink the four cups of wine on the seder night even if this will result in a headache or hangover (see paragraph 280)[471]. Boiled or raisin wine may be used as well as grape juice[472].

280. If however drinking the four cups of wine or grape juice would lead to illness serious enough to force him to take to bed, he is exempt[473]. Similarly, he is exempt if eating matzah or maror would make him sufficiently ill to have to take to bed[474].

281. A person who vomited after eating the obligatory quantity of matzah or maror, or after drinking one of the four cups of wine, has nevertheless fulfilled the mitzvah[475]. However Birkath hamazon is not recited unless another olive's bulk of matzah is eaten[476].


[443] Mishnah Berurah 666:2 and Sha'ar ha-Tsiyyun 666:6.

[444] Shemirat Shabbat Kehilchata 40:74.

[445] Rambam, Hilchot Yesodei ha-Torah 5:8; Chazon Ish, Orach Chayyim 116:8; Resp. Iggerot Moshe Orach Chayyim 2:92 and 3:62; Resp. Tsits Eliezer Pt. 10, 22:20; Shemirat Shabbat Kehilchata 40:74. See Nishmat Avraham Pt. 1, Orach Chayyim 666:1 (pages 261-266).

[446] R. Sh.Z. Auerbach in Lev Avraham Pt. 2, page 21.

[447] Mishnah Berurah 675:9.

[448] Based on Mishnah Berurah 482:6 (end).

[449] Mishnah Berurah 475:11 and Be'ur Halacha s.v. ke-zayt.

[450] Orach Chayyim 155:2.

[451] Orach Chayyim 184:6.

[452] Oral communication R. Y.Y. Neuwirth based on Orach Chayyim 477:2. For an explanation of the condition, see Nishmat Avraham Pt. 1, Orach Chayyim 477:1a (page 272).

[453] Kaf ha-Chayyim 673:109. See Nishmat Avraham Pt. 1, Orach Chayyim 477:2a (page 272).

[454] Mishnah Berurah 477:1.

[455] It is preferable to eat an olive's bulk of maror, which fulfills a rabbinic commandment and requires a blessing, than to eat the afikoman, which is merely a reminder; oral communication from R. Y.Y. Neuwirth.

[456] Because of his illness he has already diverted his attention after the first cup.

[457] Mishnah Berurah 477:17; Ben Ish Chay, First Year, Be-Ha'alotecha 2. See Nishmat Avraham Pt. 1, Orach Chayyim 178:1 (page 84).

[458] Mishnah Berurah 274:1.

[459] Oral communication from R. Sh.Z. Auerbach.

[460] Mishnah Berurah 477:7 and Sha'ar ha-Tsiyyun 477:6.

[461] R. O. Yosef in Chazon Ovadia, page 188. See his opinion that one should not recite the blessing "boreh peri ha-gefen" on the fourth cup even if one would recite it in other years. In an oral communication, R. Y.Y. Neuwirth added this applies only if already recited the blessing on the cup of birkat ha-mazon or on the third cup.

[462] Magen Avraham 481:2.

[463] Rema 481:2.

[464] Orach Chayyim 472:14.

[465] Mishnah Berurah 473:1.

[466] Be'ur Halacha 461, s.v. yotseh. See Nishmat Avraham Pt. 5, Orach Chayyim 612:1 in the name of R. Sh.Z. Auerbach regarding the measure of an olive's bulk of matsah for the Passover Seder.

[467] Resp. Binyan Tsiyyon 29.

[468] Mishnah Berurah 461:18.

[469] Mishnah Berurah 461:20. It should not be soaked for 24 hours; Mishnah Berurah 461:17.

[470] Magen Avraham 461:7; Mishnah Berurah 461:18.

[471] Orach Chayyim 472:10.

[472] Chazon Ovadia, page 128.

[473] Mishnah Berurah 462:35; Chazon Ovadia, page 128.

[474] Chazon Ovadia, page 173. Regarding celiac patients, see Nishmat Avraham Pt. 5, Orach Chayyim 273:1.

[475] Resp. Torah le-Shemah, Orach Chayyim 125.

[476] ibid.; Ben Ish Chay, First Year, Chukkat 13.