Medicines that Contain Non-Kosher Ingredients or Chametz - Part Three by Rabbi Chaim Jachter
In the last two weeks, we reviewed the debate regarding taking medicines that contain either Chametz or other forbidden substances. We noted that the consensus appears to permit swallowing either poor tasting or tasteless medicine in tablet form. However, we noted that good tasting liquid medicine or chewable medicine is a problem. Thus, many children’s medicines, which frequently contain glycerin, seem to pose a serious problem. We noted last week that glycerin comes either from a forbidden animal, plant, or petroleum source, and it is impossible to determine the source of the glycerin in a product that one has purchased.
Pleasant Tasting Children’s Medicine
Nevertheless, Rav David Heber of the Star-K presents a lenient approach in the Orthodox Union’s journal Mesorah (7:91-96, published in 1992, when Rav Heber served as a Kashrut coordinator for the OU). Rav Heber told me (in 1995) that Rav Hershel Schachter agreed with this ruling that permits one to give children pleasant-tasting medications.
We noted last week that Rav Waldenburg (Teshuvot Tzitz Eliezer 6:16) notes, based on the Minchat Kohen and the Pri Chadash, that almost all medications are at worst a rabbinic prohibition. The medications are taken in small doses and thus constitute a Chatzi Shiur (see the full explanation of this concept in last week’s essay). Moreover, the non-kosher ingredients are usually less than half of the volume of the product. The Minchat Kohen and the Pri Chadash rule that a Chatzi Shiur is regarded as only a rabbinic prohibition if it is in a mixture and constitutes less than half of the mix.
The most straightforward manner in which one may be lenient for children (at least in regard to glycerin) is that since one is unsure whether the glycerin in the medicine is not kosher, a child may consume the product based on the rule of Safek Miderabbanan Lekula (that one may be lenient in case of doubt, when a rabbinic prohibition is involved).
Furthermore, there is another lenient consideration. Rav Shlomo Kluger (Teshuvot Ha’elef Lecha Shlomo 202) argues that a Choleh She’ein Bo Sakanah (a sick individual whose life is not endangered) is permitted to consume a curative item if it is only rabbinically prohibited. He reasons that since a sick individual is permitted to consume non-kosher medicine in an unusual manner (Shulchan Aruch Yoreh Deah 155:3; Rav Kluger believes that eating non-kosher foods in an unusual manner is only rabbinically prohibited), so too a Choleh She’ein Bo Sakanah is permitted to consume any rabbinically prohibited item. Moreover, Rav Kluger believes that a Choleh She’ein Bo Sakanah is permitted to eat a Chatzi Shiur of a prohibited substance.
Both of these leniencies are highly debatable, as Rav Ovadia Yosef (Teshuvot Yabia Omer 2:Y.D. 12) and Dr. Abraham S. Abraham (Nishmat Avraham 2:52-57) note. However, the Beit Yosef (Orach Chaim 169) permits giving a rabbinically prohibited item to a child if that item is permitted according to some opinions. The Beit Yosef writes that this is the basis for the practice (which continues until this day) of giving a child to drink from the Kiddush wine, in a Shul where the custom is to recite Kiddush after the Friday night services. Even though adults follow the mainstream opinion that drinking this wine is rabbinically prohibited, we give the wine to children in accordance with the opinions that one is permitted to drink this wine.
Rav Ovadia Yosef (Teshuvot Yabia Omer 1: Y.D. 4) explains the basis for this leniency. Rav Ovadia notes the dispute (cited in the Beit Yosef, O.C. 343) between the Rambam and the Rashba as to whether one is permitted to give a child a rabbinically forbidden item. Although the Shulchan Aruch (O.C. 343:1) rules in accordance with the strict view of the Rambam on this matter, the Rashba (Yevamot 114 and Teshuvot HaRashba 1:92) adopts the lenient view (he agrees, however, that one is forbidden to give his child an item that is biblically prohibited). The Beit Yosef, explains Rav Ovadia, uses this lenient approach of the Rashba to permit giving children to drink from the Friday night Kiddush, as there is a Sfeik Sfeika (double doubt) to permit this practice. The first Safek is that perhaps the Rashba is correct that it is not forbidden to give a child a rabbinically forbidden item. The second Safek is that perhaps it is permitted to drink from the wine of the Kiddush that is recited after Friday night services. Thus, even though adults do not drink this wine due to concern for the opinions that rule that it is forbidden to do so, it is permitted to give this wine to a child.
Rav Ovadia writes (ad. loc.) that this is also the basis for the practice of serving dairy products to children even though they have not completed waiting six hours after eating meat. Rav Ovadia explains that we rely on a similar Sfeik Sfeika, combining the Rashba and the lenient view of Tosafot (Chulin 105a s.v. Liseudata) that do not require waiting a full six hours between meat and milk.
Accordingly, Rav Heber reasons that a similar Sfeik Sfeika permits giving the usual small doses of pleasant tasting medicine with non-kosher ingredients to children. This Sfeik Sfeika combines the lenient views of the Rashba and Rav Shlomo Kluger. Although each of these opinions is debatable, one may be lenient when one is able to “combine” these two lenient rulings. Furthermore, it is doubtful even if the ingredients of the medicine are non-kosher. Thus, there seems to be ample Halachic basis to permit giving children the usual small doses of medicines whose ingredients might be non-kosher. However, despite the cogency of this argument, Rav Heber noted (in 2003, at a conference of the Council of Young Israel rabbis) that some Rabbanim do not agree with this lenient approach. Moreover, an alternative approach is necessary to permit adults to consume cough syrup that contains glycerin and is not certified kosher.
Nullifying the Glycerin
Rav Heber (Mesorah 14:93 and in an essay written in English that is available at www.star-k.org) cites a solution to this problem offered by Rav Moshe Heinemann, the rabbinic administrator of the Star-K, in the context of cough medicines. Rav Heber notes that glycerin usually composes from 5-15% of the cough medicine’s volume, but never more than 20% of the product. Accordingly, he suggests nullifying the potentially prohibited glycerin by mixing each required teaspoon of elixir into two fluid ounces of water or juice. Thus, there will be twelve times as much juice than medicine (there are six teaspoons in one fluid ounce) and the glycerin will be nullified by at least sixty times (Batel Beshishim), as the glycerin constitutes no more than twenty percent of the medicine. Rav Heber writes that the Star K has consulted with various pharmaceutical companies, and they all stated that cough syrup does not lose its potency in such a mixture.
There are two potential Halachic problems with this solution. First is that Ein Mevatlin Issur Lechatchila, we cannot intentionally nullify forbidden items (Shulchan Aruch Y.D. 99:5). Rav Heber, though, explains that Rav Heinemann relies on the Shach who rules (Y.D. 84:40, 92:8, 114:21 and 115:28) that this prohibition does not apply to an item that is only possibly prohibited (Safek Issur). Since Ein Mevatlin Issur Lechatchilah is only a rabbinic prohibition (according to most Rishonim, see Encyclopedia Talmudit 1:637-638) it does not apply in a case of Safek Issur because we say Safek Miderabbanan Lekula. Accordingly, since the glycerin in a product is only possibly prohibited and it is impossible to clarify whether the glycerin in the product is derived from a forbidden animal (see Shach, Y.D. 98:9, that when something is potentially known but one has failed to take the necessary steps to secure the necessary information, it is not considered even a Safek), it is permissible to intentionally nullify it.
We should add that the fact that the original dose constituted only a rabbinic prohibition (as we explained earlier citing Rav Waldenburg) is an important factor in this leniency, as some Acharonim (see Darkei Teshuvah 99:37 and Teshuvot Igrot Moshe Y.D. 2:32) permit relying on this leniency of the Shach only if a potential rabbinic prohibition is involved. These authorities do not permit relying on the Shach if a potential biblical prohibition is involved. (The Aruch Hashulchan Y.D. 99:28 and Rav Feivel Cohen in his Badei Hashulchan also cite and discuss this lenient ruling of the Shach, but do not endorse it.)
The other possible problem with this leniency is the issue of Chatichah Atzmah Naaseit Neveilah (commonly abbreviated as “Chanan”). This means that if there is a mixture of forbidden food with permitted food, it is necessary to nullify sixty times the entire mixture (including the permitted component) in order to render it permissible (Shulchan Aruch 92:4). This is because either the permissible component of the mixture is viewed conceptually as forbidden food, or (as Rav Menachem Genack cites Rav Yosef Dov Soloveitichik) because the permissible food functions as a “carrier” for the forbidden food, so it is necessary to nullify the carrier of the forbidden food as well as the forbidden food itself. Thus, sixty times the entire medicine should be required to nullify it, rather than merely sixty times the glycerin contained in the medicine.
A solution hinges on the dispute among the Rishonim (Rabbeinu Tam and Rabbeinu Efraim, see Tosafot Chullin 100a s.v. Bishekideim) whether Chanan applies only to mixtures of milk and meat or to all prohibitions. The Rama (ad. loc.) rules in accordance with the view of Rabbeinu Tam that it applies to all prohibitions. However, in a case where the prohibited and the permitted items are thoroughly mixed (Lach Belach), the Rama rules that we may be lenient in case of very great need. In the case of nullifying the glycerin there seems to be a need to follow the lenient approach, since otherwise ten ounces of liquid per teaspoon would be necessary to nullify the medicine, which is far less practical than two ounces per teaspoon. Moreover, Rav Moshe Feinstein rules (Teshuvot Igrot Moshe Y.D. 2:34 and 36) that if the underlying prohibition is only a rabbinic prohibition, we may be lenient even when it is not a case of great need (Rav Menachem Genack told the Semichah students at Yeshiva University in 1989 that one may rely on this ruling of Rav Moshe). Once again, we see that Rav Waldenburg’s assertion that medicines taken in the usual small doses are at worst a rabbinic prohibition serves as the basis of Rav Heinemann’s ruling that permits nullifying the glycerin.
Next week, IY”H and B”N, we shall conclude our review of the permissibility of consuming medicine that contains either Chametz or other forbidden foods.