One of the most difficult decisions a Rabbi must make is whether a sick individual may eat on Yom Kippur due to medical concerns. Nevertheless, Rabbis do not recommend intravenous feeding or any other form of artificial feeding to sick people to avoid the necessity to eat on Yom Kippur. In this essay, we will explore why Rabbis do not make such a recommendation. The essay will be based on a discussion of this issue by Rav J. David Bleich that appears in his work Contemporary Halachic Problems 3:129-140.
Many have questioned great Rabbinical authorities whether one must attach an IV to a sick individual to avoid the need to eat on Yom Kippur. They argue that although a sick person is excused from fasting, it is Halachically desirable to put him into the position of being obligated to perform Mitzvot (see Tosafot Pesachim 113b s.v. V’ein). The Gemara explains that Moshe Rabbeinu craved to enter Eretz Yisrael, in order to obligate himself to observe the Mitzvot Hateluyot Baaretz (Mitzvot that are performed only in the Land of Israel). Men wear a four-cornered garment in order to obligate themselves to wear Tziztit. Similarly, one might think that a sick individual should attach himself to an IV to enable himself to fast on Yom Kippur.
Moreover, one should try to make advance preparations to avoid having to violate the Torah in order to preserve life. For example, the Mishna Berura (330:1) cites the Sefer Chassidim, which says that a woman in her ninth month of pregnancy should prepare on Friday whatever might be necessary for her in the event that she begins labor on Shabbat. The Rama (Orach Chaim 328:12) rules that, if possible (i.e. it will cause no delay and danger), one should ask a non-Jew to do the work necessary for a dangerously ill person or perform the action in an unusual way. For example, if one must call for emergency services on Shabbat, one should do so in an unusual manner.
Artificial Feeding on Yom Kippur – Rav Chaim Ozer Grodzinski’s Ruling
An individual suggested to Rav Chaim Ozer Grodzinski (Teshuvot Achiezer 3:61) that even artificial feeding on Yom Kippur should be forbidden because it satisfies the patient’s hunger. The questioner noted that the volume of food and drink necessary to incur punishment on Yom Kippur is determined by the amount of food that satiates an individual and not by what otherwise constitutes a formal “act of eating” by Halachic standards (Yoma 79a). The questioner thus concluded that the prohibition on Yom Kippur essentially is to satisfy one’s hunger or thirst.
Rav Chaim Ozer responded that nonetheless Halacha defines only oral ingestion as eating. He cites the Gemara’s discussion (Yoma 74b) of the source of the assumption that when the Torah commands us to “afflict ourselves on Yom Kippur” it refers to refraining from food and drink. The Gemara refers to the verse (Devarim 8:3) that states that first Hashem afflicted us and then he fed us the manna. We see that the term “affliction” as used in the Torah refers to not eating or drinking. Rav Chaim Ozer argues that since the Torah records that Hashem fed us the manna to satisfy our hunger, we see that only oral ingestion of food satisfies hunger. Thus, Halacha defines one as afflicting himself if he does not ingest food or drink orally. Indeed, people do not find artificial feeding particularly satisfying.
Rav Moshe Shternbuch’s Approach
Rav Moshe Shternbuch (Moadim U’zmanim 1:60) writes that Halacha does not require one to engage in extraordinary means to enable oneself to fast on Yom Kippur. He notes that the Gemara and Shulchan Aruch make no mention of a requirement for a sick individual who must eat on Yom Kippur to eat very bitter food instead of regular food. Although eating very bitter food on Yom Kippur is only rabbinically forbidden, Chazal apparently felt that eating bitter food instead of conventional food is an extraordinary step that is not required to avoid the necessity to eat on Yom Kippur.
Support for Rav Shternbuch’s Approach
Although Teshuvot Binyan Tzion (35) recommends that a very sick person eat very bitter food instead of regular food on Yom Kippur, Rav Shternbuch’s approach appears to be accepted among rabbinical authorities. We will cite a number of rulings of various rabbinical authorities in a variety of areas to demonstrate this point.
Rav Moshe Feinstein (Teshuvot Igrot Moshe Yoreh Deah 2:74) writes that one is not obligated to induce labor early in the week in order to avoid giving birth on Shabbat. Rav Moshe writes a general statement “that one is not obligated to utilize Tachbulot (extraordinary means) in order to have to avoid violation of Shabbat.” Parenthetically, Rav Moshe strongly opposes inducing labor except in the case of an emergency. The consensus agrees with Rav Feinstein about this point (see Nishmat Avraham 2:105).
Rav Shlomo Zalman Auerbach (cited in Nishmat Avraham 4:187) rules that if a man is diagnosed with cancer he is not obligated to bank his sperm so that he can have children after chemotherapy treatment. Rabbis debate whether he is permitted to do so if he wants to, but Rav Auerbach feels that he certainly is not obligated to do so, even if he is married. For further discussion of this issue see Rav Eliyahu Bakshi Doron, Teshuvot Binyan Av 2:60.
Rav Shlomo Zalman Auerbach (Teshuvot Minchat Shlomo 1:7) also rules that one is not obligated to engage in heroic measures to avoid working on Shabbat to save lives. He presents numerous examples of this principle. One is not required to wake his neighbor in the middle of the night in order to avoid the need to turn on a light for a dangerously ill individual. One is not required to summon a neighbor to drive a dangerously ill individual to a hospital to avoid having to telephone for an ambulance. Rav Shlomo Zalman cites as a precedent the ruling of the Rama (Yoreh Deah 374:2) that a Kohen is not required to hire someone to bury a Meit Mitzva (a dead person who has no one to bury him) instead of the Kohen burying him.
Accordingly, Halachic authorities do not require a dangerously ill person to take heroic measures to avoid eating on Yom Kippur.
Rav Moshe Feinstein’s Approach
Rav Moshe Feinstein (Teshuvot Igrot Moshe 3:90) presents an intriguing approach to this issue. He suggests that it may be forbidden for one to attach himself to an IV to avoid having to eat on Yom Kippur. He notes that the Gemara (Bava Kama 85a) states that Hashem sanctioned doctors to heal. We see that employing medical procedures is not a human right; rather, it is permitted only because of Hashem’s permission. Rav Moshe argues that it is possible that the Divine sanction is limited to resolving medical problems and does not extend to utilizing medical procedures to enable people to fast.
Other rabbinical authorities that address this issue do not mention this concern. Indeed, we commonly engage in medical procedures for Halachic purposes, such as drawing blood to take a bilirubin count to determine if a Brit Mila can be performed. Indeed, Rav Soloveitchik did not agree with Rav Moshe’s suggestion, as Rav Soloveitchik was fed by IV on Yom Kippur when he was an elderly man. Rav Soloveitchik explained to his student-assistants that one is not required to attach himself to an IV if he must eat on Yom Kippur. However, The Rav found it profoundly traumatizing to eat on Yom Kippur, and artificial feeding was the only viable option for him.
Virtually all Rabbinical authorities agree that one is not required to attach himself to an IV to avoid having to eat on Yom Kippur. For further discussion of this interesting issue, see the many sources cited in Rav J. David Bleich’s aforementioned essay.