The Shulchan Arukh (“Set Table”) is the most widely accepted code of Jewish law ever written. Compiled in the 16th century by Rabbi Yosef Karo, it is a condensed and simplified version of the Beit Yosef, a commentary that Karo wrote on the Tur. Karo’s rulings are in accordance with Sephardic traditions; the text of the Shulchan Arukh also includes the glosses of Rabbi Moshe Isserles, which cite Ashkenazic traditions. Orach Chaim (“Way of Life,” a reference to Psalms 16:11) is the first of four sections. It discusses daily ritual observance, like prayer, Tefillin, Tzitzit, Shabbat, and holidays.
Jewish learning and access to sources is an important part of our work. As we begin learning today, we want to note the distinction mentioned in this text between a Jewish and non-Jewish doctor. This was indicative of the relationship between Jews and non-Jews when the Shulchan Arukh was codified, where non-Jews, as outsiders, were seen differently than those inside the Jewish community. This is not overly connected to the main points we are learning from this text, but we still want to acknowledge its presence.
Secondly, we find that there’s a common perception that a person needs to be seriously ill in order to eat on Yom Kippur. But, the foundational text for Jewish law never mentions that. Rather, the Shulchan Arukh says that if there is a *possibility* that the illness will worsen or that not eating would cause danger, that is enough to eat on Yom Kippur.
As we see in this text, when a sick person, meaning someone who could be harmed by fasting, is deciding whether to eat or fast on Yom Kippur, sometimes there is a conflict between what the sick person wants and what the health professional suggests. Jewish law listens to both the health professional and the sick person, ultimately choosing whichever view most saves life or health.
This is a crucial point, because sometimes we hear about people who don't follow their doctor's or therapist’s advice to eat on fast days, reasoning that their health professional doesn't understand the importance of the day. We feel that the Shulchan Arukh addresses this issue by saying that we follow the doctor’s advice even if the doctor is not Jewish. So, in a case where the doctor says to eat, while the person wants to fast, whether or not the doctor knows about the importance of the day, Jewish law would still say to follow the doctor, and to eat.
דין חולה ביום הכפורים ובו י סעיפים
חולה שצריך לאכול אם יש שם רופא בקי אפי' הוא עכו"ם שאומר אם לא יאכילו אותו אפשר שיכבד עליו החולי ויסתכן מאכילין אותו על פיו ואין צריך לומר שמא ימות
אפי' אם החולה אומר אינו צריך שומעים לרופא
ואם החולה אומר צריך אני אפילו מאה רופאים אומרים אינו צריך שומעים לחולה:
“The law concerning one who is sick on Yom Kippur” - Containing ten paragraphs.
A sick person who needs to eat, if there is an expert doctor there, even if he is a non-Jew, who says that if this person is not fed it is possible that the illness will worsen on him and he will be in danger, they feed him on the doctor’s orders, and [the doctor] does not need to say that [if the person doesn’t eat] he might die.
Even if the sick person says he doesn't need [to eat], we listen to the doctor.
But if the sick person says, “I need [to eat],” even if one hundred doctors say that he does not need to, we listen to the ill person.
(Translation by Sarah Osborne)
(ב) רופא אחד אומר צריך ורופא אחד אומר אינו צריך מאכילין אותו: הגה והוא הדין לשנים נגד שנים ואפילו קצתן יותר בקיאים מקצתן כנ"ל:
(2) One doctor says that the sick person needs (food) and another doctor says that he does not need (the food), we feed him (the sick person).
Hagah: The same holds true if two (doctors) disagree with two others even if some of them are better experts than the others (you listen to those who say the patient should eat even if they are the inferior doctors who say this) and so it seems to me (to be the correct decision).
(ג) אם החולה ורופא אחד עמו אומרים שאינו צריך ורופא (אחר) אומר צריך או שהחולה אינו אומר כלום ורופא אחד אומר צריך ושנים אומרים אינו צריך אין מאכילין אותו:
(3) If the sick person and one doctor with him say that he (the sick person) does not need (food), and another doctor says he does need (food), or if the sick person says nothing and one doctor says he needs (food) and two say he does not need (the nourishment), we do not feed him.
(ד) אם שנים אומרים צריך אפי' מאה אומרים אינו צריך ואפי' החולה אומר עמהם שאינו צריך מאכילים אותו מאחר ששנים אומרים צריך: הגה וה"ה אם החולה ורופא א' עמו אומרים צריך אע"פ שמאה רופאים אומרים אינו צריך מאכילין אותו (טור) ולא חיישינן דהחולה אומר צריך משום דמאמין לרופא זה שאומר צריך: (ב"י בשם מהרי"א):
(4) If two (doctors) say that he (the sick person) needs (food) and even if one hundred (doctors) say that he does not need (food) even if the sick person agrees with them (who say) he does not need (the food) we feed him since two say that he does need (the food).
Hagah: The same holds true (if the sick person and one doctor with him say he needs (the food) even though one hundred doctors say he does not need (the food) we feed him. (טור)), and we are not afraid that the sick person says that he needs (food) because he believes this doctor who says that he needs (the nourishment), (ב״י בשם מהרי״א).
Today, we are finishing our study of the Shulchan Aruch, Orach Chayim 618, about whether a sick person should eat or fast on Yom Kippur. The text we are learning today is a source for the practice that some people follow, of eating in shiurim on Yom Kippur - eating/drinking small amounts every nine minutes. We have strong feelings about shiurim - we feel that they should not be advised by clergy members indiscriminately. This is because some people find them to be insufficient, and also because some people may actually be harmed by eating in such a regimented, restrictive way.
While source 618:7 describes what a shiur is, source 618:8 teaches who should use shiurim. As you can see, this Shulchan Aruch source supports a nuanced and holistic approach to those who need to eat and/or drink on Yom Kippur. It is very clear in saying that those who are unable to fast without harm should only use shiurim if they are enough. Any doubt at all that shiurim are sufficient, whether from the health professional or the person themselves is enough of a reason to eat as much as is needed immediately.
(ז) כשמאכילין את העוברות או את החולה מאכילין אותם מעט מעט כדי שלא יצטרף לשיעור הילכך מאכילין אותו כשני שלישי ביצה בינונית וישהו כדי אכילת ארבעה ביצים והשתיה יבדקו בחולה עצמו כמה היא כדי שיסלקנו לצד אחד ויראה כמלא לוגמיו:
(7) When one feeds the pregnant woman or the sick person, we feed that person little by little so that it (the food) will not combine to the prescribed amount of food which is prohibited to eat, therefore we feed him (the equivalent of) two-thirds of a medium (sized) egg and (then) wait as long as the time that is required for the eating of four eggs, and as to the drink, they should examine the sick person himself how much is the liquid so that he can, when it is moved to one side (of his mouth), appear as if he had a mouthful.
(ח) וישקוהו פחות מאותו שיעור וישהו בין שתיה לשתיה כדי אכילת ארבעה ביצים ולפחו' ישהו בין שתיה לשתיה כדי שיעור שתיית רביעית ואם אמדוהו שאין השיעורים הללו מספיקים לו או שהחולה אומר כן או שנסתפקו בדבר מאכילים ומשקים אותו כל צרכו (מיד):
(8) One should give him to drink (the above amount), and they should wait between one drink and the next one as long as the time that it would take to eat four eggs. And if he (the doctor) estimated that these amounts are not enough for him (the sick person), or if the sick person says thus, or they are doubtful about the matter, we give him food and drink according to his need (immediately).