Patients Fasting on Yom Kippur: A Physician's Guide
With Yom Kippur approaching, here is a compilation of Halachos from Rav Asher Weiss regarding one who is sick and how they should conduct themselves. Rav Asher Weiss quotes a story that on Yom Kippur in the city of Pressburg, doctors would get an aliyah and be introduced as Moreinu, a title usually reserved for Halachic decisor. The reason behind this is that doctors have the ability to permit someone to break their fast. Therefore, in Pressburg, they considered doctors to have semicha per se, and the ability to issue a ruling was granted to doctors; hence, they were rewarded this title. Therefore, as medical professionals, we should be aware of these halachos so we can help our patients.
Medication during the fast: If a patient, not a Choleh Sheyesh Bo Sakanah, is currently on a regimen of conventional medications and the doctor feels that a dose cannot be skipped over the 25-hour fast period, then it could be taken as usual on Yom Kippur. However, one should try to take this medication without water. If one cannot, then they should make the water taste unpleasant.
Patients allowed to eat: Patients who are permitted to eat on Yom Kippur (either in small portions, Pachus me’k’Shiur, or regular amounts) should not make their food or drink taste unpleasant. Instead, if drinking is necessary, it's preferable to drink small amounts of a calorie-dense beverage, like grape juice, which might reduce the frequency and quantity needed throughout the day. Generally, a person who eats Pachus me’k’Shiur every 9 minutes does not make a new bracha each time.
Leniency for pain or pregnancy and elderly: If a patient is suffering from unbearable pain or a pregnant woman is concerned for the wellbeing of her fetus to eat, one can eat and drink Pachus me’k’Shiur, even when there is no immediate medical danger if they were to continue fasting. Similarly, an extremely frail individual whose health is fragile, though not currently in a life-threatening state, should be broadly permitted to eat and drink Pachus me’k’Shiur, as any slight change in their condition could endanger their health.
Pregnant women in late stages: A woman with a healthy pregnancy in the late stages of her third trimester with a fetus in the breech position is not permitted to eat or drink, even Pachus me’k’Shiur. Although fasting may induce labor, which could lead to a possible cesarean section since it's uncertain whether fasting will bring on labor and cesarean sections are not inherently dangerous, she cannot be permitted to break the fast. However, an expecting mother should consult their doctor and Rav, especially in the case of an at-risk pregnancy.
Psychotic patients & psychiatric medications: A psychotic patient may eat and drink until they calm down, as the stress of fasting could pose a life-threatening danger to themselves or others. Individuals who take psychiatric medications regularly to prevent psychosis should continue taking them on Yom Kippur. Some of these medications, such as lithium, can lead to dehydration, so it is important to consult a doctor to determine how much fluid is necessary to avoid dehydration.
Other mental health conditions: However, those with other mental health conditions like depression or bipolar disorder are generally not considered to be at risk by fasting and are, therefore, not permitted to eat or drink. However, if someone is severely depressed and suicidal, and doctors believe their life is in danger, they should be allowed to eat or drink to stabilize their emotional state.
Patients in Hospitals: A hospital patient who may need to drink during Yom Kippur but does not currently have an IV line should not have one inserted before the fast just to avoid drinking, as this carries a small risk of infection. A "Choleh Sheyesh Bo Sakanah" (i.e., a sick person in mortal danger) scheduled for a medical scan or test shortly after Yom Kippur that requires drinking beforehand may drink Pachus me’k’Shiur on Yom Kippur even if their current condition doesn't otherwise justify it. For such patients, scheduling scans without delay is a matter of Pikuach Nefesh (saving a life), and the scans should not be postponed so the person can fast.
At-risk patients: A Choleh Sheyesh Bo Sakanah or a pregnant woman who anticipates they will not be able to complete the fast should not wait until they are in danger to eat or drink. They should eat earlier with Pachus me’k’Shiur, because delaying could force them to consume larger quantities, leading to an Issur d’Oraisa.
Diabetes management: Generally, patients with Type 1 diabetes can fast on Yom Kippur; however, this should be tested on other fast days (such as Shiva Asar b'Tammuz and Tisha b'Av) and monitored by a doctor. If blood sugar levels have been successfully maintained during a fast, they should fast on Yom Kippur. If a type 1 diabetic patient has never fasted before, they should do Pachus me’k’Shiur due to multiple risks such as: taking blood sugar measurements (Issur d’Oraisa) or eating more than Pachus me’k’Shiur. Nevertheless, a patient should consult his diabetes specialist, who is familiar with him.
Alzheimer’s and dementia: A patient with Alzheimer’s or dementia who suffers from memory loss but usually has clarity and understanding is not considered a "Shoteh" (legally incompetent). If they forget it is Yom Kippur, family members should remind them and prevent them from eating or drinking. However, there is no obligation for someone to supervise them all day to ensure compliance.
Adapted from medicalhalacha.org