Guidelines for Those Unable to Fast on Yom Kippur

There are people for whom fasting is very difficult, and in some cases they are unable to fast for medical reasons. In any case of doubt about whether one can fast, it is appropriate to consult a rabbi. If that is not possible and there is genuine doubt, one should refrain from fasting and not endanger himself – even if the danger is not immediate but only remote. A sick person is forbidden to endanger himself and fast against a doctor’s instructions. Of such a person it is said, “But your blood, of your souls, I will demand” (Mishnah Berurah, 618:5).

The Shu”t Chatam Sofer (vol. 6, ch. 23) writes that it is preferable not to go to synagogue if doing so might prevent one from being able to fast. It is better to forgo prayer in shul if attending would make fasting impossible – even if the only consequence of staying home is avoiding a single drink of measured amounts, known as drinking “shiurin” (Shmirat Shabbat Kehilchatah, ch. 39, note 94). Therefore, someone who fears that going to shul will prevent them from fasting should rest throughout Yom Kippur, praying according to his ability – even in bed – so as not to break the fast. 

Even when drinking shiurin – the measured amounts mentioned above – becomes necessary, it is preferable that each drink contain less than a melo lugmav (a cheekful), taken no more than once every nine minutes (Mishnah Berurah 618:20). Although any drinking on Yom Kippur is Biblically prohibited, consuming a full shiur increases the severity of the transgression, incurring karet if done deliberately – so drinking less than the minimum measure is always preferable where possible. The interval between drinks may be shortened as needed: if necessary, one may drink every six minutes (Aruch HaShulchan 618:14), every four minutes (Shiurei Torah, 203–204), and in pressing circumstances every two minutes (the most lenient opinion cited in Shu”t Chatam Sofer, vol. 6, ch. 23).

How does one measure melo lugmav? This is half a mouthful and therefore varies from person to person. It can easily be measured: fill your mouth with water and spit it into a disposable cup. Divide this water equally between two disposable cups. The amount in one cup is the measure of melo lugmav. Before Yom Kippur one can mark a line on the cup at the water level, and drink that amount each time.

Once the need for measured drinking has passed, one must stop drinking, because each act of drinking is a separate prohibition. Drinking once does not constitute a “breaking of the fast” that permits continued measured drinking freely.

Should one limit himself to water, or may one drink sweetened juice? According to the Nefesh Chayah (Rabbi Margolies, 618:17), one may drink only water. However, most poskim allow a flavorful beverage as well (Nishmat Avraham, 612:1). There may even be a preference for this – Yom Kippur is a Yom Tov, and if one is already drinking, it is better to derive some enjoyment from it. Additionally, drinking a sweetened beverage may help one avoid eating and drinking later on.

Where possible, even someone who needs to eat or drink on Yom Kippur should limit himself to drinking alone. When eating is unavoidable, the same principle of shiurin applies: eat less than a kotevet hagasah (the bulk of a large date, approximately 30 cc – roughly the volume of a standard matchbox) every nine minutes. Even food that only becomes smaller than a matchbox after chewing falls within this allowance (Kuntres Mevakshei Torah 15–16). 

When eating and drinking shiurin, no waiting period is required between them (Mishnah Berurah 618:21). However, foods whose status is ambiguous – neither clearly food nor clearly drink, such as pureed fruit, porridge, or cream (Minchat Shlomo 21:1; vol. 2, 58:27) – must be separated from both eating and drinking by a full nine minutes. 

When eating or drinking in measured amounts, a single beracha rishonah before the first portion suffices, unless there is a lengthy interruption and a complete lapse of attention between portions. One does not recite a beracha achronah for measured eating.

If a shower is needed for recuperation, one may shower – and this is preferable to eating or drinking. Showering is permitted even for a non-critically ill person (Rema, 613:9; Aruch HaShulchan, ibid., 9).

A non-critically ill person who takes medication that must be continued on Yom Kippur may take it without water. If water is needed to swallow the medication, he should take a small amount of water and render it unpalatable (by adding something bitter or a little salt, so that people would not normally drink it) and then swallow the medication with it (Shmirat Shabbat Kehilchatah, ch. 39, 9). If the pill is pleasant-tasting, it should be wrapped in thin paper and swallowed while wrapped.

May G-d “accept the fast of His people” – and may we and all the house of Israel be sealed for a good life and for peace.

Rabbi Yosef Zvi Rimon is the Nasi of World Mizrachi. He is the Founder and Chairman of Sulamot and La’Ofek, and serves as the Chief Rabbi of Gush Etzion, and Rosh Yeshivah of the Jerusalem College of Technology.