The first passuk of this week’s parashah describes Hashem’s visit to Avraham, three days after having his bris mila. The 99-year old Avraham was not feeling well, and Hashem came to visit him. This passuk serves in the Gemara as the source for the mitzva of visiting the ill. The Gemara (Sota 14a) explains: “Rabbi Chama, son of Rabbi Chanina, says: What is the meaning of that which is written: ‘After the Lord, your G-d, you shall walk…’ (Devarim 13:5)? Is it possible for a person to follow the Divine Presence?… Rather, the meaning is that one should follow the attributes of the Holy One, blessed be He. … Just as the Holy One, blessed be He, visits the sick, as it is written regarding G-d’s appearing to Avraham following his circumcision: ‘The Lord appeared to him in the plains of Mamre…’ (Bereshis 18:1), so too, you should visit the sick…”
The obligation to visit the sick is part of the obligation to behave in a G-dly way, to so-to-speak “Walk in G-d’s ways” – just as G-d visited the ill, so, too we should visit the ill.
What is included in this mitzva? The Gemara (Maseches Nedarim 40a) explains that Bikur Cholim includes tending to a sick person’s needs – cleaning his room, preparing his food, and making him comfortable in general. The Gemara continues with a story: one of Rabbi Akiva’s students lay sick without visitors. His room was dirty and he was about to die. Rabbi Akiva went to visit him and cleaned out his room. Thanks to his care, the student recovered. The Meiri explains that Rabbi Akiva cleaned the room himself, while others maintain that when people heard that Rabbi Akiva would be coming they cleaned up the room in his honor. Regardless of how it actually played out, it was because of Rabbi Akiva’s visit that the student’s life was saved. Indeed, the same equation is true in medical settings today: more visitors = better care for the patient. As a result of this story, chazal teach us: “One who refrains from visiting the ill is considered to have shed blood.”
Another aspect of the mitzva is prayer – praying for the health of the ill. When seeing first-hand his medical situation, one is aroused to pray for him with deeper sense of urgency and fervor. This is a crucial aspect of the mitzva, so much so, that the Rama (Yore Deah, 335:4) rules that one who visits the ill but fails to pray for his health did not fulfill the mitzva.
The Igros Moshe (Yore Deah, volume 1, 223) explains that the core obligation of this mitzva is to make sure the sick is receiving good care. Praying for someone’s health is just as much part of looking out for a person as talking to his doctor or getting him a drink. Since one cannot serve as a messenger to pray instead of another, this mitzva cannot be done by a shliach, although taking care of the sick person’s needs can.
When standing by the sickbed one does not mention the name of the person, but rather says – “Kel na refa na la/o (I beseech you, G-d, please heal him/her).” On Shabbos, the standard prayer for the ill is “Shabbat hi mliz’ok u’refuah kerova lavo“.
The Bahag (Minyan Esin, 36) counts the mitzva of Bikur Cholim as one of the 613 mitzvos, although according to the Rambam (Sefer Hamitzvos) it is not counted as an independent mitzva but included in the mitzva of “V’ahavta l’reiacha kamocha – you shall love your fellow as you love yourself” (Vayikra 19:18). The Rambam, however, ruled (Hichos Avel, chapter 14:1) that it is counted as an independent mitzva d’rabonon. This is learned from the Gemara (Bave Metzia 33a) where we find that beyond the mitzva of Gemilus Chassadim, there is a chiyuv of Bikur Cholim – even when there is a slight risk of infection.
The Shita Mekubetzes (Nedarim 39b) writes that one is obligated to visit the sick even if it means losing worktime. At the same time, he quotes the Re’em: one is only obligated to stop his work slightly. One does not have to spend a long time at the ill person’s bedside during workhours.
Do people of the medical profession fulfil the mitzva of visiting the ill? This question can be answered through analysis of the following discussion:
The Gemara (Nedarim 39a) writes that one should not take payment for visiting the ill while standing up. Why is the position of any importance? The Tosefos write: since it is a mitzva, one should not receive payment. The Rosh (ibid) explains that taking payment for the mitzva is degrading it. One is permitted to charge for sitting next to the ill, because sitting goes beyond the basic obligation — the mitzva includes only a walk-by visit, inquiry and prayer.
Some places, though, instituted a rule that no payment could be made for any form of visiting the ill – whether standing or sitting. The Ran explains that people in those locales were concerned that visitors would charge for their visit even while standing up, so they instituted no payment could be made for visiting he ill, whether sitting or standing.
We can derive that for extra treatment that goes beyond the basic obligation of the mitzva one may charge a fee. Therefore, a doctor or nurse who provides care beyond the basic definition of Bikur Cholim may receive payment for his services, without forfeiting the mitzva. If they intend their actions as a mitzva, their profession will be an ongoing, everlasting source of spiritual advancement.
Not all patients are in a position to receive visitors. The Shulchan Aruch writes (Yore Deah 335:8) that one should not visit someone who is embarrassed to be seen in his situation. When a patient is not ready for visitors, the mitzva can still be accomplished by staying in the foyer or hallway, and helping family members or praying on behalf of the person. Bikur Cholim is a mitzva that requires use of one’s sixth sense — when the visit is helpful, and when it is time to leave.
The Gemara (Nedarim 40a) indicates the exact time visiting the ill should take place – not in the first three hours of the day when people usually feel better; and not in the final three hours of the day when they feel worse. This is to ensure that the visitor will not refrain from praying for him – either because he looks good and will mistakenly think his prayers are unnecessary, or because he looks bad and will despair from his recovery. The Rambam (Hilchos Avel, chapter 14:5) provides another explanation: these times are when people relieve themselves, and a visit would be uncomfortable. The Birkei Yosef (Yore Deah 335:2) tags this reason irrelevant nowadays when we have bathrooms. He adds that according to the Gemara’s explanation – if one will see the patient several times a day, he may visit at any time. There is no fear the visitor will fail to pray if he sees his sick friend at different times and in different states of health.
Rabbi Yosef Chaim Zonnenfeld was asked (Shalmat Chaim, Yore Deah 185) about the visiting hours instituted in the Shaarei Tzedek Medical Center (under his rabbinical supervision). Visiting hours were at the end of the day, and the question referred to the above-mentioned sources. Rabbi Zonennfeld answered that it is more important that visitors not be present when doctors make their rounds, or during meal time. Since the end of the day is the preferable time for doctors, what’s good for the doctor is good for the patient. Therefore, one should only visit during visiting hours. Similarly, the Aruch Hashulchan writes (Yore Deah 335:5) that this halacha regarding the time of visiting is not a blanket issur, but a suggestion. Therefore, we are presently not careful to visit only at the halachically recommended times, and the mitzva pertains to all times of day.
The Gemara (Gitin 61a) writes that one should visit the ill, Jewish and non-Jewish alike. This is mipnei darkei shalom – for the sake of peace. This halacha appears in the Shulchan Aruch (335:9). The Rambam adds (Hilchos Melachim chapter 10:12) that the passuk reads: “The Lord is good to all, and His mercies are on all His works” (Tehilim 145:9) and, “Its ways are ways of pleasantness, and all its paths are peace” (Mishlei 3:17). The Rambam notes that this halacha is relevant even if the ill person is an idol worshipper who does not adhere to the Seven Noahide Laws.
This can be relevant when going to visit a patient hospitalized in medical centers, both in Eretz Yisroel and in chutz la’aretz. Many times, a Jewish patient has numerous visitors and relatives, whereas the non-Jew has none. This may distress him, or cause jealousy. Therefore, it is important to pay attention to the other patients in the ward, inquire about their health and if they need something. If planning on staying by a relative’s bedside for an extended time it is recommended to let the other patents in the room know they can feel free to ask for anything they may need.
Telephone, Zoom or Email
Contemporary poskim write that there is a mitzva pay a visit in person, see the patient’s medical situation and pray for his welfare in response to his medical situation. Since this kind of response results of awareness which is impossible to achieve through means of a telephone call, it is preferable to come in person. An in-person visit also conveys a special kind of caring which cannot be conveyed through a telephone call and which greatly assists in recovery. This detail is learned from the halacha that visiting the sick takes place at the bedside, and standing in the foyer or hallway is acceptable only when sick person’s situation warrants it, as stated earlier in this article. An additional source can be deduced from the Shulchan Aruch’s ruling (221:4) regarding nedarim: one who swore that the ill would not benefit from him is only permitted to visit him exactly as obligated by halacha – he should enter his room, remain standing, and not spend time in the room. Since even in this case the mitzva cannot be done by a messenger or from the window or foyer, we learn that Bikur Cholim should not be performed via telephone or email.
The Igros Moshe (Yore Deah part 1, 223) and Minchas Yitzchak (Volume II, chapter 84:1) write that Bikur Cholim on the telephone is a partial fulfillment of the mitzva and therefore if one can visit the ill he is certainly obligated to do so; but if not, he is obligated to fulfill the partial part and give him a call. The Chelkas Yaakov (Yore Deah 188), however, opines that a telephone, email or letter do not fulfill the mitzva at all. The call or letter are, however, a fulfillment of the mitzva of Gemilus Chasadim.
In the article for Parashas Ki Savo 5780 we discussed contagious diseases, and whether there was a mitzva to visit the ill who were stricken by such a disease. Practically, the Shevet Halevi writes (volume 7, chapter 251:5) that today, where we know how to protect ourselves when making contact, which diseases are contagious and to what degree, one can perform the mitzva of Bikur Cholim in a medically safe manner. For example, if necessary one can stand in the hallway and keep a safe distance while asking the ill person if he has everything he needs and how he can be helped. This is also the ruling of the Klausenburger Rebbe (Divrei Yatziv, Choshen Mishpat 79:37). The medical team and essential aids are obligated to care for a person who contracted a disease that is mildly contagious, even if it presents a slight risk of infection.
A Coronavirus patient, however, should not be visited in person in order to help cut the chain of infection. The ill should be visited by telephone or Zoom, and ensuring he gets what he needs and boosting his mood is essential. In this regard, a video call is preferred because it allows one to see the patient, in contrast with just hearing his voice over the phone. The medical team or visitors who are able to wear the proper protective gear and spend time with him, are obligated to do so.
People who have already been ill with Coronavirus and have antibodies should seriously consider the great mitzva of Bikur Cholim they can perform. Although the risk of reinfection is still very slightly present, it is dramatically lessened especially if one wears protective garments and falls within the category of danger that still obligates the mitzva of Bikur Cholim. One who goes into Coronavirus units and assists patients there is clearly saving lives and aiding patients’ recovery. Especially as those wards are known to be understaffed, and patients do not receive care beyond their most basic needs. In Eretz Yisroail, Ezer Mitzion sends these types of volunteers, in co-operation with the hospitals, and it is a big mitzvah for suitable individuals to volunteer.
A Kohen and Bikur Cholim
Most medical centers, especially if associated with medical schools, contain cadavers or body parts, which, according to some sources (Shulchan Aruch Yore Deah 372:2, and Pischei teshuva 9), if Jewish would render all those in the building t’mei meis. Some medical centers in Israel have made the necessary arrangements to limit the exposure to tumas meis, while others have not.
Rabbi Shlomo Zalman Auerbach (Michas Shlomo chapter 100:8) writes that a Kohen should refrain from entering large medical centers in Eretz Yisroel for Bikur Cholim (where most of the deceased are Jewish) when the presence of tumas meis is likely. However, he quotes the Tshuros Shai (559) who permits it because the issur is usually mi’drabonon (sof tuma’a lotzeis) and as long as there is no existing knowledge of a death in the building, the ill have a chezkas chai, and one can be lenient when entering for the mitzva of Bikur Cholim.
Therefore, when visiting first-degree relatives who need ongoing care and supervision, for whom refraining from doing so may result in what chachomim describe as “shedding blood”, one should not be stringent. Only when there are other family members available is there room for reconsidering the situation in light of tumas kohanim.
To clarify the halachic situation regarding tumas kohanim in various medical centers and for private questions on the matter, Rabbi Yochanan Lombard, Director of Taharas Hakohanim may be contacted at [email protected].
The Aruch Hashulchan writes (Yore Deah 355:2): “Bikur Cholim is one of the greater mitzvos, one of those for which one ‘eats of its fruits’ in this world, and retains the ‘principle’ in the next.”
The main component of the mitzva is to see if the sick person needs something and feel for him, which will, in turn arouse one to pray for his welfare. One who refrains from this mitzva is considered having “shed blood” because lack of visitors might cause the ill to die. His death will then be attributed to the person who refrained from visiting him.
The poskim disagree if this mitzva obligates one to lose worktime. The basic mitzva is to walk in for a short standing visit. This obligates all, even during work hours.
The mitzva is to physically enter the room and see what the sick person needs. When that is impossible, it can be fulfilled by telephone or, preferably by video-call whereas the ill person’s situation can be seen better. In addition, when the medical staff is made aware of the patient’s relatives’ interest and care, they give the patient better attention. If possible, one should visit the contagiously-ill patient with proper protective gear.
For a Kohen, when Bikur Cholim is absolutely pikuach nefesh, there is room for leniency in entering medical centers. But when the visit is non-essential, one should investigate the specific medical center’s policies. If the policies are problematic and there are other visitors, consider a phone or video call instead.