Yom Kippur questions from my archives
A. Marmorstein
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A.M.
11 Tishrei 5761
Among the usual pre-Yom Kippur questions the following two seemed worth
bringing up as topics for discussion in this forum.
Topic #1.
Anorexics
A recovering anorexic is advised by her doctor that any fasting may
cause a
regression to food deprivation. The patient is no longer at a stage
where the
lack of food for the one day is potentially dangerous, but the
regression in
her recovery incurs a risk of relapse, which could be life-
threatening. Should
she (a) fast (b) eat less than the minimum "shiyur" <size of a kosves
in time
of kedi achilas pras =2+ fl.oz. in 12 minutes> (c) eat normally. The
reason to
consider possibly recommending that she eat normally is that eating
minimal
precisely measured quantities could cause a reversion to a dangerous
pattern.
Furthermore, many eating disorder specialists consider a person to be a
recovering anorexic for five years. Can one be lenient for someone
who has been
anorexic several years earlier?
Interesting topic #2.
Underdeveloped children of 13 or 14 who have great difficulty
fasting. If a
child is physically diminutive and is just over the age of obligation
for
mitzvos and has a hard time fasting, does one wait until the child
seems about to
faint or has other signs of danger before telling the child to eat?
Or can one
assume that the child may also have delayed puberty and therefore is
not yet
really obliged to fast.
(I subsequently noticed that the Mateh Efraim discusses the issue of
very
weak children just over the age of Bar and Bas Mitzvah, and that one
may consider
the possibility that there is no physical maturity unless it is
absolutely
clear that the child has attained puberty.)
Practically speaking, when the girl's mother raised the question, was I
obligated to inquire whether she was physically developed
sufficiently to be
considered a definite adult. <I should point out that the standard 12
year old
halachic age of majority for a girl and 13 for a boy is considered by
the Talmud to
be a chazakah---a standard assumption, but clearly a child that has no
physical maturity is exempt by Torah law from fasting. We are allowed
for most
purposes to rely on the chazakah and assume the attaining of halachic
majority.>
Rabbi Avrohom Marmorstein
Cong. Minchas Chinuch NYC
meha...@aol.com
I seem to remember that in de'oyrisos we are generally machmir with
respect
to puberty e.g unless one knows for certain that the adolescent has
"shtei
sa'aros" he/she can not for example do tevilas kelim or bake matzos (to
think of two practical examples) - I am unclear as to whether one can
extrapolate this rule lekuklah in de'oyrisos to exempt an adolescent
from
fasting.
Dr Joseph Spitzer
MB BS MRCGP DCCH DRCOG
General Medical Practitioner
The Surgery
62 Cranwich Road
London N16 5JF
Telephone:- +44 181 802 2002
Fax +44 181 880 2112
Residence:- +44 181 802 4104
Honorary Senior Lecturer in General Practice & Primary Care
St Bartholomews & the Royal London School of Medicine & Dentistry
--------------------
To: Rabbi Avrohom Marmorstein
Cong. Minchas Chinuch NYC
Dear Rabbi Marmorstein,
I believe that the best approach to this problem is to understand
Anorexia
Nervosa (AN) as-amongst other things-a severe disorder of eating
behavior,
which includes a prolonged disruption and distortion of reasonable
patterns
of food intake, table behavior and attitudes to food. These patterns
often
become entrenched and the patient often maintains them secretively and
often even by deception. Where treatment has succeeded in stabilizing
and
normalizing eating behavior, it is often the result of enormous
therapeutic
effort. The stabilization of therapeutic gains and long term
maintainance
of the improvement is often a fragile process.
In the light of this I would recommend that the question of fasting or
limiting food intake on Yom Kippur be regarded as requiring a very high
level of clinical judgement requiring an individualized approach.
There is
little doubt that in some patients fasting or limiting food intake may
carry the risk of precipitating the active condition again; yet in other
patients it may function as a challenge which if successfully negotiated
may lead to increased self-confidence and further consolidation of
healthy
eating behavior- irrespective of the duration of the remission.
In summary I feel that the best approach here is that careful and mature
clinical judgement by the treating professional must be a priori; great
additional value may be achieved in some cases by case-based
consultation
with a rabbinical authority to complete the picture.
Chag Sameach,
David L. Rabinowitz MD
David L. Rabinowitz MD
Director
Psychiatric Outpatients' Service
Rambam Medical Center, Haifa
ISRAEL
Incidentally, at a meeting in Boro Park last winter, organized by
AOJS, addressed by the renowned Dr. Abraham S. Abraham of Jerusalem
the author of Nishmas Avrohom, I asked what his opinion was about
being lenient for anorexics with regard to Yom Kippur. He responded
very curtly that anorexia is a common psychological problem that
should be treated by psycho-tropic medication and there is absolutely
no reason to consider leniency for fast days. He said something to
the effect that: "If the patient takes their medication and follows
prescribed treatment, they will be fine, and if not they dies anyway!"
I do not think that represents the last word on the issue.
A. Marmorstein
Michael Merdinger
situations specifically. What is the reason for distinguishing between
eating normally and eating less than the minimum shiur? If, however
defined, medical necessity warrants eating a certain amount, I assume
there is no issur. If that amount is more than the shiur, presumably
there would be no issur karet involved. If, on the other hand, a
person ate more than necessary, every bite more than necessary would
presumably be an issur, regardless of whether one at less than the
shiur or not. So why do we distinguish the two as distinct
possibilities?