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Beit Midrash הלכה מחשבה ומוסר גמילות חסדים

Taking Care of the Ill -- The Mitzvah of Bikur Cholim

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Those of us living in Eretz Yisroel, are reading parshas Korach this week, from which the Gemara cites a source for the mitzvah of bikur cholim. Those living in chutz la’aretz, can certainly find ample reason to study the laws of bikur cholim this week.

Question #1: "Rabbi," asked Mr. Greenberg, "My neighbor, Mrs. Friedman, is having an operation. Is it appropriate for me to visit her?"

Question #2: Does Dr. Strauss fulfill the mitzvah of bikur cholim when he makes his hospital rounds?

Question #3: "My sister-in-law is hospitalized for a few days for a minor procedure. I should really visit her, but I just can’t find the time. Is it halachically sufficient for me to call her?"


Based on a pasuk in parshas Korach, the Gemara (Nedarim 39b) teaches: "There is an allusion to the mitzvah of bikur cholim in the Torah: When Moshe declares, ‘If these people (Korach’s party) will die like most people do, and the destiny of most people will happen to them, then Hashem did not send me.’ How do we see an allusion to the mitzvah of bikur cholim in the pasuk? Moshe declared: If these people will die like most people do – if they will become ill and bedridden and people will come to inquire about their needs (in other words, illness provides an opportunity for people to fulfill the mitzvah of bikur cholim) – then people will say ‘Hashem did not send me.’" Thus, the Gemara cites this week’s parsha as one of the sources in the Torah for the mitzvah of bikur cholim since Moshe specifically asked that Korach and his party not die in the manner that most people, where this a chance to achieve this important mitzvah.

Another allusion to bikur cholim is in the beginning of Parshas Vayeira, where is says that Hashem visited Avraham Avinu three days after his Bris Milah. Rashi points out that Hashem was performing bikur cholim, visiting and providing care for the ill. In the same way, by taking care of the ill, we fulfill the mitzvah of emulating Hashem’s ways, in addition to the special mitzvah of bikur cholim (Sotah 14a). Thus, physicians, nurses or other medical professionals should have in mind before every visit or appointment that they are performing two mitzvos, one of emulating Hashem, and the other of bikur cholim. Since we rule that mitzvos tzerichos kavanah, to fulfill a mitzvah requires being cognizant of that fact, any medical professional gains much merit by being aware of this every day and all day.

Every community should have an organization devoted to the needs of the sick, and it is a tremendous merit to be involved in organizing and participating in such a wonderful chesed project (Ahavas Chesed 3:3).

The Kli Yakar (Bamidbar 16:29) offers an additional reason for fulfilling bikur cholim -- to benefit the visitor. Seeing someone ill influences the visitor to think about the importance of doing teshuvah. And this influence provides extra merit for the sick person, since he caused someone else to do teshuvah!

The Gemara (Nedarim 40a) reports that when one of Rabbi Akiva’s disciples was ill, no one came to check his welfare. Then Rabbi Akiva entered his dwelling, cleaned it and sprinkled water on the floor (to prevent dust from rising), and the student exclaimed, "Rabbi Akiva, you have brought me back to life!" After this experience, Rabbi Akiva taught that someone who visits the ill is considered to have saved his life!

WHY "BIKUR" CHOLIM?

What does bikur cholim mean?

It is worth noting that although "bikur" means "visit" in modern Hebrew, the original meaning of "bikur" is not "visit" but "checking." In other words, the actual mitzvah of bikur cholim is to check which of the sick person’s needs have not been attended to (Toras HaAdam).

There are two main aspects of this mitzvah:

I. Taking care of the physical and emotional needs of someone who is ill.

II. Praying for the recovery of the ill person (Toras HaAdam, based on Nedarim 40a).

I. TAKING CARE OF PHYSICAL NEEDS

In addition to raising the sick person’s spirits by showing concern, the visitor should also ensure that the physical, financial, and medical needs of the ill person are properly being attended to, as well as other logistical concerns that may be troubling him/her. Often, well-meaning people make the effort to visit the sick, but fail to fulfill the mitzvah of bikur cholim properly, because they fail to take care of the choleh’s needs (Gesher HaChayim).

Always cheer up the choleh (Gesher HaChayim). This is included in attending to his emotional needs.

The visit is to benefit the choleh. In most circumstances, a visit should be short and not tire out or be uncomfortable for the ill person. Sometimes the sick person wants to rest, but feels obligated to converse with a visitor (Aruch HaShulchan, Yoreh Deah 335:4). In such cases, visitors think they are performing a mitzvah, while, unfortunately, they are actually doing the opposite. It is important to remember that the entire focus of bikur cholim is on the sick person’s needs and not on the visitor’s desire to feel noble or important. I remember my mother, a"h, having such guests during one of her hospital stays; although she kept hinting that she wanted to rest, they didn’t catch on and stayed put. They thought they were performing a kind deed, while, in reality, they were harming a sick person who desperately needed to rest.

OVERNIGHT CARE

One of the greatest acts of chesed is to stay overnight with a choleh (Aruch HaShulchan, Yoreh Deah 335:3; Shu’t Tzitz Eliezer, Volume 5, Ramat Rachel, #4). A similar act of bikur cholim and true chesed is to stay overnight with a hospitalized child to enable parents to get some proper sleep and keep their family’s life in order.

A person can fulfill the mitzvah of bikur cholim even a hundred times a day (Nedarim 39b). If one frequently pops one’s head into one’s sick child’s bedroom to see how the child is doing, or periodically drops in to visit a shut-in, one fulfills a separate mitzvah each time, so long as it does not become burdensome to the choleh. Similarly, a nurse fulfills the mitzvah of bikur cholim each time he/she checks on a patient, and, therefore, she should have intent to do this for the sake of fulfilling the mitzvah.

This applies even if the nurse is paid, because the proscription against being paid to do a mitzvah applies only to the mitzvah’s minimum requirement. Once one does more than this minimum, one can be paid for the extra time one spends. The same certainly applies to someone paid to stay overnight with a sick patient.

IS THERE AN OPTIMUM TIME OF DAY TO VISIT?

The Gemara states that one should not visit a sick person during the first quarter of the day, since one usually looks healthier in the morning and the visitor may not be motivated to pray on behalf of the ill person. One should also not visit a sick person at the end of the day, when he looks much sicker and one might give up hope. Therefore, one should visit an ill person during the middle part of the day (see Nedarim 40a, and Ahavas Chesed 3:3). Rambam offers a different reason for this halacha, explaining that at other times of the day, visitors might interfere with the attendants and medical personnel who are taking care of the choleh (Hilchos Aveil 14:5).

Thus, the ideal time for visiting an ill person is in the middle of the day, unless he is receiving medical treatment at that time.

Despite the above, the custom is to visit the ill person, regardless of the time of the day. Why is this so? The Aruch HaShulchan (Yoreh Deah 335:8) explains that the Gemara’s visiting times are advisory rather than obligatory. The Gemara is saying that one should visit the ill person at the time most beneficial for his care, which is usually the afternoon, either because this does not interfere with medical care or because it is the best time to detect the patient’s medical status. However, this is only advice and can be tempered by other practical concerns.

WHAT IF THE ILL PERSON IS RECEIVING SUBSTANDARD CARE?

In this instance, one should try to upgrade the choleh’s care without agitating him in the process (Gesher HaChayim).

WHOM TO VISIT FIRST

Usually, it is a greater mitzvah to visit a poor choleh than a wealthy one. This is because there is often no one else to care for the poor person’s needs (Sefer Chassidim #361). Additionally, he may need more help because of his lack of finances, and he is more likely to be in financial distress because of his inability to work (Ahavas Chesed 3:3).

If two people need the same amount of care and one of them is a talmid chacham, the talmid chacham should be attended to first (Sefer Chassidim #361). If the talmid chacham is being attended to adequately and the other person is not, one should first take care of the other person (Sefer Chassidim #361).

CROSS-GENDER VISITING

Should a man pay a hospital visit to a female non-relative, or vice versa?

The halacha states that a man may attend to another man who is suffering from an intestinal disorder, but not to a woman suffering from such a problem, whereas a woman may attend to either a man or a woman suffering from an intestinal disorder (Mesechta Sofrim Chapter 12). This implies that one may attend to the needs of the opposite gender in all other medical situations (Shach, Yoreh Deah 335:9; Birkei Yosef, Yoreh Deah 335:4; Aruch HaShulchan, Yoreh Deah 335:11 and Shu’t Zakan Aharon 2:76).

There is a famous story of Rav Aryeh Levin, the tzaddik of Yerushalayim. He was once concerned that a certain widow who had been told not to fast on Yom Kippur would disobey orders, he personally visited her on Yom Kippur and boiled water for a cup of tea to ensure that she drank. In this way, he fulfilled the mitzvah of bikur cholim on Yom Kippur in a unique way (A Tzaddik in Our Time).

However, some halachic authorities distinguish between attending to a sick person’s needs, and visiting, contending that although a woman may usually provide a man’s nursing needs and vice versa, there is no requirement for a woman to visit an ill man (Shu’t Tzitz Eliezer, Volume 5, Ramat Rachel, and Zichron Meir pg. 71 footnote 24 quoting Shu’t Vayaan Avrohom, Yoreh Deah #25 and others). Other authorities contend that when one can assume that the woman’s medical needs are provided, a man should not visit her, because of tzniyus concerns (Shu’t Chelkas Yaakov 3:38:3; Shu’t Tzitz Eliezer, Volume 5, Ramat Rachel, #16). Instead, the man should inquire about her welfare and pray for her. I suggest asking your rav or posek for direction in these situations.

II. PRAYING FOR THE ILL

The Beis Yosef (Yoreh Deah 335) writes, "It is a great mitzvah to visit the ill, since this causes the visitor to pray on the sick person’s behalf, which revitalizes him. Furthermore, since the visitor sees the ill person, the visitor checks to see what the ill person needs." We see that Beis Yosef considers praying for the ill an even greater part of the mitzvah than attending to his needs, since he first mentions praying and then refers to attending to the other needs as "furthermore."

Someone who visits a sick person without praying for his recovery fails to fulfill all the requirements of the mitzvah (Toras HaAdam; Rama 335:4). Therefore, physicians, nurses, and aides who perform bikur cholim daily should accustom themselves to pray for their sick patients, in order to fulfill the mitzvah of bikur cholim. A simple method of accomplishing this is to discreetly recite a quick prayer (such as "Hashem, please heal this person among the other ill Jewish people [b’soch she’ar cholei yisrael]") as one leaves the person’s room. (A doctor in his office can recite the same quick prayer.)

MUST ONE PRAY FOR A SICK PERSON BY NAME?

When praying in a sick person’s presence, one does not need to mention his name, and one may recite the prayer in any language. The Gemara explains that this is because the Shechinah, the Divine presence, rests above the choleh’s head (Shabbos 12b). However, when the ill person is not present, one should pray specifically in Hebrew and should mention the person’s name (Toras HaAdam; Shulchan Aruch Yoreh Deah 335:5). If one cannot pray in Hebrew, one may do so in English or any other language except Aramaic (see Taz, Yoreh Deah 335:4).

[Incidentally, since the Shechinah is in the choleh’s presence, visitors should act in a dignified manner (Shabbos 12b; Shl"a). This includes both their behavior and their mode of dress.]

Why must one pray in Hebrew when the ill person is not present? Rashi explains that in such a case, when one prays for an individual, angels have to transport the prayer to the Divine presence (the Shechinah) – these angels transport only prayers recited in Hebrew and not those recited in Aramaic (Rashi, Shabbos 12b s.v. Deshechinah). However, when praying in the presence of the sick person, one may pray in any language, since the Shechinah is nearby and the prayer does not require the angels to transport it on high (Shabbos 12b).

MAY ONE PRAY IN ENGLISH FOR THE ILL?

This explains the difference between Hebrew and Aramaic. What about other languages? Do the angels "transport" prayer recited in a different language?

To answer this question, we must first explain why angels do not transport Aramaic prayers?

The halachic authorities dispute why the angels do not convey prayers recited in Aramaic. Some contend that angels communicate only in Hebrew and, furthermore, only convey a prayer that they understand (Tosafos, Shabbos 12b s.v. She’ayn). According to this approach, the angels convey only Hebrew prayers. However, other authorities contend that the angels do not convey Aramaic prayers because they view this language as corrupted Hebrew and not a real language (Rosh, Berachos 2:2). Similarly, the angels will not convey a prayer recited in slang or expressed in an undignified way. According to the latter opinion, the angels will convey a prayer recited in any proper language, and one may pray in English for an ill person even if he is not present.

The Shulchan Aruch quotes both opinions, but considers the first opinion to be the primary approach (Orach Chayim 101:4). However, in Yoreh Deah 335:5, the Shulchan Aruch omits the second opinion completely. The commentaries on the Shulchan Aruch raise this point, and conclude that the Shulchan Aruch felt that praying for an ill person is such a serious matter that one should certainly follow the more stringent approach and pray only in Hebrew when the choleh is not present (Taz, Yoreh Deah 335:4). Therefore, one should not pray for an individual sick person’s needs in any language other than Hebrew. Only if one is unable to pray in Hebrew, may one rely on the second opinion and pray in any language other than Aramaic.

DOES ONE FULFILL BIKUR CHOLIM OVER THE TELEPHONE?

To answer this question, let us review the reasons for this mitzvah and see if a telephone call fulfills them. One reason to visit the ill is to see if they have any needs that are not being attended to. Although a phone call might discover this, being physically present at the bedside is usually a better method of ascertaining what is needed. The second reason one visits the ill is to motivate the visitor to pray on their behalf. Again, although one may be motivated by a phone call, it is rarely as effective as a visit. Furthermore, although a phone call can cheer up the choleh and make him feel important, a personal visit accomplishes this far more effectively. Therefore, most aspects of this mitzvah require a personal visit. However, in cases where one cannot actually visit the choleh, for example, when a visit is uncomfortable for the patient or unwanted, one should call (Shu’t Igros Moshe, Yoreh Deah 1:223; Shu’t Chelkas Yaakov 2:128). Some authorities contend that it is better for a man to call, rather than visit, a hospitalized or bed-ridden woman who is not a relative, since it is difficult for an ill person to maintain the appropriate level of tzniyus (Chelkas Yaakov 3:38:3).

ALWAYS PRAY FOR GOOD HEALTH

A healthy person should daven for continuing good health, because it is far easier to pray that one remain healthy than to pray for a cure after one is already ill. This is because a healthy person remains well so long as no bad judgment is brought against him in the heavenly tribunal, whereas an ill person needs zechuyos to recover. This latter instance is not desirable for two reasons -- first, the choleh may not have sufficient zechuyos, and second, even if he does, he will lose some of his zechuyos in order to get well.

Before taking medicine or undergoing other medical treatment one should recite a short prayer: "May it be Your will, Hashem my G-d, that this treatment will heal, for You are a true Healer" (Magen Avraham 230:6; Mishnah Berurah 230:6, based on Berachos 60a).

People who fulfill the mitzvah of bikur cholim are promised tremendous reward in Olam Haba, in addition to many rewards in this world (Shabbos 127a). Someone who fulfills the mitzvah of bikur cholim properly is considered as if he saved people’s lives and is rewarded by being spared any severe punishment (Nedarim 40a).

May Hashem send refuah shleimah to all the cholim of Klal Yisrael!

- This Shiur is published also at Rabbi Kaganof's site


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