Taking Care of the Ill -- The Mitzvah of Bikur Cholim | Rabbi Yirmiyohu Kaganoff | Beit Midrash

Jewish Laws and Thoughts
General Lessons

קטגוריה משנית

Question #1: Not a doctor
"If the mitzvah of bikur cholim is to see that the patient’s needs are taken care of, what am I accomplishing by visiting him in the hospital? I am not a physician, and my inquiring about the patient’s medical care is probably intrusive and counter-productive."

Question #2: Is there a rabbi in the house?
"Why do people ask tzaddikim to pray on behalf of someone who is ill?"

Question #3: Visiting alone
"I was told not to visit a sick person by myself. Is there a halachic basis for this practice?"

Introduction
The Gemara (Sotah 14a) teaches that we have a mitzvah to follow in Hashem’s ways, and that this mitzvah includes the requirement to take care of the needs of the ill. "Rabbi Chama the son of Rabbi Chanina said, ‘How are we to understand the words of the Torah: "You should follow Hashem, your G-d." How is it possible for a human being to follow the Holy One, blessed is He, when the verse states that ‘Hashem, your G-d, is a consuming fire?’ Rather, it means that we are to emulate Hashem’s attributes – just as he dresses the naked… takes care of the sick… consoles the mourners, and buries the dead, so should we.

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 – the people will say ‘Hashem did not send me.’" Thus, the Gemara cites this week’s parsha as one of the direct sources in the Torah for the mitzvah of bikur cholim.

Last week, our article was on the topic of bikur cholim and discussed many of its basic halachos. This article includes a review of some of the basic laws and concepts of this very special mitzvah, but will primarily cover details that were not discussed in the previous article.

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).

What does the word bikur mean?
Although the word "bikur" means "visit" in modern Hebrew, the original meaning of "bikur" is not "visit" but "examine" or "check." The primary responsibility of the mitzvah of bikur cholim is to check and see what the ill person needs and to do whatever one can to meet those needs (Toras Ha’adam). Thus, a physician, nurse, nurse’s aide, or medical clown performs the mitzvah of bikur cholim all day long. If they regularly have in mind that they are fulfilling what Hashem wants us to do, they are rewarded for each and every time that they stop in to inquire about the ill and assist in his care. Each time a person visits an ill person, he fulfills an additional act of the mitzvah of bikur cholim, provided that the ill person appreciates the visit. However, one who performs the same activities while looking at it exclusively as a job, but not as an opportunity to imitate Hashem’s wondrous deeds, misses the opportunity to receive all this reward. In addition, constantly recognizing that I am acting like Hashem and fulfilling His mitzvos makes a tremendous impression on one’s neshamah.

There are two main aspects of this mitzvah:

I. Taking care of the physical and emotional needs of ill people.

II. Praying for their recovery (Toras Ha’adam, based on Nedarim 40a).

Taking care of needs
In addition to raising the sick person’s spirits by showing one’s concern, the visitor should also ascertain that the physical, financial, and medical needs are properly cared for, as well as other logistical concerns that may be troubling the patient. Often, well- meaning people make the effort to visit the sick, but fail to fulfill the mitzvah of bikur cholim fully, because they fail to check if the choleh needs something (Gesher Hachayim).

Visiting a child
The mitzvah of bikur cholim includes visiting a child who is ill (Yalkut Yosef, Volume 7, page 27). If the child is accompanied by a parent, one can accomplish all aspects of the mitzvah by visiting the parent and child in the hospital, seeing that their needs are being met and praying for the recovery of the child.

Praying
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 the 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."

The authorities note that someone who visits a sick person without praying for his recovery fails to fulfill all the requirements of the mitzvah (Toras Ha’adam; Rema, Yoreh Deah 335:4). Therefore, physicians, nurses, aides and medical clowns should accustom themselves to pray for their sick patients in order to fulfill the complete 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 [besoch she’ar cholei Yisroel]") as one leaves the person’s room. (A doctor in his office can recite the same quick prayer.) When wishing someone refuah sheleimah, what one is doing is praying on his behalf.

When praying for someone ill, always include a request that he get well together with the rest of the Jewish ill (Shabbos 12b).

Small illness
The Gemara (Yerushalmi, Brochos 4:4) implies that one should pray for the healing of even a relatively minor illness. To quote: "We should assume that any illness carries with it the potential to become dangerous."

Just pray?
At this point, let us look at the first of our opening questions: "If the mitzvah of bikur cholim is to see that the patient’s needs are taken care of, what am I accomplishing by visiting him in the hospital? I am not a physician, and my inquiring about the patient’s medical care is probably intrusive and counter-productive."

Aside from the advantage in cheering them up, which can certainly help in their medical care, visiting the patient and seeing him motivates one to daven harder for his recovery and that Hashem should give the medical personnel the wisdom to provide the proper treatment (Shu"t Yechaveh Daas 3:83).

Is there a rabbi in the house?
At this point, let us address the second of our opening questions: "Why do people ask tzaddikim to pray on behalf of an ill person?"

Anyone can daven on behalf of an ill person, and should do so; of course, this includes the ill person himself. The Gemara teaches that King Chizkiyahu was healed exclusively in the merit of his own prayer.

Notwithstanding that everyone can and should pray for the sick, the prayers of a great tzaddik have additional merit and can accomplish what the prayers of others cannot. The Gemara (Bava Basra 116a) teaches this lesson in the following way: "Whoever has an ill person in his house should go to a wise man, so that he can pray for mercy on his behalf, as the verse states, ‘The angels of death are the fury of the King, but a wise man will atone for it’ (Mishlei 16:14)."

Ben gilo
The Gemara (Nedarim 39b; Bava Metzia 30b) teaches that the most effective person to visit someone ill is one who qualifies as a ben gilo. The Gemara states that when a ben gilo visits someone ill he takes with him 1/60 of the illness. This means that the ill person is better, but the ben gilo may be affected. What is the definition of a ben gilo?

Among the authorities, I found three interpretations of the term.

(1) One approach I found is that a ben gilo shares a common mazel, meaning that he and the ill person were born under the same astrological sign (Rosh and Ran, Nedarim 39b; Taz, Yoreh Deah 335:2).

(2) The Meforeish (Nedarim 39b) defines ben gilo as a young person visiting someone young, or an older person visiting someone in his age range.

(3) The Meiri (Nedarim 39b) defines ben gilo as someone whose company the ill person enjoys. The company of someone the patient enjoys eases the illness, but it also affects the health of the friend seeing him so ill.

The probable source for the Meiri is a Midrash Rabbah (Vayikra 34:1), where it states the following: "Rav Huna said: ‘Whoever visits the ill removes one sixtieth of his illness.’ They then asked Rav Huna, ‘Then let sixty people come and visit him, and he’ll leave with them afterwards for the marketplace, completely cured!’ To this Rav Huna answered: ‘Sixty people can indeed accomplish this, but only if they love him as they love themselves!’"

Thus, we see the tremendous value of feeling empathy for the pain of the ill. (We should note that the Gemara supplies an answer to the question that was asked of Rav Huna that disputes the answer provided by the Midrash.)

Brocha for bikur cholim
One of the interesting aspects of the mitzvah of bikur cholim is that we do not recite a brocha prior to performing it. Why not?

There are many approaches to answer this question. I will here share some approaches mentioned by the early commentaries.

Patient may not want
1. One recites a brocha only prior to fulfilling a mitzvah which one knows is within his ability to perform. The patient may not want someone to take care of matters for him, or may not want to be visited. If indeed, he does not want visitors, someone who visits him does not fulfill any mitzvah (Shu"t Harashba #18).

Let me explain this approach in a bit more detail. There is a mitzvah that the ill be treated medically and properly. This is included under the mitzvah of the Torah of venishmarta me’od lenafshoseichem, you should be very careful to take care of your lives (Devorim 4:15). One would perhaps think that, therefore, I should recite a brocha on visiting the sick, since my goal is to help cure the ill person, and he is required to seek a cure for his illness. However, this is not sufficient reason to recite a brocha, since the patient is under no obligation to accept my offer to help. He may seek his relief elsewhere.

Not uniquely Jewish
2. Some authorities explain why we do not recite a brocha because the text that we say for birchos hamitzvos is: Asher kideshanu bemitzvosav, that He sanctified us with His mitzvos. They contend that we recite a brocha only when a mitzvah is uniquely Jewish (see Rokei’ach, quoted in Encyclopedia Talmudis, Volume IV, column 525). However, non-Jews also take care of the ill, so this mitzvah does not reflect anything special about the relationship of Hashem to the Jewish people.

This answer is reinforced by the fact that when fulfilling a mitzvah that is uniquely theirs, the kohanim recite a brocha that begins with the words Asher kideshanu bikedushaso shel Aharon, that He sanctified us with the sanctity of Aharon. This demonstrates that the text of brochos for mitzvos is because of the unique ability we have to perform specific commandments that we, as Jewish people or part of the Jewish people, can perform.

3. Prefer not
Yet another reason cited why we do not recite a brocha on bikur cholim is because reciting a brocha prior to observing this mitzvah sounds like we want the situation to exist (Raavad, quoted by Yalkut Yosef, page 24). We certainly would prefer that there be no ill people who require medical attention. This reason also explains why we do not recite a brocha on mitzvos such as nichum aveilim, consoling the mourners, and tearing keriyah upon hearing of the passing of a loved one.

4. Not time bound

Some rishonim note that all mitzvos upon which we recite brochos are those bound by time – meaning that there are times when we are obligated to observe the mitzvah and times when no obligation exists (Or Zarua, Birchas Hamotzi #140). Obviously, the mitzvah of bikur cholim can be fulfilled at any time.

How to visit
The Gemara states that the shechinah rests above the head of a sick person (Shabbos 12b; Nedarim 40a). For this reason, it states that someone who visits a sick person should not sit on a bed, a stool or a chair, but should wrap himself in his talis and sit on the floor. (The Gemara is referring to the time in history when a talis was the standard outer garment that a man wore. It does not mean to imply that one should put on a talis in order to fulfill the mitzvah of visiting the ill.) Alternatively, he can remain standing during his visit.

However, the Rema (Yoreh Deah 335:3) rules that when the Gemara prohibits sitting on a bed, a stool or a chair when visiting someone ill, it was referring to a situation where the patient is lying on the floor – in such a situation, one should not sit in a position higher than the shechinah. When the ill person is in a bed, one can sit on a chair that is no higher than the bed (see Yalkut Yosef, pg 28, quoting Rav Eliezer Yehudah Valdenberg).

Visiting alone
At this point, let us address the last of our opening questions: "I was told not to visit a sick person by myself. Is there any halachic basis for this practice?"

Before answering this question, I will provide a bit of historical background. Most of the earlier halachic compendia we have date to the time of the rishonim, about 700-1000 years ago. However, one of the major halachic works dates back earlier, to the era of the geonim, who were the roshei yeshiva of the yeshivos in Bavel (Mesopotomia, in today’s Iraq) and the poskim of all of klal Yisroel for a period of approximately 400 years prior to the times of the rishonim.

One of the geonim, Rav Acha’i, authored a halachic work, called the She’iltos, probably the earliest post-Talmudic halachic compendium. In one of his essays there, he discusses the mitzvah of bikur cholim as follows:

"The Jewish people are required to inquire about the wellbeing of the ill, as Rav Chanina said, ‘How are we to understand the words of the Torah: "You should follow Hashem, your G-d." How is it possible for a human being to follow the Holy One, blessed is He, when the verse declares that Hashem, your G-d, is a consuming fire?’"
Rav Acha’i continues: "Therefore, one is obligated to go and inquire about the needs of the ill. And when one goes, one should not go alone, but with someone else."

Thus, there is a halachic source for the practice not to visit the ill alone.
Notwithstanding this ruling of the She’iltos, normative halachic practice does not follow the opinion of Rav Acha’i.

The Netziv, a Hebrew acronym of Rav Naftali Tzvi Yehudah Berlin, was the Rosh Yeshiva of the Volozhin Yeshiva in the late nineteenth century, at the time that it was the preeminent yeshiva in the world. He authored several monumental works, including highly original commentaries on the Torah, and on several halachic midrashim: the Sifrei, the Mechilta, and the Sifra. He also wrote what has become the standard commentary on the She’iltos of Rav Acha’i. There the Netziv writes that he is unaware of the source for the She’iltos ruling that one should not visit the ill by himself, and he is unaware of any other halachic authority who mentions this.

Among late compendia on the laws of bikur cholim, I found this question discussed in the Yalkut Yosef, written by the current Sefardic chief rabbi of Israel, Rav Yitzchak Yosef. Rav Yosef concludes that, since no other halachic authorities, including the Shulchan Aruch, mention a halacha that one should not go alone to visit the ill, one should observe it only when it will not prevent someone from fulfilling the mitzvah. In other words, if it will be inconvenient to visit the ill person with someone else, or the ill person would prefer to be visited by one individual at a time, or the only other person available may make the ill person uncomfortable, one should certainly not take along another person when visiting the sick.

Conclusion
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). In addition to all the obvious reasons for the mitzvah of bikur cholim, the Kli Yakar, in his commentary to this week’s parsha (Bamidbar 16:29), offers an additional reason for fulfilling bikur cholim - to benefit the visitor. This influences the visitor to think of the importance of doing teshuvah. And this provides extra merit for the sick person, since he caused someone else to do teshuvah, even if it was unintentional. May Hashem send a speedy recovery to all the ill!

This Shiur is published also at Rabbi Kaganof's site

General Lessons