The first pasuk of this week's parsha describes Hashem’s visit to Avraham Avinu, three days after his bris milah. The 99-year-old Avraham was not feeling well, and Hashem came to visit him. The Gemara in Sotah (14a) learns out from here the mitzvah of bikur cholim, the mitzvah of visiting the ill. The Gemara points out that our mission as humans is to emulate our Creator, since Hashem visited the ill, we, too, are required to do the same. Therefore, this week I would like to focus on a number of halachos related to the mitzvah of bikur cholim.
What is the definition of the mitzvah of bikur cholim? What should one daven for when visiting one who is sick? If the sick person is sleeping, does one fulfill the mitzvah of bikur cholim? If the sick person is very ill and it’s likely that he will never know that you came, is there still a mitzvah to visit? Is one obligated to miss work to visit the sick? Is it possible for a medical professional who is already next to a sick person to fulfill the mitzvah of bikur cholim? When is the best time to visit the sick? Is there a mitzvah to visit a non-Jew who is sick? Can one fulfill the mitzvah of bikur cholim on the telephone? Is it ok for a kohen to enter a big medical center/hospital to fulfill the mitzvah of bikur cholim? Is there a mitzvah of bikur cholim if one is ill in one part of the body (i.e. a fractured bone)? Of this and more below.
What Is Included in This Mitzvah?
The Gemara in Nedorim (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 talmidim 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 talmid 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 talmid’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 mitzvah is tefillah – davening for the health of the ill. When seeing first-hand his medical situation, one is aroused to daven for him with a deeper sense of urgency and fervor. This is a crucial aspect of the mitzvah, so much so, that the Rema (Yoreh Deah, 335:4) rules that one who visits the ill but fails to daven for his health does not fulfill the mitzvah.
R’ Moshe Feinstein (Igros Moshe, Yoreh De’ah 1:223) explains: The core obligation of this mitzvah is to make sure the sick is receiving good care. Davening 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 daven instead of another, this mitzvah cannot be done by a shliach, although taking care of the sick person's needs can.
Rebuke from the Shevet HaLevi
We just mentioned that there are at least two parts to the mitzvah of bikur cholim, taking care of the sick persons needs and davening, and that the Rema writes that if one doesn’t daven for the sick person, he doesn’t fulfill the mitzvah. I feel like here is a good place to mention something the Shevet HaLevi writes.
He writes (Vol. 5, siman 184): The overwhelming majority of visits to the hospital in the eyes of halachah are consider regular visits (and not bikur cholim). Certainly people who visit family members who have just given birth, and simply waste time there, are not doing anything connected to the mitzvah of bikur cholim. Even if they bless the sick person which would be considered “asking for mercy for him/her” it still doesn’t save many situations which are far removed from the actual mitzvah.” (So if one does go out his way to visit someone sick in hospital, he/she may as well try and fulfill the mitzvah properly.)
What To Daven For
When standing by the sick persons bed, 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 tefillah for the ill is "Shabbos hi mliz'ok u'refuah kerova lavo”.
The sefer Shavosi Alecha (Tefillah al Hacholeh pg. 94) brings that R’ Aharon of Belz would bless the sick person by saying: הקב״ ה ישלח לך רפואה שלימה – “The Holy One Blessed Be He shall send you a complete recovery”. He then brings the Chida who quotes the Zohar who says, “When one wants to bless a friend or his son, he must first bless Hashem. If one doesn’t then the blessing won’t come to fruition”. He then quotes R’ Zilberstein who says that when one says: הקב״ ה – “The Holy One Blessed Be He”, that itself is considered blessing Hashem.
However, it is brought down from R’ Shlomah Zalman Auerbach that simply saying “refuah shlaimah” is considered a tefillah (Halichos Shlomah – Tefillah, Perek 8, he’orah 63).
What is the Source for Not Mentioning the Sick Persons Name and Why Not?
The Yalkut Reuveini quotes the Soday Rezayah who learns that the source is from Hashem’s visit to Avraham Avinu in this week’s parsha. When Hashem came to visit Avraham it says: וירא אליו – “He appeared to him”, and it doesn’t say: וירא אל אברם – “He appeared to Avram”, we see from here that Hashem never mentioned Avram’s name when coming to visit.
The Magen Avraham (Orach Chaim 119, s.k. 1) brings this idea from the Maharil who writes: “One who comes to beseech for mercy for his friend doesn’t need to mention his name. This is provided, that he is in front of him. If he is davening for him not in his presence then his name should be mentioned.”
The Chasam Sofer (Nedorim 40a) writes in the name of mekubolim:שיש בהזכרת שמו של חולה קצת התעוררת הדין עליו ולפעמים איכא קצת הפסד ע ״ י הזכרת שמו – “Mentioning the name of the sick sometimes causes Hashem to act with strict justice on the person, and sometimes mentioning the name is detrimental for the sick person.”
The Ta’amei Minhogim (ois 1006, in the he’oras) quotes the Nachlas Yaakov who writes: “Perhaps it was decreed that this particular name must die chas vesholam, and the name needs to be changed, as changing name is one of the things that can remove a bad decree, therefore, when visiting it is best not to mention the name.”
Does One Fulfil the Mitzvah if the Sick Person Is Sleeping?
It’s very common that one goes out his way to visit someone who is sick in hospital, and when he arrives the sick person is sleeping (after all, he is sick). Does one fulfill the mitzvah of bikur cholim in such a case?
Rashi at the beginning of this week’s parsha on the pasuk: וירא אליו – “And He appeared to him”, explains that Hashem came to Avraham Avinu: לבקר את החולה – “To fulfill the mitzvah of bikur cholim”. The Rosh writes: From the expression “He appeared” it’s clear that Hashem didn’t tell Avraham anything, and all He did was visit. If Hashem would have said anything the pasuk would mention it. The Rosh continues:ובא ללמד דרך ארץ שיש לו לאדם לבקר החולה ואפילו לא ידבר עמו דבר כגון שמצאו ישן – “This teaches us derech eretz and that it is possible to fulfill the mitzvah of visiting the sick without speaking to him at all – for example, if he is sleeping.” Such a visit is purposefull, as when the sick person wakes up someone else will tell him that so and so came to visit and it will make him happy.
We see from here, that even if the sick person doesn’t know about the visit at the time, if later on he is told about it and it makes him happy, one fulfills the mitzvah of bikur cholim.
A Number of Points to Consider According to Chiddush of the Rosh
1) According to the Rosh that one can fulfill the mitzvah of bikur cholim without speaking to the sick person, as he will be told when he wakes up that you came and this will make him happy, what would be in a case when one came to visit and the sick person wasn’t there and the visitor left a note? Does one fulfill a mitzvah in such a case, or do we say that this case is worse as he hasn’t seen the sick person at all?
Based on the Rema that says that if one visits a sick person and doesn’t daven for him he doesn’t fulfill the mitzvah, then even if one leaves a note, he certainly fulfils the mitzvah of chesed, however, since he never davened in his presence, it would seem that he doesn’t fulfill the mitzvah.
2) According to the Rosh, if one has the option of visiting either a sick person who is awake, or a sick person who is sleeping, which one comes first? Are they both equal, or do we say that the one who is awake comes first, as visiting him will achieve two things: Firstly, he will be happy that you came, and secondly, he will enjoy the visit as well?
Although most people would say that one should prioritize the one who is awake, R’ Yom Tov Sanger suggests, that perhaps it would be better to visit the one who is sleeping. The one who is sleeping is likely to get less visitors, as even those who come will leave immediately, and they may not leave any message and won’t even daven for him, therefore, perhaps one should prioritize the one who is sleeping.
3) If one goes to visit a sleeping sick person, is he considered osek bemitzvah [busy with a mitzvah] and exempt from giving tzedokah, or do we say that he only gets the mitzvah when the sick person wakes up and finds out that he had a visitor.
If The Sick Person Is Very Ill and It Is Likely He Will Never Know You Came, Is There Still a Mitzvah to Visit?
R’ Yitzchok Zilberstein (Shiurei Torah Vol. 1, siman 11, pg. 139) writes that even in such cases, there is a great gain of going to visit, and he lists a number of reasons:
1)The doctors and nurses will look after the patient better if they see that people care (see also Shu”t Teshuvos V’Hanagos 2:478).
2) Although it may seem that the sick person doesn’t understand anything, sometimes he does in fact see or feel that someone came, he just doesn’t have the strength to respond.
3) R’ Elyashiv would say that even if one looks like he is beyond help, there is an inyan to daven for him, to make things easier for him. And sometimes, miracles happen and people do get better.
R’ Yom Tov Sanger adds: One can daven for him, and tefillos next to the sick person are more powerful.
Does One Need to Miss Work?
The Shita Mekubetzes (Nedorim 39b) writes that one is obligated to visit the sick even if it means losing worktime. However, at the same time he quotes the Re’em who writes that 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.
Medical Professionals
Do people of the medical profession fulfil the mitzvah of visiting the ill? This question can be answered through analysis of the following discussion:
The Gemara in Nedorim (39a) writes that one should not take payment for visiting the ill while standing up. Why is the position of any importance? Tosfos writes: Since it is a mitzvah, one should not receive payment. The Rosh explains that taking payment for the mitzvah is degrading it. However, one is permitted to charge for sitting next to the ill, because sitting goes beyond the basic obligation - the mitzvah includes only a walk-by visit, inquiry and quick tefillah.
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 mitzvah 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 mitzvah. If they intend their actions as a mitzvah, their profession will be an ongoing, everlasting source of spiritual advancement.
Conduct
Not all patients are in a position to receive visitors. The Shulchan Aruch writes (Yoreh De’ah 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 mitzvah can still be accomplished by staying in the foyer or hallway, and helping family members or davening on behalf of the person. Bikur cholim is a mitzvah that requires use of one's sixth sense - when the visit is helpful, and when it is time to leave.
Leaving Is Also Part of the Mitzvah
When visiting a sick person, as we mentioned above, it is important to use one’s sixth sense and know when it is time to leave.
The Rambam (Hilchos Avel 14:6) writes: “One who enters to visit a sick person, shouldn’t sit on the bed or on a stool ... he should wrap himself and sit by the sick person head, he should beseech for mercy on his behalf, and leave.” We see that leaving is also part of the mitzvah.
It is said over that the Brisker Rav would be medayek this from another Rambam as well. The Rambam (14:4) rules: “One should visit many times in a day, and the more the better, as long as it doesn’t become too bothersome for the one who is sick” The Gaon (Yoreh Deah 335:3) cites a source for the Rambam from the Gemara in Nedorim (39b). The Gemara says: “One can visit even 100 times a day”. We see that one isn’t supposed to stay by the sick person for many hours, because if that is what one is supposed to do how could one visit 100 times a day? We see that one should keep his visits short and should go in and out.
There is a story with the HaSar HaChosid R’ Shimon Wolf Rothchild and the Kesav Sofer, R’ Rothchild would visit the Kesav Sofer very often. One time he came to visit the Kesav Sofer and he saw that he was in great pain and very weak and kept the visit very short. The Kesav Sofer asked him, why this time he made the visit so short? R’ Rothchild answered: Chazal (Bava Metzia 30b) darshen from the pasuk: את הדרך ילכו בה – “In its ways you shall go”, to be referring to the mitzvah of bikur cholim. The question is, what does הליכה – “going” have to do with bikur cholim? R’ Rothchild explained: Sometimes when visiting one who is sick it’s not nice to stay, and the longer one stays the more tiring and strenuous it is for the one who is sick, and the one visiting should understand this on his own and leave. That is why Chazal learn from the pasuk את הדרך ילכו בה the mitzvah of bikur cholim, as sometimes leaving (הליכה) is included in the mitzvah.
Time
The Gemara in Nedorim (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 davening for him – either because he looks good and will mistakenly think his tefillos are unnecessary, or because he looks bad and will despair from his recovery. The Rambam (Hilchos Avel 14:5) provides another explanation: These times are when people relieve themselves, and a visit would be uncomfortable. The Birkay Yosef (Yoreh 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 daven if he sees his sick friend at different times and in different states of health.
Rav Yosef Chaim Sonnenfeld was asked (Shu”t Salmas Chaim, Yoreh Deah 601) about the visiting hours instituted in the Shaarei Tzedek Medical Center (under his rabbinical supervision). The visiting hours were at the end of the day, yet we mentioned above that one shouldn’t visit in the final three hours of the day?
Rav Sonennfeld answered that it is more important that visitors not be present when doctors make their rounds, or during mealtime. 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 (Yoreh Deah 335:5) that this halachah 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 mitzvah pertains to all times of day.
Non-Jews
The Gemara in Gittin (61a) writes that one should visit the ill, Jewish and non-Jewish alike. This is mipnei darkei shalom – for the sake of peace. This halachah appears in the Shulchan Aruch (335:9). 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 patients in the room know they can feel free to ask for anything they may need.
Can One Fulfill the Mitzvah of Bikur Cholim Via Telephone, Zoom or Email?
Contemporary poskim write that there is a mitzvah to pay a visit in person, see the patient's medical situation and daven 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 halachah 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. An additional source can be deduced from the Shulchan Aruch's ruling (221:4) regarding nedorim: One who swore that the ill would not benefit from him is only permitted to visit him exactly as obligated by halachah – he should enter his room, remain standing, and not spend time in the room. Since even in this case the mitzvah 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 (Yoreh Deah Vol. 1, 223) and Minchas Yitzchak (Volume 2, chapter 84:1) write that bikur cholim on the telephone is a partial fulfillment of the mitzvah 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 (Yoreh Deah 188), however, opines that a telephone, email or letter do not fulfill the mitzvah at all. The call or letter are, however, a fulfillment of the mitzvah of gemilus chasadim.
Contagious Disease
Is there a chiyuv to visit someone who is carrying a contagious disease?
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 mitzvah 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 Mishpot 79:37).
A Kohen and Bikur Cholim
Most medical centers, especially if associated with medical schools, contain cadavers or body parts, which, according to some, if Jewish would render all those in the building t'mei meis. Some medical centers in Eretz Yisroel have made the necessary arrangements to limit the exposure to tumas meis, while others have not.
Rabbi Shlomah Zalman Auerbach (Minchas Shlomah 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 Teshuros 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 [presumed status of being alive], and one can be lenient when entering for the mitzvah 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 Chazal 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.
Illness in One Part of the Body
As we mentioned above, this week’s parsha describes Hashem's visit to Avraham Avinu, three days after his bris milah. Why did Hashem wait three days before visiting?
The Maharal (Gur Aryeh, Bereishis 18:1) explains: On the first two days after the bris, the baby is not considered ill all over, but rather ill in one limb. On the third day he is considered dangerously ill because he is ill in his entire body. That is when he requires visits.
What happens on the third day after a bris? The Maharal explains (as well as contemporary medical literature) that on the third day, a wound reaches the second stage of healing which is inflammation. During this phase, damaged and dead cells are cleared out, along with bacteria and other pathogens or debris. This happens when the area is engulfed with mucus, and white blood cells engulf debris and destroy it. At this stage one’s entire body is ill, and this is the time to visit.
Accordingly, the mitzvah of bikur cholim does not apply to visiting one suffering from a broken bone, even if he needs a cast because the rest of his body is functioning well.
