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Medicines on Shabbos

Question #1: Vitamin E oil

“May I rub Vitamin E oil on Shabbos into my skin to alleviate some discomfort?”

Question #2: Mixed before Shabbos

“May I mix a medicine into food before Shabbos and then take it on Shabbos?”

Introduction

In parshas Chukas, the Torah teaches that when the Bnei Yisroel complained against Hashem and Moshe for taking them through the desert without adequate provisions and for providing them with mann, a plague of poisonous snakes was unleashed among them and killed many Jews. When the Jews did teshuvah and asked Moshe to daven on their behalf, Hashem commanded him to make a snake out of copper and place it on top of a pole. Subsequently, anyone bitten by a poisonous snake would look at the copper snake and live.

The Mishnah (Rosh Hashanah 29a) comments: Does the copper snake determine life and death? No, it does not. When people looked in its direction, they were reminded of Hashem, prayed to Him and survived the bite.

Later in history, an image of a snake wrapped around the upper end of a pole became the international symbol of an apothecary or other medical facility. Obviously, this is the perfect week to discuss the halachos of using medicines on Shabbos, particularly since the work of the pharmacist is the basis for this halachic discussion.

Don’t take your medicine!

The Mishnah and Gemara allude to a prohibition that Chazal instituted not to take medicines on Shabbos. For example, the Mishnah (Shabbos 111a) records the following:

Someone whose teeth are causing him pain may not sip vinegar as a remedy, but is permitted to dip his food into vinegar in his usual method of eating; there is no concern if this accomplishes his purpose of using the vinegar as an analgesic.

From this Mishnah, we see that Chazal prohibited doing anything that is clearly performed to alleviate pain or discomfort. This prohibition is called “refuah” by the poskim.

The Gemara concludes that it is prohibited to sip vinegar only if he spits it out, but it is permitted to sip vinegar and swallow it, since people sometimes do this to arouse a greater appetite.

From a different passage of Gemara (Beitzah 22a), we see that this prohibition also exists on Yom Tov. This article will attempt to clarify the rabbinic prohibition of refuah on Shabbos. Explaining this topic adequately requires two introductory lists:

Hierarchy of prohibitions

To begin with, we need to understand that there are different levels of prohibition that are set aside for the needs of a person who is ill. First, I will list these, and then afterward, we will see what rules apply to permit these activities – in other words, how ill must a person be to permit them.

A. De’oraisa – A Jew performing an action that is usually prohibited on Shabbos min haTorah.

B. Derabbanan – A Jew performing a rabbinic prohibition.

C. Derabbanan with a shinuy – A Jew performing a rabbinic prohibition in an unusual way.

D. Amirah lenachri – Asking a non-Jew to do something that a Jew is not permitted to do.

E. Refuah – An action that is prohibited solely because it serves a medical purpose.

Hierarchy of conditions

According to most poskim, levels of “illness” or “wellness” are classified under five categories (cf. Eglei Tal, Meleches Tochein 17, 18 and notes who disagrees). I am listing these beginning from the category that is most severe medically, where the halacha is most lenient:

Choli she’yeish bo sakanah

Any medical condition or situation that might be a threat to life, even if remote, is called a choli she’yeish bo sakanah. In this situation, we perform whatever is necessary to make the patient safe and properly treated. In other words, none of the categories of activities above is prohibited, and it is meritorious and required to perform whatever is necessary as quickly as possible to save the patient (pikuach nefesh).

What type of condition qualifies as choli she’yeish bo sakanah?

In general, an internal injury is assumed to be pikuach nefesh until determined otherwise (Avodah Zarah 28a, see Tur, Orach Chayim 328). Excess or unusual internal pain is similarly assumed to be pikuach nefesh until determined otherwise. The extensive details germane to these situations will not be dealt with in this article.

2. Sakanas eiver

This is a situation in which there is no threat to a person’s life, but he runs the risk of losing the use of part of his body irreversibly, if it is left untreated. Contemporary authorities rule that this category includes a patient in which the result may be a limp or permanent weakness in a limb (Chut Hashani, Volume 4, 89:27), and even if this result is only a possibility (Minchas Shelomoh, Volume 2:34:36).

The Shulchan Aruch quotes several opinions regarding what the halacha is germane to this situation. He concludes that although violating Torah law is permitted only when there is risk, albeit remote, to someone’s life, violating any rabbinic prohibitions is permitted in a situation of sakanas eiver (Orach Chayim 328:17). This includes asking a non-Jew to do anything for his needs (Ran, Shabbos 39b s.v. Umeiha). It goes without saying that the prohibition not to take medicines does not apply to this category. In other words, to treat this patient, all categories of prohibitions listed above, except for level A, are permitted.

To the best of my knowledge, the approach preferred by the Shulchan Aruch is accepted by all the subsequent authorities (Rema, Magen Avraham, Taz, Gra, Nishmas Adam 69:1, et al.).

3. Choleh kol gufo she’ein bo sakanah

This refers to a condition in which someone is ill in a way that affects his entire body, such as he is ill enough to go to bed (Shulchan Aruch, Orach Chayim 328:17). It also includes situations in which the discomfort is intense enough that he feels that his entire body is affected (Rema ad locum), he is running a fever that is higher than his usual body temperature (Shemiras Shabbos Kehilchasah 33:1) or if, without medical intervention, he will end up with a condition similar to one of those mentioned above (Shemiras Shabbos Kehilchasah 33:1). In addition, a child, an elderly person or someone whose general condition is weak may be in this category.

In this situation of choleh kol gufo, we find differing opinions among the rishonim regarding how lenient the halacha is. All authorities agree that a choleh kol gufo may ask a non-Jew to do something for him (level D), and it is prohibited for a Jew to perform on Shabbos or Yom Tov a melacha min haTorah for this patient (level A).

The Rosh was uncertain whether you can perform an issur derabbanan other than asking a non-Jew, and Rashi may have been stringent regarding this issue (levels B and C, see Eglai Tal, Meleches Tochein #36 and #38). On the other hand, the Rambam rules that any issur derabbanan is permitted. The Ramban splits the difference, permitting a Jew to do a melacha only with a shinuy, in other words, permitting level C and forbidding level B.

The Shulchan Aruch concludes, according to the Ramban, that an activity that is ordinarily prohibited because of a rabbinic injunction may be performed by a Jew in an indirect way (i.e., with a shinuy). Furthermore, a non-Jew can be asked to do anything for his needs (Ramban and Rashba, Shabbos 129a). In addition, the prohibition of performing a refuah activity does not exist for this person when no other melacha activity is involved. In other words, to treat this patient, all categories listed above, except for levels A and B, are permitted.

4. Meichush

The word meichush means an ache, and carries with it the inference that it is a relatively minor discomfort. The term also includes someone who is mildly ill, but does not pass the threshold of the previous category of choleh kol gufo. One of the terms used to describe this category is that the person is walking around like a healthy person – he does not appear to be ill, but he is suffering from some minor ailment. If it is clearly noticeable that he is in pain or that he is experiencing discomfort, he is not in the category of meichush, but in the previous category of choleh kol gufo.

A meichush does not permit performing any melacha activity, even one that is prohibited only because of a rabbinic decree. Furthermore, he may not attempt to alleviate the discomfort by use of any treatment being performed for that purpose. This is referred to as the prohibition against refuah, established by Chazal. In other words, to treat this patient, all categories listed above are prohibited.

5. Bari

This refers to someone who is perfectly healthy, but would like to do something that is usually considered a medicinal-type act to maintain or bolster his health. All authorities agree that a person may not perform a melacha activity for this purpose, whether the activity is forbidden min haTorah or miderabbanan. There is a dispute between the Shulchan Aruch and the Magen Avraham whether the special prohibition of refuah, i.e., preparing or taking medicinal aids or doing healing acts, applies to someone who is not sick. The Shulchan Aruch (Orach Chayim 328:37) rules that it does not; the prohibition to perform refuah applies only to someone who qualifies as being a bit ill. The Magen Avraham concludes that the prohibition of refuah applies, also, to someone who is completely well, but wants to do something that would usually be considered a medicinal type of activity.

In other words, a person who is healthy may certainly not do anything in categories A-D to enhance or bolster his health. Whether the prohibition of refuah, category E, applies is a dispute between the Shulchan Aruch, who is lenient, and the Magen Avraham, who rules strictly. As there does not appear to be a consensus among halachic authorities which approach to follow, I recommend that our readers consult with their rav or posek for halachic guidance.

Why are medicines prohibited on Shabbos?

The rest of this article will focus on explaining what I called above “Category E”: the rabbinic prohibition to do anything on Shabbos that is usually performed for medical reasons.

First we want to understand: Why did Chazal establish this prohibition?

The Gemara (Shabbos 53b) implies that the reason for the prohibition of refuah on Shabbos is because preparing medicines often involves crushing raw herbs, thus violating the melacha of grinding. This reason is mentioned by the primary early rishonim in several places (Rashi, Brachos 36b, Shabbos 108b, Beitzah 11b, Avodah Zarah 28a; Tosafos, Shabbos 64b, 93a, Eiruvin 102b; Rambam, Hilchos Shabbos 21:2; Rashba, Shabbos 129a; Rosh, Avodah Zarah 2:10). Other authorities provide an additional reason for the prohibition: at times, the application of a medicinal preparation involves a different melacha activity, that of memarei’ach, smearing and smoothing the salve onto the skin (Chayei Adam 69:1).

The discussion about this prohibition is scattered across many different places in the Gemara, and the conclusions are explained in Shulchan Aruch in Orach Chayim, Chapters 327 and 328.

At this point, we will return to the Mishnah I quoted above (Shabbos 111a): Someone whose teeth are causing him pain may not sip vinegar as a remedy, but he is permitted to dip his food into vinegar in his usual method of eating; there is no concern if this accomplishes his purpose of using the vinegar as an analgesic. Someone experiencing pain in the sides of his body may not smear wine or vinegar as a remedy, but he may apply oil as long as it is not rose oil.

Based on our previous discussion, we now know that this Mishnah is discussing someone who is uncomfortable because of a toothache or minor irritation on his side, but who does not qualify as a choleh kol gufo — in other words, what we called before someone suffering from a meichush (category 4). We also see another very important principle: An activity that would commonly be done for a non-medical reason may be done notwithstanding that the person intends to alleviate thereby pain or discomfort — a medical reason.

Rashi explains that people smear oil on their bodies for other than medical reasons, but not wine, vinegar or rose oil. Wine and vinegar were smeared only for medical reasons, and rose oil was not smeared for non-medical reasons, because it was too expensive to use for this purpose. Therefore, smearing wine, vinegar or rose oil is clearly for a medical reason, and is included under the rabbinic prohibition of refuah, but smearing other oils is not.

Incidentally, we see from this Mishnah that there is no prohibition of memarei’ach when rubbing oil into your skin on Shabbos. This is explained by halachic authorities to be permitted because oil is too thin to smooth out surfaces. Since this is not our topic for today’s article, we will not spend more time on it.

Individual circumstances

Whether something is done usually for medical purposes or not might be subjective. In certain societies, there are things that are considered a normal activity, whereas in others, the same activity would not be done except as a medical treatment. How do we determine what is a “normal activity?”

The answer to this question is found in the continuation of the Mishnah, which states: Princes may smear rose oil on their injuries, because they smear it on regular days, even without a medical purpose. Rabbi Shimon rules that all Jews are treated like princes, and that therefore they may all smear rose oil as a medical treatment.

Both the first tanna and Rabbi Shimon agree that an activity that is sometimes performed for non-medical reasons may be done to alleviate a discomfort. Therefore, princes, who might apply rose oil not as a medical treatment, may use it to alleviate discomfort, whereas, according the first tanna, common folk ,may not. Rabbi Shimon permits someone to do something that a different person would be doing for non-medical reasons, whereas the first tanna requires that he, himself, would do this activity on other occasions when not uncomfortable.

Notwithstanding Rabbi Shimon’s position, the majority of early authorities and the Shulchan Aruch (Orach Chayim) conclude according to the first tanna’s opinion: someone can do something to alleviate discomfort only if he, himself, might do the same for a non-medical purpose.

Vitamin E oil

Thus, we can now answer our opening question: “May I rub Vitamin E oil on Shabbos into my skin to alleviate some discomfort?”

The answer is that it will depend: If people do rub Vitamin E oil when there is no medical discomfort, this would be permitted. I believe that this is not standard practice, and therefore it would seem to me that this is prohibited on Shabbos, unless the person is a choleh kol gufo.

Local circumstances

We see from this part of the Mishnah that when an act is performed commonly for non-medical reasons, someone may do it on Shabbos to alleviate discomfort or for a different medical reason. The Gemara expands this by noting that Rav permitted people in his town to smear rose oil on Shabbos, because where he lived it was plentiful, inexpensive and was used commonly without medical need. We see that local circumstances can determine what is permitted typical use.

Does this concept apply only lekula or even lechumrah? Is an activity that is common for non-medical reasons, be performed in a geographic location where it is done only to alleviate discomfort? The answer is that this concept is true also lechumrah: the Rema (Orach Chayim 327:1) prohibits rubbing oil on the body on Shabbos if locally this is done only for medical reasons.

From this discussion, we see that a Shabbos prohibition existed even to use a medicinal process or aid whose preparation did not involve the melacha of grinding. We also see that an item that might be used by a healthy person is not included in the prohibition, and that determining whether a substance may be used or not can be dependent on local circumstances.

May I mix?

At this point, let us address the second of our opening questions: “May I mix a medicine into food before Shabbos and then take it on Shabbos?”

Based on an extensive analysis of one of the sugyos, Rav Moshe Feinstein permits mixing a medicine into food before Shabbos and eating the food on Shabbos, since people see him eating regular food. Rav Moshe demonstrates that the mixing of the food must be before Shabbos, not on Shabbos itself (Shu”t Igros Moshe, Orach Chayim 2:86).

Conclusion

The Gemara teaches that the rabbinic laws are dearer to Hashem than the Torah laws. In this context, we can explain the vast halachic literature devoted to understanding this particular prohibition, created by Chazal to protect the Jewish people from major sins.

Medicines for Pesach

Question #1: The Ubiquitous Lists

“Why do we have lists of acceptable medicines for Pesach? Aren’t they all inedible?”

Question #2: Leavening Forever!

“Is leavened dough always chometz?”

Question #3: The Spoiler

“Do prohibited foods remain so after they spoil?”

Introduction

As we all know, the Torah prohibits eating, using or even owning chometz on Pesach. But do these laws apply to something that is no longer edible? May I swallow it as medicine? Understanding properly the source material is our topic for this week’s article.

We should first note that many of these issues are germane not only to chometz, but also in regard to all foods that the Torah prohibits (issurei achilah): Does the Torah ban them even after they have become inedible? Can this be considered eating? And, assuming that the Torah does not prohibit them, are they perhaps forbidden because of a rabbinic injunction? Furthermore, if they were proscribed due to a rabbinic decree, perchance some exemption was provided for a medical reason, even when it is not pikuach nefesh, a life-threatening emergency.

Pikuach nefesh

It is important to point out that most of our discussion is not about instances of medicines necessary because of pikuach nefesh. With very few exceptions, an emergency that might endanger someone’s life, even if the possibility is remote, requires one to take whatever action is necessary, including consuming non-kosher food and benefiting from prohibited substances. We will return to this discussion later in this article, but only after we understand the basic principles.

Unusual benefits

A question similar to what was raised above — whether non-kosher foods that are now inedible remain prohibited — relates to items from which the Torah prohibited benefit (issurei hana’ah), such as the mitzvah of orlah. Does this prohibition apply only if one benefits from orlah fruit the way people typically utilize the forbidden item, such as by selling it or by polishing furniture with orlah lemon juice, or does the prohibition apply even to using the item in an unusual way, such as by taking edible fruit and using it as an ointment?

Unusual eats

Let us begin our search with the original Gemara sources of this discussion, which provides the following statement: One does not get punished for violating any prohibitions of the Torah unless he consumes them the way they are usually eaten (Pesachim 24b). It is not prohibited min hatorah to eat or drink a prohibited substance that is now inedible either because it became spoiled or because a bitter ingredient was introduced (Rambam, Hilchos Yesodei Hatorah 5:8). We will discuss shortly whether there is a rabbinic prohibition involved in eating this food.

The same rule applies regarding eating on Yom Kippur. For example, someone who drank salad dressing on Yom Kippur is not punished for violating the Torah’s law requiring one to fast, because this is not a typical way to eat (Yoma 81a). However, someone who dipped food into salad dressing and ate it violates the Torah laws of Yom Kippur also for the dressing, since this is a normal way of consuming it.

Bad benefits

Similarly, when the Torah prohibits issurei hana’ah, they were usually prohibited min hatorah only when used the way the substance is typically used. However, using the material in an abnormal way, such as by smearing an orlah fruit on his body as an ointment, is not proscribed by the Torah, but only because of an injunction introduced by the Sages, an issur derabbanan. Such an atypical benefit is called: shelo kederech hana’asah.

Rubs me the wrong way

Since the prohibition of benefiting in an unusual way is rabbinic, it is relaxed when there is a medical reason to do so, even when no life-threatening emergency exists. These principles are reflected by the following Talmudic passage:

Mar the son of Rav Ashi found Ravina rubbing undeveloped orlah olives onto his daughter, who was ill. Whereupon Rav Ashi asked Ravina why he did this since the disease was not life threatening? Ravina responded that using the fruit this way is considered unusual because people typically wait until the olives ripen before extracting their oil. Since this is not the normal way to use the olives, the prohibition to use orlah fruit this way is only miderabbanan, and in the case of medical need Chazal were lenient (second version of Pesachim 25b, see Rashi ad locum and Tosafos, Shavuos 22b s.v. aheitera and 23b s.v. demuki).

To sum up: We have established that both issurei achilah and issurei hana’ah are prohibited min hatorah only when they are eaten or used in the way that someone would typically consume them or benefit from them. Benefiting from issurei hana’ah in an atypical way is prohibited miderabbanan; however, the Sages permitted this to be done when a medical need exists. We do not yet know whether this ruling holds true also regarding someone who needs to eat something that is not typically eaten.

Now that we have established some of the basic principles, let us examine some rules specific to the prohibition of chometz that will help us answer our original questions.

When is it no longer chometz?

Can chometz change its stripes so that it is no longer considered chometz? The answer is that it can lose its status as chometz – when it is decomposed or otherwise ruined to a point that it is nifsal mei’achilas kelev, a dog will no longer eat it (see Pesachim 45b). Since it no longer can be used for either food or feed, it loses its status as chometz that one is prohibited from owning and using on Pesach (Tosafos ad locum; Shulchan Aruch, Orach Chayim 442:9; cf. Rashi, Pesachim op cit., whose position is more lenient).

This is true only when the chometz was rendered inedible before Pesach. The Gemara (21b) states that if chometz became burnt before the time on Erev Pesach when one is prohibited from owning it, one may benefit from it even on Pesach. If it was still chometz when Pesach arrived, and it was destroyed or rendered inedible in the course of Yom Tov, it is prohibited from benefit on Pesach (Pesachim 21b).

We will see shortly that there are instances when it is permitted to own and use chometz on Pesach even though it is still edible. But first, we need to explain an important principle.

What is sourdough?

The Torah explicitly prohibits possessing on Pesach not only chometz, but also sourdough (Shemos 12:15, 19; 13:7; Devarim 16:4). What is sourdough? It is dough left to rise until it has become inedible. However, it can be used as a leavening agent added to other dough to cause or hasten fermentation. Since sourdough originates as chometz and can produce more chometz it shares the same fate as chometz – one may not consume, use, or even own it on Pesach. (By the way, although yeast has replaced sourdough as the commonly used fermentation agent, sourdough is often used today in rye breads and other products to impart a certain desired flavor.) This halachah implies that something may no longer be edible and yet still be prohibited as chometz.

Can sourdough go sour?

I mentioned above that once chometz is no longer edible for a dog, it loses its status as a prohibited substance. Does this law apply also to sourdough? Although a Jew may not own or use inedible sourdough on Pesach, does this prohibition apply only to what a dog would eat? May one own and use sourdough on Pesach that decomposed to the point that a dog would not eat it?

These questions are the subject of a disagreement among the rishonim. Many authorities permit owning sourdough that would no longer be eaten by a dog, whereas others, such as the Raavad (Hilchos Chometz Umatzoh 1:2), proscribe owning over-soured dough on Pesach. Those who forbid it do so because sourdough is never considered an edible product, yet the Torah banned it because of its facility as a leavening agent, which is not harmed by its becoming inedible. Edibility, whether for man or beast, is only a factor when we are defining prohibited foods, but not when the Torah forbade an item that was never a food to begin with.

The later authorities dispute which way we should rule in this last matter. See the Biur Halachah 442:9 s.v. Chometz who quotes much of the dispute.

When is edible chometz permitted?

We have so far established that although chometz that a dog would not eat is no longer forbidden as chometz, sourdough that a dog would not eat might still be prohibited. However, there is a major exception to this rule – that is, there are instances when chometz may not have reached the level of nifsal mei’achilas kelev, and yet one may own it and even use it on Pesach. This exception is when the chometz is no longer considered to have any food use, notwithstanding that it is technically still edible. Here is the germane passage of Gemara:

Rabbi Shimon ben Elazar says one must destroy chometz only as long as the bread or the sourdough still exists as a food. However, a block of sourdough that was designated to use for sitting is no longer considered chometz, even when it is still edible (Pesachim 45b and Tosafos ad loc.).

How can one possibly own this sourdough on Pesach if a dog would still eat it?

When presenting this case as a halachic rule, the Rambam (Hilchos Chometz Umatzoh 4:10, 11) introduces us to a new term: nifsad tzuras hachametz, literally, its appearance as chometz is lost. The Chazon Ish (Orach Chayim 116:8) explains this to mean that since people are now repulsed to eat it or to use it in a food product, it is no longer halachically chometz since people no longer regard it as food. The same ruling applies to similar items whose use is not for food, such as chometz used in ointments or to starch clothes (Rambam, Hilchos Chometz Umatzoh 4:10; Rosh, Pesachim 3:5).

A sourdough cover-up

Although the Gemara concludes that we are not quite as lenient as is Rabbi Shimon ben Elazar, this is a question of degree, but not of basic principle. Whereas Rabbi Shimon ben Elazar permitted sourdough that one intends to use as a seat, the Gemara permits it only when the surface of the block is coated with a layer of dried mud. This demonstrates that it is now viewed as a piece of furniture (Rashi). The halachic authorities dispute to what extent one must coat the sourdough block, some ruling that it must be covered on all sides whereas others rule that it is sufficient if the top, the part that will be sat upon, is coated with mud (see discussion in Mishnah Berurah 442:42 and Shaar Hatziyun ad loc.).

Notwithstanding this dispute concerning how much of the block needs to be coated, all agree that the sourdough beneath the dried mud surface is still theoretically edible, yet one may own and use it on Pesach (Shaar Hatziyun 442:69). Since people no longer view this sourdough as food, it loses its status. As the Mishnah Berurah (442:41) emphasizes, our conclusion is that two steps must have occurred to this block before Pesach to permit owning and using it on Pesach:

The owner must have designated the sourdough as a seat.
Its surface was overlaid with mud.

The dispute among tanna’im regards only whether we require the second step, which Rabbi Shimon ben Elazar did not require.

At this point we can answer one of our opening questions:

“Is leavened dough always chometz?”

The answer is that there are two instances when it is not considered chometz anymore:

When it was rendered before Pesach so inedible that a dog would not eat it.
When it is being used for a non-food purpose and something has been done to it that makes people repulsed by the idea of eating it.

Eating spoiled chometz

We mentioned above the Gemara’s statement that chometz burnt before Pesach may be used on Pesach (Pesachim 21b). The wording of the Gemara causes the rishonim to raise the following question: Why does the Gemara say that one may benefit from the burnt chometz, rather than permit even eating it, since it is no longer considered food and therefore not included under the prohibition of chometz?

There are two major approaches to answer this question, which result in a dispute in practical halachah. According to the Ran, since the burning rendered the chometz inedible even by an animal, one may even eat it, but the Gemara does not mention this. This approach seems to have the support of the Rambam (Yesodei Hatorah 5:8), who permits consuming a prohibited beverage after a bitter ingredient was added to it.

However, the Rosh contends that the rabbis prohibited one from eating the inedible chometz because of a principle called achshevei, which means that by eating it one is treating it as food. Most later authorities (e.g., Terumas Hadeshen #129; Taz, Orach Chayim 442:8; Magen Avraham 442:15; Shaagas Aryeh #75) follow the Rosh’s approach, prohibiting someone from ingesting inedible chometz because of this rabbinic prohibition.

Is chometz medicine prohibited?

With this lengthy introduction, we are now able to discuss the original question posed above: “Why do we have lists of acceptable medicines for Pesach? Aren’t they all inedible?”

I will now rephrase the question: Does oral intake of a chometz-based medicine qualify as achshevei? If it does, then it is prohibited to ingest inedible chometz, even as medicine, unless the situation is life-threatening.

We find a dispute among later authorities whether ingesting medicine is prohibited because of achshevei. We can categorize the positions into three basic approaches:

Taking medicine is considered achshevei.

The Shaagas Aryeh (#75) rules that ingesting medicine is prohibited miderabbanan because of the rule of achshevei.

Taking medicine is not considered achshevei.

Rav Moshe Feinstein (Shu”t Igros Moshe, Orach Chayim 2:92) maintains that medicine never qualifies as achshevei. His reason is that people take even very bitter items for their medicinal value; thus taking something as a medicine does not demonstrate that one views it as food. (See also Shu”t Yechaveh Daas 2:60.)

It depends on why the chometz is an ingredient.

The Chazon Ish advocates a compromise position. Although he agrees with the Shaagas Aryeh that consuming something as a medicine qualifies as achshevei, he contends that achshevei applies only to the active ingredient – the item for which one is taking the medicine. However, he maintains that achshevei does not apply to the excipient ingredients, those added so that the medicine can be made into a tablet.

According to Rav Moshe, as long as the medicine is foul-tasting, there is no need to check if it contains chometz. The chometz is nifsal mei’achilas kelev, and the consumption of medicine does not qualify as achshevei. The only need for a medicine list is when the medicine is pleasant tasting.

On the other hand, according to the Shaagas Aryeh, barring a situation of pikuach nefesh, one may not ingest a medicine containing chometz on Pesach, and it is important to research whether it contains chometz. There are also some authorities who contend that when a prohibited substance has a bitter ingredient added, it remains prohibited. I leave it for each individual to ask his or her own halachic authority to decide which approach they should follow. A lay person should not decide on his or her own not to take a necessary medicine without consulting with a rav or posek.

Even according to the Shaagas Aryeh, there is nothing wrong with owning or even benefiting from these medicines on Pesach – the only prohibition would be to ingest them. Thus, a Jewish owned pharmacy is not required to remove from its shelves foul-tasting medicines that are on the prohibited chometz lists.

Regardless as to which approach one follows, one must be absolutely careful not to look down on someone who follows the other approach. In any situation such as this, this attitude will unfortunately cause great harm, since it can lead to feelings of conceit.

Pikuach nefesh medicine lists

There can be another situation in which it is important for a rav or posek to know whether a product contains chometz, but, personally, I would discourage making such a list available to lay people. The case is: Someone who is taking a pleasant-tasting food supplement containing chometz for a pikuach nefashos condition in which the chometz is not a necessary ingredient. Halachically, we should try to find for this person a non-chometz substitute. For example, many years ago, someone I knew used a medicine where the active ingredient required being dissolved in alcohol, which could be chometz. We arranged to have a knowledgeable pharmacist make a special preparation for Pesach using alcohol that was kosher lepesach. (It is humorous to note that the pharmacist used his home supply of kosher lepesach Slivovitz since it was the easiest available Pesach-dik alcohol, and the preparation did not require pure alcohol.)

Is it a good idea to make a medicine list available to the general public? We know of situations when lay people thought that a product may contain chometz and therefore refused to use it, which led to a safek or definite pikuach nefashos situation, itself a serious violation of halachah. Many rabbonim feel that these lists should be restricted to the people who understand what to do with the information – the rabbonim and the poskim.

Conclusion

According to Kabbalah, chometz is symbolic of our own arrogant selves. We should spend at least as much time working on these midos as we do making sure that we observe a kosher Pesach!