Taking Care of the Ill — The Mitzvah of Bikur Cholim Part II

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 senda
speedy recovery to all the ill!