Bikkur Cholim
It is without a doubt that due to our busy schedules and hectic lives, one of the more commonly neglected mitzvot of the Torah[1] is the mitzva of bikkur cholim, visiting the sick, infirm, and otherwise shut in. Visiting the sick is also a fulfillment of the mitzva of "Don't stand idly by your brothers' blood!",[2] among others. A Jew must feel for and even join in the sufferings of fellow Jews.[3] One who visits the sick will be saved from all forms of punishments in the World to Come.[4]
We are taught that bikkur cholim is one of the mitzvot that God Himself performs.[5] Indeed, visiting the sick is among nine unique mitzvot whose vast reward is reserved for the World to Come.[6] It is taught that one who visits the sick removes one-sixtieth of the ill person’s illness. It is also a mitzva that can be done countless times each and every day. One should be sure to visit even non-Jews who are sick.[7] Visiting an enemy, however, is questionable[8] though one is encouraged to inquire whether a brief visit would be welcome which might also serve to help make amends.[9] It is permitted to visit patients of the opposite sex as long as the circumstances ensure compliance with the rules of yichud and tzniut.[10]
The great sages of Israel would make the mitzva of bikkur cholim a part of their routines. Rabbi Akiva Eiger would make sure to visit a sick person every single day. In the rare event that he was unable to do so on a given day, he would appoint an emissary to visit the sick on his behalf.[11] Rabbi Aryeh Levine would visit hospitals every Friday and inquire from the nurses and doctors on the patients' welfare. Rabbi Shlomo Zalman Auerbach was also known to emphasize bikkur cholim in his routine. One should visit the sick regardless of their financial status or prominence. Adults should not hesitate to visit sick children nor should great rabbis hesitate to visit simple people.[12] One is not obligated to visit someone with a contagious disease.[13]
Every city is encouraged to establish a bikkur cholim committee.[14] Such committees not only serve the sick which is in itself a great mitzva, but they also serve the needs of friends and family members who might legitimately need a break from tirelessly assisting their loved ones.[15] It is considered especially meritorious to donate money to the functioning and maintenance of hospitals.[16] One should not serve as a doctor for one's parents nor perform any medical procedures on them unless there is no alternative.[17]
The mitzva of bikkur cholim has many different applications, and is not merely a generic “Hello, how are you?” inquiry or "Get Well" greeting.[18] Rabbi Akiva would personally clean the room of the sick people he visited and tend to even their most mundane needs.[19] He used to say that “anyone who fails to visit the sick contributes to their death.”[20] To remain with a sick person overnight in order to watch over them and tend to their needs is considered to be an extraordinary act of kindness.[21] One is not obligated to miss work or otherwise lose income in order to fulfill the mitzva of bikkur cholim.[22] It is customary to seek the blessings and prayers of great rabbis on behalf of those who are ill.[23]
The halacha states very clearly that for one to fulfill the mitzva of bikkur cholim, one must pray for the patient’s recovery. We are taught that the Divine presence is at the head of the bed of a sick person, and it is therefore proper that one pray on behalf of the sick individual at the time of the visit.[24] If one visited a sick person and did not pray for their recovery or otherwise provide some substantial benefit, the mitzva remains unfulfilled.[25] While the ideal prayer that one should recite when visiting a sick person is "hamakom yishlach lecha refua shleima b'toch shaar cholei Yisrael" or other similar formula, Rabbi Shlomo Zalman Auerbach rules that one fulfils this requirement even by simply wishing the person a "refuah shleima".[26] When praying for a sick individual one should also include "all the sick of Israel". [27] It goes without saying that one may pray for the sick in any language.[28] It is recommended to visit the sick in groups rather than to go alone,[29] a notion derived in part from Yosef who took his children along with him to visit Yaakov.[30]
The Zohar teaches that a person should not sit parallel to the head of one who is ill, because the Divine presence dwells there, nor should one sit parallel to his feet because the angel of death dwells there. A popular custom based in the Talmud is to change the name of a sick individual which is believed to assist in having any negative decrees on that person annulled.[31] This is because when a person's name is changed he or she is considered to be born anew, along with a clean slate. However, a number of authorities are opposed to the custom of changing the name of one who is ill arguing that in our day we lack the required expertise for this highly sensitive and mystical endeavor.[32]
The Rambam wrote extensively on the duties and requirements relating to the mitzva of bikkur cholim.[33] He states that no one should think that fulfilling this mitzva is beneath one's dignity. Repeated visits to the sick are encouraged, so long as the visits do not become burdensome to the patient. Several shorter visits are to be preferred over one long one.[34] One is even required to visit those who are in a coma or otherwise unaware that someone is visiting them, as doing so will arouse one to pray on their behalf.[35] Furthermore, the fact that the hospital staff sees that the patient is being visited and that there are people who truly care about the patient will likely encourage them to treat the patient with utmost care.
It is vital, however, to continually keep in mind the respect and dignity of the patient. Perhaps visiting those with intestinal diseases, severe deformities, and other challenging conditions should be discouraged, lest the patient feel embarrassed.[36] Likewise, perhaps those with severe head illnesses may be better off without visitors, so as not to aggravate their condition. It is suggested that one we avoid visiting people at the very start or very end of the day, a time when their strength is likely at its minimum. It is also inappropriate to visit people immediately upon their taking ill unless the situation is critical.[37]
One may visit a sick person on Shabbat. However, if seeing someone in an unfortunate state will cause one to be distressed then the visit should be postponed for another day.[38] When one visits the sick on Shabbat, one should pray for them using the Shabbat version of the prayer that is normally recited.[39] One is obligated to violate Shabbat in order to save a life.[40] Indeed, one must do anything required at any time in order to save a life.[41]
When visiting the sick one is advised to speak to the patient about daily affairs, trying to get his mind off his troubles. So too, one is not to inform someone who is severely ill about the death of a loved one lest the news cause the person's condition to deteriorate further.[42] Sadly, there are times when praying for the speedy death of one who is ill is appropriate, such as in situations where recovery is simply not possible and the patient is suffering terribly.[43] If the circumstances allow, one should encourage a terminally sick individual to recite the vidui and other end-of-life prayers.[44]
A preliminary blessing is not recited before performing the mitzva of bikkur cholim as is common when performing many other mitzvot. One of the reasons for this is because one does not recite a blessing when performing a mitzva dependant upon another person, such as bikkur cholim or tzedaka. In fact, if the patient was to refuse the visit or has recovered to the point that he is no longer considered sick from the perspective of halacha, one would not have fulfilled the mitzva and any blessing recited would have been in vain.[45]
It is also explained that a blessing is only recited on mitzvot which are performed exclusively by Jews. Bikkur cholim is a mitzva that is also performed by non-Jews, as they too visit the sick.[46] There is also a general rule that blessings are only recited upon mitzvot bein adam l'makom – between man and God - and not for performing mitzvot which are bein adam l'chaveiro – between man and his fellow man.[47]
It is ideal to try to arrange for another visitor to take one's place when leaving the bedside of one who is ill.[48] Under most circumstances, a patient who is refusing life-saving treatment should have the treatments administered against their will.[49] If one has the opportunity to perform either bikkur cholim or nichum aveilim (comforting mourners) the latter takes priority. If, however, one intends to do both anyways, then the mitzva of bikkur cholim takes precedence.[50] The Talmud teaches that although most things in life are a matter of Divine Providence, illness generally comes upon a person due to one's own negligence.[51]
One who is unable to personally visit a sick person should at least phone in order to convey one's concern and inquire on their welfare. Although a phone call is not the same as a personal visit, there is a bikkur cholim component to a phone call, as well.[52] One of the reasons that a personal visit is so much more valuable than simply making a phone call is because when one sees the state of the patient one is more moved to pray for them than when merely hearing a voice over the phone.[53] The Chazon Ish writes that one is also obligated to observe the mitzva of bikkur cholim upon oneself, which means that one must be sure to take care of one's own health![54]
[1] Regarding whether bikkur cholim is a mitzva of biblical or rabbinical origin, see Sdei Chemed 1:2:116.
[2] Vayikra 19:16.
[3] Sefer Chassidim 753.
[4] Nedarim 40a.
[5] Sota 14a; God went to visit Avraham personally after his circumcision.
[6] Nedarim 39b; Shabbat 127a; Aruch Hashulchan, YD 335:2.
[7] Gittin 61a.
[8] Shach, YD 335.
[9] Aruch Hashulchan, YD 385:5.
[10] Aruch Hashulchan, YD 335:11; She'arim Metzuyanim B'halacha 192:18; Zekan Aharon 2:76; Be'er Moshe 2:107.
[11] Chut Hameshulash 207.
[12] Rambam, Hilchot Avel 14:4.
[13] Radbaz 3:627 cited in Mishpetei Hashalom, Bikkur Cholim; Shevet Halevi 10:292.
[14] Aruch Hashulchan, YD 335:4.
[15] Ahavat Chessed 3:3.
[16] Tzitz Eliezer 15:38.
[17] CM 424:1.
[18] Shevet Halevi 5:184.
[19] Nedarim 40a.
[20] Rambam, Hilchot Avel 14:4.
[21] Aruch Hashulchan, YD 335:3.
[22] Taz, YD 240:7.
[23] Bava Batra 116a; Darkei Moshe, YD 335:2; Aruch Hashulchan, YD 335:12; Ramban, Shemot 18:15.
[24] Tur, YD 335.
[25] Rema, YD 335:4.
[26] Halichot Shlomo 8 footnote 63
[27] Shabbat 12b, YD 335:6.
[28] YD 335.
[29] Sheiltot 93.
[30] Bereishit 48:1.
[31] Rosh Hashana 16b; Maharsha, Rosh Hashana 16b; Rema, YD 335:10.
[32] Mara D'ara D'yisrael Vol. 1 p. 94, Shama Garim p.216.
[33] Rambam, Hilchot Avel 14.
[34] Rambam, Hilchot Avel 14:4.
[35] Bishvilei Haparasha p.23.
[36] Aruch Hashulchan, YD 335:4.
[37] Rambam, Hilchot Avel 14:5.
[38] Shaarei Teshuva, OC 287:1.
[39] YD 335:6; OC 267.
[40] OC 328:2.
[41] CM 426:1.
[42] YD 337:1.
[43] Ran, Nedarim 40a; Yalkut Shimoni, Devarim 11; Aruch Hashulchan, YD 337.
[44] YD 338:1.
[45] Teshuvot Harashba 1:18; Teshuvot Haramban 189.
[46] Binyamin Zev 1:169.
[47] Chatam Sofer, OC 54; Yafeh Lalev 240:2.
[48] Salmat Chaim 4:4.
[49] Igrot Moshe, CM 2:73.
[50] Rema, YD 335:10; Shach, YD 335:11.
[51] Ketubot 30a.
[52] Igrot Moshe, YD 1:223; Yechaveh Daat 3:83; Chelkat Yaakov 2:128; Minchat Yitzchak 2:84; Be’er Moshe 2:104; She'arim Metzuyanim B’halacha 193:1.
[53] See Tur, YD 335.
[54] Collected Letters Volume 1:138. See also Tzafnat Pane'ach 73a and Zayit Ra'anan to Yalkut Shmot 21:19.