(2005/5765)

 Before Pesach, we explored the debate regarding owning and using products that contain inedible Chametz on Pesach.  This week we shall begin to discuss a more challenging issue, the question of the permissibility of taking medicines that contain non-kosher ingredients or Chametz.

Background – The Three Categories of Sick Individuals

When discussing Halachic issues regarding sick individuals and ailments it is important to outline the three classes of sick people, as presented in Shulchan Aruch Chapter 328.  The categories are a Choleh Sheyeish Bo Sakanah (a sick individual whose life is endangered), a Choleh She’ein Bo Sakanah (someone who is ill but his life is not endangered) and a Meichush (someone who is functioning normally but is bothered somewhat by a minor problem such as a mild headache or a mild cold).  A Choleh Sheyesh Bo Sakanah is unquestionably permitted to take medicine that contains Chametz if it is necessary to cure his illness (such as antibiotics).  One is defined as a Choleh Sheyesh Bo Sakanah even if we are unsure if the patient’s life is endangered (Safek Nefashot Lihakel; Shabbat 129a andYoma 83a). 

However, even a Choleh Sheyesh Bo Sakanah should avoid medicine with forbidden ingredients if an equally effective medicine that contains only kosher ingredients is readily available.  This is an application of the Gemara’s (Yoma 83a) principle that Ma’achilin Oto HaKal HaKal Techilah (we seek to reduce the severity of prohibitions that even a sick person violates).  The Rama (Yoreh De’ah 155:3) codifies this rule and the Biurei HaGra (Y.D. 155:24) clarifies that this rule applies even to a Choleh Sheyesh Bo Sakanah.  For example, one should ask if a medicine comes in an equally effective tablet form as an alternative to a capsule, to avoid consuming a gelatin coated capsule (common custom in this country is to regard gelatin as non-kosher, as we outlined in a  Kol Torah essay a number of years ago).  In this series, we shall focus on the question of the permissibility for a Choleh She’ein Bo Sakanah  or one who is suffering only from a Meichush to take medicines that contain  non-kosher ingredients or Chametz. 

It is vitally important to emphasize, though, a Choleh Sheyesh Bo Sakanah should never risk his life by improperly delaying taking a pill due to Kashrut concerns.  For example, one should never  inappropriately delay taking antibiotics, even if there is only a possibility that the delay might cause damage.  We must always recall the Talmudic principle that Safek Nefashot Lihakel.

Does Achshevei Apply to Medicines?

It is important to distinguish between medicine that tastes good and medicine that does not taste good.  We shall first focus on medicine that does not taste good.  Before Pesach, we We    discussed that one is permitted to own and benefit from Chametz that is Nifsal Meiachilat Kelev (unfit for canine consumption).  However, we noted that the Shulchan Aruch (Orach Chaim 442:9) rules that one is forbidden to eat an item that contains Chametz even if it is unfit for canine consumption.  The reason for this is that by eating the Chametz one “upgrades” the food (Achshevei) and renders it as if it is edible.  We noted, though, that the Aruch Hashulchan and other Acharonim rule that Achshevei is only a rabbinic level concern.  The Rambam (Hilchot Ma’achalot Asurot 14:11) seems to support this view.  We should add that the Achshevei principle is not unique to the prohibition to consume Chametz.  Rather, it applies to all forbidden foods.   

A major question  is whether one is considered to have upgraded inedible food if he takes it as medicine.  The Acharonim debate this issue.  The Shaagat Aryeh (75) rules that Achshevei applies even when one consumes an inedible item for medicinal purposes.  Rav Chaim Ozer Grodzinsky (Teshuvot Achiezer 3:31) takes this opinion of the Shaagat Aryeh into consideration when rendering Halachic decisions.  However, the majority of Acharonim disagree with the Shaagat Aryeh.  These authorities include Yad Avraham (Y.D. 155:3), the Chazon Ish (O.C.116:8), Teshuvot Igrot Moshe (O.C. 2:92), Rav Gedalia Felder (Yesodei Yeshurun 6:221) and Rav Ovadia Yosef (Teshuvot Yechave Da’at 2:60).  The Rama (Y.D. 155:3 and Orach Chaim 320:1) seems to reject the Shaagat Aryeh’s stringent view.  Moreover, the Yad Avraham and Chazon Ish write that Achshevei applies only when one eats the inedible forbidden item alone.  However, one is not considered to have upgraded the inedible item when  consuming it  mixed with other permissible items. 

Accordingly, Rav David Heber writes in the Orthodox Union’s journal Mesorah 7:91-96 (in 1992, when Rav Heber worked as a rabbinic Kashrut coordinator for the OU; Rav Hershel Schachter and Rav Menachem Genack are the editors of Mesorah) that one may take medicine that contains non-kosher ingredients if it either has a poor taste or no taste, in accordance with the ruling of Rav Moshe Feinstein and Rav Ovadia Yosef.  However, in deference to the Shaagat Aryeh and in keeping with the Rama (Y.D. 155:3) one should make an effort to take medicines that contain no  forbidden iingredients (see the Pri Megadim, Orach Chaim 328:11, who explains that this rule  applies even to foods that are only rabbinically prohibited).  This is one of the reasons why lists are compiled of medicines that do not contain Chametz.

Another reason for these lists is that it is difficult to determine whether an item is considered Nifsal Meiachilat Kelev, as Rav Shlomo Zalman Auerbach writes (Teshuvot Minchat Shlomo 1:17).  Rav Shlomo Zalman writes that he is inclined to rule that even most medicine tablets are not Nifsal Meiachilat Kelev.  Indeed, Rav David Heber, who currently works as a rabbinic coordinator for the Star-K, presents (in an essay available at www.star-k.org; also see his essay in Mesorah 14:90-94) Rav Moshe Heinemann’s (rabbinic administrator of the Star-K) definitions of edibility regarding medicines

“Medication is considered not fit for human consumption if all ingredients have no food, hydration or nutritional value [e.g. charcoal tablets generally consisting of one hundred percent charcoal].  However, most tablets contain a substantial amount of starch, which is a food.”   

Swallowing Pills – Shelo Kiderech Hana’atan

Rav Shlomo Zalman and Rav Heinemann, though, present a different approach to permit swallowing medicines that contain  non-kosher ingredients or Chametz.  The Gemara (Pesachim 25b) states that a Choleh She’ein Bo Sakanah may derive benefit from Orlah (the product of the first three years of a new fruit tree) in an unusual manner (Shelo Kiderech Hana’atan) even though the Torah forbids deriving benefit from Orlah.  The Shulchan Aruch (Y.D. 155:3) codifies this Talmudic passage as normative and states that it applies to all Torah prohibitions except for the three cardinal sins for which one is required to sacrifice his life (murder, idolatry and adultery). 

The Acharonim (cited in Pitchei Teshuvah Y.D. 155:6) debate whether swallowing a food without chewing is considered Shelo Kiderech Achilato.  The stringent opinion of Teshuvot Noda Biyehuda (Y.D. 35) seems compelling as the Gemara (Pesachim 115b) rules that one who swallows Matzah at the Seder without chewing has fulfilled the Mitzvah of eating Matzah.  The Rashbam (ad. loc. s. v. Bala Matzah) explains that swallowing without chewing is considered an act of eating.

 However, Rav Shlomo Zalman Auerbach (ad. loc.) rules that the Nodah Biyehuda’s strict ruling applies only to swallowing conventional food without chewing.  Rav Shlomo Zalman argues that even the Noda Biyehuda would agree that swallowing medicine pills does not constitute an act of eating.  This is because pills are made to be swallowed and are intended only for sick individuals.  Thus, Rav Shlomo Zalman rules that swallowing medicine pills is regarded as  benifitting She’lo Kiderech Hana’atan and is permissible even for a Choleh She’ein Bo Sakanah. 

Rav Chaim Ozer Grodzinsky (ad. loc.) seems to disagree with Rav Shlomo Zalman and permits swallowing medicines with non-kosher ingredients only if he wraps the medicine with paper.    This is analogous to the Gemara that states that one has not fulfilled the Mitzva of eating Matzah if one wraps Matzah in bark of a palm tree and swallows it (Pesachim ad. loc.; see Rashbam, ad. loc. s.v. Korchan, who explains that this is not considered to be an act of eating).  I recall  Rav Yisroel Belsky telling me that he heard that Rav Yosef Eliyahu Henkin ruled in accordance with Rav Chaim Ozer.  However, Rav Yoezer Ariel (Techumin 15:353) presents compelling evidence for this leniency of Rav Shlomo Zalman and Rav Heinemann also rules in accordance with Rav Shlomo Zalman’s ruling.  Rav Heber reports (on a tape available from the Star-K) that most Rabbanim do not rule in accordance with Rav Chaim Ozer and Rav Henkin.

Conclusion

Next week, IY”H and B”N, we shall continue our discussion of this important issue.