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Fasting on Yom Kippur is an essential part of our experience of the day. it contributes emotionally and spiritually to the day’s sense of uniqueness, and to our capacity to imagine the process of cleansing and expiation.

At the same time though, fasting can present a major challenge to people who are not physically well, turning a day of religious exultation into a day of dread, or possibly even a day of risk. The Halacha of course takes this into account, and much has been written, from the Talmud on down to today, on how to manage fasting if one is not physically well.

What follows is a description – in broad terms – of the key Halachic categories and recommendations pertaining to this issue. My hope is that it will help you become oriented to the system, and that you will be able to use this orientation to then turn to me with your specific personal questions.

1. The most severe category in halacha is “someone who is ill and in danger”. People who are hospitalized over Yom Kippur, and people dealing with potentially life-threatening situations are in this category, and should eat and drink as directed by their physician, and / or according to their own assessments of their needs.

2. After that we have the category of “someone who is ill, is not in danger, but whose condition could deteriorate into something much more serious”. This can include someone who is given to fainting if not properly hydrated for example. Under these circumstances, the person begins the fast, and upon sensing symptoms (i.e. the symptoms that lead to the possibly dangerous consequence), will eat and/or drink “shiurim” (prescribed amounts). The idea here is that it is possible to technically still be fasting, even while eating and/or drinking small amounts of liquid and food. These amounts are usually defined as:
   1.  an ounce and a half of solid food, and
   2. Just under a cheek full of liquid (varies by person, but on average about typically also about 1.5 oz.)

These amounts can be ingested every 9 minutes until symptoms subside.

Often, women who are pregnant and have some risk factor, fall into this category.

3. A variation on the above category is someone whose condition will definitely NOT reach or precipitate any level of “danger”, but which will be completely debilitating. People who suffer severe migraines are in this category. Under such circumstances, when the symptoms begin it is advised to drink the cheek full every 8 minutes as above, but to do so with a liquid that has been mixed with lemon juice so that it is more sour than any liquid that people will drink under ordinary circumstances (1/3 lemon juice should do the trick). 

4. Finally, it is permissible to simply swallow an unflavored pill on Yom Kippur, in order to address significant (but otherwise nonthreatening) pain.