Fasting, Health and Decision Making in the Talmud
חוֹלֶה מַאֲכִילִין אוֹתוֹ עַל פִּי בְּקִיאִין. אָמַר רַבִּי יַנַּאי: חוֹלֶה אוֹמֵר צָרִיךְ, וְרוֹפֵא אוֹמֵר אֵינוֹ צָרִיךְ — שׁוֹמְעִין לַחוֹלֶה. מַאי טַעְמָא — ״לֵב יוֹדֵעַ מׇרַּת נַפְשׁוֹ״. פְּשִׁיטָא! מַהוּ דְּתֵימָא: רוֹפֵא קִים לֵיהּ טְפֵי, קָא מַשְׁמַע לַן.
§ It was taught in the mishna: If a person is ill and requires food due to potential danger, one feeds him according to the advice of medical experts. Rabbi Yannai said: If an ill person says he needs to eat, and a doctor says he does not need to eat, one listens to the ill person. What is the reason for this halakha? It is because the verse states: “The heart knows the bitterness of its soul” (Proverbs 14:10), meaning an ill person knows the intensity of his pain and weakness, and doctors cannot say otherwise. The Gemara asks: It is obvious that a person knows himself better than anyone else does. Why does this need to be stated explicitly? The Gemara answers: It is lest you say that the doctor is more certain because he has had more experience with this condition. Therefore, the verse teaches us that even so, it is the ill person who knows his own suffering better than anyone else.
רוֹפֵא אוֹמֵר צָרִיךְ, וְחוֹלֶה אוֹמֵר אֵינוֹ צָרִיךְ — שׁוֹמְעִין לָרוֹפֵא. מַאי טַעְמָא — תּוּנְבָּא הוּא דְּנָקֵיט לֵיהּ.
However, in the opposite case, if a doctor says that the ill person needs food, but the ill person himself says he does not need to eat, one listens to the doctor. What is the reason for this halakha? It is because confusion [tunba] has taken hold of the ill person on account of his illness, and his judgment is impaired. Consequently, he himself does not know how much he needs food.
תְּנַן: חוֹלֶה — מַאֲכִילִין אוֹתוֹ עַל פִּי בְּקִיאִין. עַל פִּי בְּקִיאִין — אִין, עַל פִּי עַצְמוֹ — לָא! עַל פִּי בְּקִיאִין — אִין, עַל פִּי בָּקִי אֶחָד — לָא!
§ We learned in the mishna: If a person is ill, one feeds him according to the advice of medical experts. This implies that if there are experts present, then according to the advice of experts, yes, one feeds the ill person; but at his own instructions, no, one does not feed him, contrary to Rabbi Yannai’s opinion. It further implies that according to the advice of several experts, yes, one feeds an ill person; however, according to the advice of only one expert, no, one does not feed him. There appears to be a requirement for at least two doctors, which also contradicts Rabbi Yannai’s opinion that the opinion of one expert is sufficient to override the opinion of the ill person.
הָכָא בְּמַאי עָסְקִינַן, דְּאָמַר לָא צְרִיכְנָא. וְלִיסְפּוֹ לֵיהּ עַל פִּי בָּקִי! לָא צְרִיכָא, דְּאִיכָּא אַחֲרִינָא בַּהֲדֵיהּ דְּאָמַר לָא צְרִיךְ — מַאֲכִילִין אוֹתוֹ עַל פִּי בְּקִיאִין.
The Gemara rejects this: With what are we dealing here? We are dealing with a unique circumstance: The ill person says I do not need food, and the consultation of experts is required. The Gemara suggests: But let them feed him according to the advice of one expert, as Rabbi Yannai said that in such a circumstance one feeds the ill person based on the advice of one doctor. The Gemara answers: No, the requirement of two experts is necessary in a case where there is another, third expert with him who says that the ill person does not need to eat. In such a case, one feeds the ill person according to the advice of two experts who agree that he requires it.
פְּשִׁיטָא, סְפֵק נְפָשׁוֹת הוּא, וּסְפֵק נְפָשׁוֹת לְהָקֵל! לָא צְרִיכָא, דְּאִיכָּא תְּרֵי אַחֲרִינֵי בַּהֲדֵיהּ דְּאָמְרִי לָא צְרִיךְ. וְאַף עַל גַּב דְּאָמַר רַב סָפְרָא: תְּרֵי כִּמְאָה וּמְאָה כִּתְרֵי, הָנֵי מִילֵּי לְעִנְיַן עֵדוּת, אֲבָל לְעִנְיַן אוּמְדָּנָא — בָּתַר דֵּעוֹת אָזְלִינַן.
The Gemara asks: If so, this is obvious, since it is a case of uncertainty concerning a life-threatening situation, and in all cases of uncertainty concerning a life-threatening situation, the halakha is lenient. The Gemara answers: No, this halakha is necessary in a case where there are two other doctors who, along with the ill person, say that he does not need food. And although Rav Safra said that two witnesses are like one hundred witnesses, and one hundred witnesses are like two witnesses, that rule applies specifically to the matter of testimony; however, in the matter of assessing a situation, we follow the majority of opinions. Therefore, one might think in this case that the ill person should not be fed because the opinion of two doctors plus the ill person should override the opposing opinion of two other doctors.
וְהָנֵי מִילֵּי לְעִנְיַן אוּמְדָּנָא דְמָמוֹנָא, אֲבָל הָכָא סְפֵק נְפָשׁוֹת הוּא.
Generally speaking, two or more witnesses constitute complete testimony, and there is no difference between the testimony of two and the testimony of a large number of people. However, this principle of following the majority applies specifically to assessing monetary issues, but here it is a case of uncertainty concerning a life-threatening situation. Therefore, although it is the opinion of two doctors against the opinion of two doctors and the ill person, the ill person must eat.
וְהָא מִדְּקָתָנֵי סֵיפָא: וְאִם אֵין שָׁם בְּקִיאִין מַאֲכִילִין אוֹתוֹ עַל פִּי עַצְמוֹ, מִכְּלָל דְּרֵישָׁא דְּאָמַר צָרִיךְ! חַסּוֹרֵי מִיחַסְּרָא וְהָכִי קָתָנֵי: בַּמֶּה דְּבָרִים אֲמוּרִים — דְּאָמַר לֹא צָרִיךְ אֲנִי, אֲבָל אָמַר צָרִיךְ אֲנִי, אֵין שָׁם בְּקִיאִין תְּרֵי אֶלָּא חַד דְּאָמַר לֹא צָרִיךְ — מַאֲכִילִין אוֹתוֹ עַל פִּי עַצְמוֹ.
The Gemara asks: But from the fact that it is taught in the latter clause of the mishna that if there are no experts present one feeds him according to his own opinion, by inference, the first clause of the mishna is referring to a case where the ill person said he needs to eat. In that case, the mishna states that one follows the experts’ opinion, not his own, and feeds him. The Gemara answers: The mishna is incomplete and is teaching the following: In what case is this statement that he may eat only based on the advice of experts said? It is when the ill person said: I do not need to eat. But if he said: I do need to eat, and instead of two experts there is only one who says that he does not need to eat, one feeds him according to his own opinion.
מָר בַּר רַב אָשֵׁי אָמַר: כֹּל הֵיכָא דְּאָמַר צָרִיךְ אֲנִי, אֲפִילּוּ אִיכָּא מְאָה דְּאָמְרִי לֹא צָרִיךְ לְדִידֵיהּ שָׁמְעִינַן — שֶׁנֶּאֱמַר: ״לֵב יוֹדֵעַ מׇרַּת נַפְשׁוֹ״.
Mar bar Rav Ashi said: Any instance where an ill person says: I need to eat, even if there are one hundred expert doctors who say that he does not need to eat, we listen to his own opinion and feed him, as it is stated: “The heart knows the bitterness of its soul” (Proverbs 14:10).
תְּנַן: אִם אֵין שָׁם בְּקִיאִין — מַאֲכִילִין אוֹתוֹ עַל פִּי עַצְמוֹ. טַעְמָא דְּלֵיכָּא בְּקִיאִין, הָא אִיכָּא בְּקִיאִין לָא! הָכִי קָאָמַר: בַּמֶּה דְּבָרִים אֲמוּרִים — דְּאָמַר ״לֹא צָרִיךְ אֲנִי״, אֲבָל אָמַר ״צָרִיךְ אֲנִי״, אֵין שָׁם בְּקִיאִין כְּלָל — מַאֲכִילִין אוֹתוֹ עַל פִּי עַצְמוֹ, שֶׁנֶּאֱמַר: ״לֵב יוֹדֵעַ מׇרַּת נַפְשׁוֹ״.
We learned in the mishna: If an ill person himself says he needs to eat and there are no experts present, one feeds him according to his own opinion. This implies that the reason one feeds him is because there are no experts present. One may infer from this that if there were experts present, no, one would not feed the ill person based on his own opinion but would instead listen to the advice of the experts. The Gemara rejects this: This is what the mishna is saying: In what case is this statement that one follows the opinion of the experts said? It is when the ill person said: I do not need to eat. However, if he said: I do need to eat, it is considered as if there were no experts there at all; we feed him based on his opinion, as it is stated: “The heart knows the bitterness of its soul” (Proverbs 14:10). All the experts are ignored in the face of the ill person’s own sensitivities.