RIETS Dinner 5781

Bikur Cholim

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Jan 28, 2008

a) Perhaps the most prominent category of chesed is that of Bikur Cholim, or visiting the sick. While the Rambam's aforementioned listing of the categories of chesed certainly includes Bikur Cholim, as do the general Talmudic references, other more specific sources exist as well. The Talmud (Nedarim 39b.) offers what it terms as a "hint" (remez): "Resh Lakish said: Where is visiting the sick indicated in the Torah? In the verse, "If these men die the common death of all men, or if they be visited after the visitation of all men, etc" (Numbers 16:29). How is it implied? — Raba answered: [The verse means this:] If these men die the common death of all men, who lie sick in bed and men come in and visit them, what will people say? "The Lord has not sent me" for this [task]". As the Torah Temimah clarifies, the "hint" presumes that a natural lifecycle, with death preceded by illness, will by definition include visitation by others during that illness; such is the intuitive and necessary way of the world. R. Yitzchak Zev Yadler (Tiferet Tziyon) suggests that this 'hint' actually conveys a stronger message than an explicit commandment, because it indicates that the Jews, descendants of Abraham, had long ago adopted this practice on their own, and needed no further commandment once the Torah was given. Similarly, R. Natan Gestetner (Natan Piryo) asserts that being mentioned in the Torah, this pre-existing practice is codified as a mitzvah. Further, the general advice Yitro gives to Moses, which includes chesed as a whole, according to Talmudic interpretation (Bava Metzia 30b ) singles out bikkur cholim: " '[And you] shall show them the way they must walk', 'they must walk' [refers to] visiting the sick". Similarly, when G-d declares about Abraham (Genesis 18:19), "For I have known him, to the end that he may command his children and his household after him, that they may keep the way of the Lord, to do righteousness and justice; to the end that the Lord may bring upon Abraham that which He hath spoken of him", the Midrash states, in the name of the Rabbis: "this is bikkur cholim." (Genesis Rabbah 49:4.) R. Yosef Molkho (Shulchan Gavohah, Yoreh Deah 335:1.) asserts that both of these verses are not meant to convey the basic obligation, which is commanded elsewhere, but to require that this practice be taught to the entire population and to future generations. The classical authorities debate whether to assign the status of an independent biblical commandment to Bikur Cholim. As noted previously, the Rambam understands there to be one broad directive of "Love your neighbor" that is inclusive of all acts of chesed, with subsequent rabbinic enactments of the particular forms, Bikur Cholim included. (Mishneh Torah, Hil. Eivel 14:1). Others understand the obligation to be overtly biblical while some, such as the Behag (36) and the Sefer Mitzvot Katan (47), list bikur cholim as a biblical commandment in its own right. As will be discussed, there are reasons to believe that visiting the sick as an actual physical effect on the patient's health. Accordingly, there are many who understand bikkur cholim to be included in the mandate to heal and to save lives. R. Chaim Bernstein (Y'kara D'Chayei, pp. 69-70.) suggests that the mitzvah of visiting the sick exists on two tiers. When the patient is completely alone, with no one else to take care of his basic needs, visiting this patient becomes an absolute obligation, and is viewed in the category of life-saving activities. When the patient is being cared for, visiting is still a mitzvah of great significance and value, but not in the obligatory sense of the first instance. As with many other instances of chesed, G-d Himself modeled Bikur Cholim, appearing before Abraham as he convalesced on the third day following his circumcision. According to the Midrash HaGadol¸ the model of G-d's behavior is yet another source for a biblical obligation of bikkur cholim. The Ohr HaChaim, in his commentary to the Torah, questions why G-d made his visit to Abraham on the third day of his recovery, when the first two days are actually a time of greater danger. R. Shammai Kehat Gross (Resp. Shevet HaKehati, VI, 394) suggests that the timing itself was instructional as to the nature of Bikur Cholim. Had the visit taken place at the time of greatest risk, the impression would be created that such attention is only necessary during a dangerous illness, but not if there is no risk. To remove this misconception, we are specifically taught of a visit that takes place after the primary danger has passed. While the benefits of visiting the sick may seem self-evident, the identifying of a primary purpose, and thus a focus to the effort, is the subject of various theories in the halakhic literature. As an act of chesed, visiting the sick is directed toward benefiting the sick. The visit itself, as an opportunity to provide comfort to a patient wracked by physical and emotional pain, discomfort, and worry, is an inherent concrete value. The Rosh, in his commentary to the Torah, wrote that even if one finds upon a visit that the patient is asleep, the visitor is still in fulfillment of the obligation, as the patient will be informed after awakening about the visit, and will receive encouragement from the knowledge. Encouragement and comfort are among a number of purposes listed by the Ramban (Torat haAdam. p. 17) in describing the purpose of bikkur cholim. R. Aharon Miasnik (Minchat Aharon al haTorah (Genesis, p. 154). notes that in doing so, the Ramban is perhaps reflecting his understanding of G-d's visit to Abraham. In his commentary to the Torah, the Ramban identifies that visit as a display of support towards Abraham in recognition of his fulfillment of G-d's command. As the Talmud has already labeled this visit as an act of bikkur cholim, it follows that this kind of emotional support is a key purpose of this form of chesed. The Ramban, together with many other authorities, notes as well that the visiting of the sick is meant to provoke the benefiting of the patient in other ways, which may also manifest themselves subsequent to the visit. Accordingly, notes R. Chaim Kanievsky,( Derekh Sichah, p. 66.) the visitor of the sleeping patient has accomplished a mitzvah even if the patient is not informed later, because of the other goals that are included in the mission. These benefits are sought by methods both natural and supernatural. The latter approach is represented by a focus found within bikkur cholim in encouraging prayer on behalf of the patient. This emphasis is so central that the Rama (Yoreh Deah 335:4. This ruling is based on the Beit Yosef, who cites the Ramban.) rules that whoever visits the sick and fails to plead for Divine mercy has not fulfilled his obligation in this regard. The Talmud (Bava Batra 116a.) states that one who has an ill person in his household should approach a Torah sage to entreat Heaven on behalf of the patient. The Nimmukei Yosef notes in this context that the practice in France was to ask a local rabbinic leader to pray on behalf of an ill relative, and this is then cited by Darkei Moshe as the basis for the "misheberakh" customarily recited in the synagogue for ill members of the community. In this context, the Arukh HaShulchan asserts that the time of the public reading of the Torah is a particular time conducive to the invoking of mercy. In the physical realm, the visit is also meant to provoke assistance from the visitor toward the patient, both at the time of the visit and afterwards. Thus, the Arukh HaShulchan states, "the main thing (ikkar) of the commandment of bikkur cholim is to look into what the patient needs, and to do for him what is necessary. Many commentaries note that in this context the proper translation of "Bikkur" may not be "visiting" but rather a connotation of "checking into", as is found in some biblical usages.… R. Avraham Yitzchak Shain (Birkhat Ish al haTorah) suggests that this is also evident from the Divine visit to Abraham. God sent, at that time, visitors to Abraham, because it was the lack of opportunities for hospitality that was causing extra pain to Abraham. Thus, in providing Abraham what he was lacking, God modeled true bikkur cholim. As anyone experienced in bikkur cholim knows, visiting the sick benefits them practically in another very significant way. Often, the medical staff is inspired by the attention and affection displayed toward a patient. Accordingly, the act of visiting, in a visible manner, can have a direct effect upon the level of care received. Both of these goals are represented by the Talmudic statement that one should not visit the ill in either the first or the last quarter of the day. The Shulchan Arukh understands this as influenced by the desire to inspire prayer. Presuming the sickness increases its burden as the day progresses, both the earlier part of the day and the later part will skew the visitor's perception of the patient's condition. If the patient is perceived as healthier than in actuality (as an early morning visit might imply), the visitor will not be sufficiently impressed to offer sufficient prayer; if the patient appears worse off than in actuality (as implied by a late in the day visit), the visitor might be discouraged. Other authorities, however, understood that the time limitations are based on the assumption that patients are attended to at those times, and the presence of outsiders may interfere with such ministrations being performed to the comfort of the patient. While this limitation is not currently practiced – the Arukh HaShulchan, for one, understood it to be advice, rather than law, and modern circumstances often suggest contrary advice– the formulation itself is indicative of both the goals and the considerations of bikkur cholim. As noted, these functions find expression even after the visit is completed. As such, they inform the procedure when the visit itself is contraindicated. The Talmud notes that there are illnesses, such as gastrointestinal disorders, which can result in embarrassment to a patient; as well as illnesses that make conversation with a visitor, or even acknowledging the presence of one, burdensome. In such instances, actual patient-visitor interaction is discouraged; nonetheless, the visitor is bidden to come as near as is indicated, with the understanding that such exposure will provoke both material assistance and meaningful prayer on behalf of the patient. The above reasons indicate that it is worthwhile to visit even if the patient is not capable of being aware of and appreciating the visit; for example, it would still be encouraged to visit a patient who is comatose, or, alternatively, an infant that is of course unaware of its surroundings. In these cases, the visitor is certainly moved to pray on behalf of the patient, as well as work to attend to any pressing needs that may exist. While some contemporary authorities suggest that the value in visiting a child is dependent on the child being old enough to appreciate the visit, others dismiss this requirement, in light of these factors. Further, as R. Yisrael Pesach Feinhandler (Responsa Avnei Yashpe, I, 230) observes, even if the child is one day olad and not aware of anything, the parents are aware, and certainly benefit tremendously from the support; thus, even the additional reason of bringing comfort is applicable, even if not directly to patient. A particularly delicate aspect of visiting the sick has to do with addressing the spiritual state of the patient. This is, of course, a highly sensitive element that requires great wisdom to undertake properly. In theory, though, a number of issues might be included in this realm, such as preparing a terminal patient for getting his affairs in order; encouraging the patient to pray on his own behalf; and guiding the patient toward spiritual introspection. Many authorities assert that bikkur cholim contains an additional element as well, one meant not so much for the benefit of others, but for oneself. The Talmud states that one who visits the sick is "saved from the judgment of gehinom". This may suggest that in addition to other accomplishments, visiting those in a crisis of health provokes one to engage in introspection, and, hopefully, self-correction. All of the above reasons are found in halachic literature, and most of them are included within the delineation of the Ramban, whose language has been adopted by the later codes. However, the goal of provoking prayer is given a distinct priority within this presentation. The Ramban and those who follow him state "Anyone who visits the sick and yet does not ask for mercy for the patient, does not fulfill the mitzvah". The implication is that one is in fulfillment of bikur cholim while only accomplishing some of its goals, as long as prayer is not the aspect that is missing. Strikingly, R. Ya'akov ben Chananel Sikli, who was a student of the classical commentator Rashba, wrote (Torat HaMinchah, #9.)that one who feels incapable of praying for the patient should not visit, as such a visit would appear hypocritical, an expression of compassion that is not actually felt. Further, this would be considered an active omission of sympathy, and thus an egregious failure in the quest to emulate G-d. Nonetheless, the emphasis put on prayer strikes some commentators as extreme. Some suggest that the Ramban means only that the mitzvah is not fully accomplished, but not that no mitzvah has been performed. R. Ya'akov Chaim Sofer (Zera Chaim, 8) records some other possible interpretations of this statement. One possibility is that other aspects, such as attending to the physical needs of the patient, are obviously crucial and do not require the emphasis that prayer does. Another possibility, supported by some manuscripts, is that the Ramban's intent was to say "does not fulfill this mitzvah", which would imply that prayer on behalf of the patient is its own, distinct obligation, that is going unfulfilled. However, R. Sofer notes that the versions found in many later works do not support this interpretation, and appear to assert that prayer is the defining, indispensable goal of bikkur cholim. R. Baruch Goldberg, in his P'nei Baruch, softens the impact of the ciatation by recording the halakhah with an extra clause: "whoever visits the sick not for the advantage of the patient, and does not pray for him, does not fulfill the mitzvah of bikur cholim." R. Avraham Erlanger (Birkat Avraham) notes that even were it to be the case that a particular visit would not fulfill the obligation of bikkur cholim, it would still fall under the general rubric of chesed. Assuming the main function of the mitzvah is physical assistance has prompted some authorities to consider the question of whether the mtzvah of bikkur cholim is fully applicable in the context of a modern hospital, where the patient is attended to exclusively by hospital staff, and visitors would not even be permitted to assist in any way. In addition to the fact that this premise is somewhat questionable, many authorities concludes that in that prayer is the primary reason for the mitzvah, the reality of the hospital care does not mitigate the obligation at all. Another aspect found in the Ramban's writings and in those who quote them is the desire that the patient "find comfort among his friends", a factor certainly applicable to the above issues. In considering this crucial element of the practical needs of the patient, the importance of conversation can not be overestimated. In his poetically presented listing of the commandments, R. Shlomo ibn Gabirol describes the obligations of chesed: "v'ha-dalim t'rachem, v'ha'aveilim t'nachem, v'hacholim t'sichem", a rhyming formulation that dictates compassion for the needy, comfort for the mourners, and conversation (sichah) for the sick. The Rashbetz, in his commentary Zohar HaRakia, explains this phrase by noting that talking is considered to be beneficial for one who is ill, as indicated by a passage in the Talmud. In addition to the general value of talking, a number of specific speech-oriented roles are noted in the halakhic literature: one can advise on treatment; can provide encouragement and support; can supply good cheer and distraction; and can enhance the atmosphere and thus make it more attractive for others to come and contribute positively. B) One of the more well-known and intriguing aspects of bikur cholim is the statement of the Talmud that the visitor removes, or perhaps absorbs, one sixtieth of the illness from the patient. In at least one context, the understanding appears to be quite literal, as the visit is identified by the Talmud as a risk, albeit one that is obligatory (Bava Metzia 30b). Further adding to the mystique of this concept is the qualification that the visitor must be a "ben gilo" of the patient. According to some of the classical commentaries, this refers to being born under the same "mazal", or sign. Other commentators, however, had a more down-to-Earth approach both in defining "ben gilo" and in understanding his impact. Rashi explains the terms as referring to one of the same age group: "a young man like him, or an elder [visiting] an elder". Similarly, the Meiri understands the category to describe a visitor whose presence will be pleasing to the patient and accordingly will alleviate his suffering. Likewise, the Ritz in the Shittah Mekubetzet understands the term ben gilo to refer to one who shares the temperament and attitudes of the patient. Thus, by spending time with the patient, the visitor enhances his atmosphere and alleviates a degree of his suffering. However, if the personalities are mismatched, there exists the risk that the visit will become burdensome to the patient and deleterious to his well-being. This understanding is consistent with the version found in other rabbinic texts where instead of ben gilo the criterion is that the vistors "love the patient like themselves". R. Yitzchak of Karlin, in his classic Talmudic commentary Keren Orah, writes that the "closeness of their souls" will not only remove one sixtieth of the illness but that the visitor will "add strength and life from his own". R. Moshe ibn Makir, in his Seder haYom, writes that the visitor brings healing with his soothing words, noting, "we have seen with our own eyes this idea, for at times a person will go in to visit a patient, and he sits with him for an hour or two, and the patient himself says, "you have comforted me, you have comforted me, you have returned my soul to me". Similarly, R. Yosef Chaim ben Eliyahu, known as the Ben Ish Chai, asserts that the intent cannot be that the visitor contracts a portion of the illness, as this is both medically incorrect and a contradiction to the promise of the Talmud that bikkur cholim is a mitzvah that yields rewards not only in the next world but in this one as well. Rather, because the visitor identifies emotionally with the patient, he feels anguish, corresponding to one-sixtieth of that of the actual illness; and it is that sharing of the pain that effects a small degree of relief for the patient. R. Yitzchak Zilberstein (Chashukei Chemed to Shabbat, p. 98) suggests that the process is similar to an inoculation for the visitor, who by joining in the suffering of the patient absorbs a small portion of he illness. This portion is not harmful, but rather enables the visitor to build up "antibodies", while not suffering any ill effects, as the degree of illness is so small; the measurement of one-sixtieth is that which is considered 'nullified' (in the context of unkosher food within kosher food, for example). As R. Yonatan Rosensweig notes (In the journal Techumin XXVI, p. 407, fn. 4), the interpretation of "ben gilo" as one of comparable age is also consistent with the desire to provoke prayer. The impulse to pray on behalf of the patient is strengthened by the identification the visitor feels with the patient, and especially with the realization that he is vulnerable to the same potential afflictions. It is noteworthy that the Rambam completely omits any reference to "ben gilo" and simply states that one who visits the sick removes a portion of his illness and alleviates his situation. In explaining this modification, some suggest that the Rambam's source is actually not the Talmud but a Midrashic statement that implies that any visitor has this effect. Similarly, R. Yehudah Ayash (Shevet Yehudah, 335:5) understands that the Rambam is not utilizing the one-sixtieth concept at all, which is connected to ben gilo, but rather the more general Talmudic statement that "whomever visits the sick causes him to live". In a very different direction, R. Yaa'kov Breisch (Responsa Chelkat Ya'akov, Yoreh Deah, 147:3) asserts that the Rambam does believe that this benefit comes only through a "ben gilo", but also understands that concept to be dependent on being born under the same "mazal". Since this is apparently impossible to discern , there is no reason to include it in a halakhic code, as it would not practically affect the motivation to visit. R. Yitzchak Arieli (Einayim L'Mishpat) takes the completely opposite approach, but ends up with a similar conclusion. The Rambam omits "ben gilo" because of his general tendency to omit supernatural elements, and understands the relief to come from a visit that is targeted towards the needs and temperament of the patient. Since anyone in theory may accomplish this, there is no need to mention any limitation. C) While chesed in general has shown itself to be resistant to quantification and limitation, the obligation of bikkur cholim is independently identified as being "without limit". The Talmud supplies a number of possible interpretations to this phrase. One interpretation, brought in the halachic codes, is that no amount of visitation completes the mission; it is appropriate "even one hundred times a day". As some commentaries explain, this reflects the reality that the patient's condition can worsen in an instant; thus, no visitor can be content by saying, "I've already seen him today". R. Eliezer Yehudah Waldenberg (Responsa Tzitz Eliezer, V, Ramat Rachel ch. 8) understands the lack of 'limit' expansively in all directions: there is no maximum or minimum, any visit, however long or however short, is a fulfillment of this obligation. Nonetheless, the Tur and the Shulchan Arukh, following the Rambam, warn that one must be especially careful not to be a burden to the patient, a necessary warning to those who may lose sight of the true goal of acts of chesed. In this context, the Arukh HaShulchan (3335:4) uses the words that identify the traits necessary to all genuine practioners of chesed: "zahir, chacham umavin" - to be careful, wise, and understanding. Thus, all discussions of the laws of bikkur cholim place a strong emphasis on knowing when and how to visit in a way that will maximize the benefit of the visit and minimize the possibility of an imposition. Honing this sensitivity is crucial to being successful in accomplishing bikkur cholim. The line between helping the patient and imposing upon him, or worse, is exceedingly thin, and the art of recognizing where it is drawn needs much attention. All of the texts that deal with this chesed describe the damage that can be done when this calculus is incorrectly performed. R. Baruch Goldberg, in his P'nei Baruch (Bikkur Cholim, 1:21, in B'fnei haChaim, #44) notes that often a patient will weaken himself through his efforts to properly receive the visitor. The visitor has to be cognizant of when this is happening, as well as when the conversation has become more an attempt to satisfy his own curiosity than a comfort to the patient. In the opening lines of the laws of bikkur cholim, the Shulchan Arukh describes the typical fashion in which visitation is appreciated and should thus be practiced. Close friends and relatives visit a a patient immediately upon hearing of an illness; while those less intimately connected wait until the condition had extended beyond three days. The Bach explains the waiting period for the latter group, noting that, for reasons presumably both spiritual and emotional, we are reluctant to prematurely confer a label of "illness" upon an individual whose condition may quickly improve. Friends and relatives, however, by their familiarity bring a different form of comfort, one that it is immediately appreciated. R. Chaim Mordechai Roller (Responsa Be'er Chaim Mordechai, III, Y.D. 36) observes that the acquaintances who come after three days perform an extra service, in that they are able to take some of the burden of care away from the close family members, who, at that point, are presumably tired. Nonetheless, in the event of an illness that advances rapidly, the waiting period is waived and all are urged to visit immediately. Unfortunately, one factor that must sometimes be considered when visiting the sick is possible animosity between the visitor and the patient. The Maharil allows one to visit his enemy, but the Rama (Y.D. 335:2) advises against it, worrying that it may appear that he is rejoicing in the other's misfortune. R. Aron Soloveichik (Od Yisrael Yosef B'ni Chai, #2) theorizes that the issue is not how the patient will interpret the event, but how others present will see things. The concern is that if the appearance is that the visitor is there to gloat, the dignity of the patient will suffer in eyes of the witnesses. R. Yosef Shaul Nathansohn (Yad Shaul) adds another reason to be wary: the patient may lose hope, assuming his own condition to be very dire indeed, if even such an enemy feels obligated to pay respects. Of course, this sad topic is a subjective one, and, in practical terms, the Shach rules that all depends on the level of hostility. The Arukh HaShulchan suggests that the adversary get permission first before coming, and then the situation could be used as an opportunity for peacemaking. Similarly, R. Eliezer Yehudah Waldenberg (Responsa Tzitz Eliezer, V, Kuntres Ramat Rachel, 9) suggests that it is precisely an enemy who should be most obligated to perform this function, in light of the Talmudic exhortation to provide assistance to n individual whom one dislikes (Bava Metzia 32b), in order to overcome that lamentable instinct. The Shevet Yehudah describes how this could happen: if the visitor is the offended party, the fact that he nonetheless is willing to make the visit may inspire the patient to ask forgiveness of him. If the patient is the offended party, the visit itself can be viewed as an overture toward reconciliation. As R. Chaim Pilagi observes , if such a plan is successfully executed, one act of chesed will be made into two, as peace-making will be added to the list. The commentary Beit Hillel records that the contemporary practice is for adversaries to visit the sick and through this to make peace. D) A topic that is taken up by many of the halachic authors is the question of whether one fulfills the mitzvah of bikkur cholim through a phone call, without a personal visit. In a sense, this discussion is of limited practical relevance. This is because most, while not all, of the decisors who take up the issue conclude that a phone call is valuable, and at least a partial realization of this obligation, while noting that the act falls somewhat short, and a personal visit is preferable. Thus, in practical terms, one is encouraged to ideally visit in person, but when that is impossible or impractical, a phone call is certainly appropriate. (See, for example, Responsa Iggerot Moshe, YD I, 223; Responsa Yechave Da'at, III, 83; R. Avraham Yaffe-Shlesinger, Responsa Be'er Sarim, II, 24-25.) However, in a broader sense, the discussions are instructive in what they indicate as to the standard and format demanded by bikkur cholim. A number of authorities note that the Talmud derives an obligation of bikkur cholim from "they must walk"; they suggest that this indicates that physically traveling to the patient is fundamental to the mitzvah. In fact, some, such as the Maharsha (Bava Metzia 30b), infer from here that one is in fulfillment of bikkur cholim simply by being physically present. R. Yitzchak Oehlbaum (Responsa Sh'eilat Yitzchak, II, 131), who adopts this position, is additionally concerned that the call may do more harm than good, as the patient may feel pressured to come to the phone at a time when it is painful or difficult to do so. R. Yisrael David Harfenes (Responsa VaYivarekh David, I, Y.D. 106, p. 365 in fn) raises the concern that the patient will not be fully open in disclosing the severity of his condition over the phone, and thus the goal of being motivated to prayer will not be fully accomplished. Similarly, R. Ya'akov Chaim Sofer (Zera Chaim, 2) is concerned that over the phone, one would not be in a position to take care of the needs of the patient. Working backwards, he therefore dismisses a written view that the main goal of bikkur cholim is to honor the patient with the attention and thus alleviate his condition from an emotional perspective. That, he concedes, can be accomplished by telephone. Out of concern for the multiple goals of the mitzvah, R. Yitzchak Weiss (Responsa Minchat Yitzchak, II, 84) rules that the first visit to a patient must take place in person, so as to properly assess the needs of the situation. After that, the phone may be used to serve the purpose of providing multiple "visits". Some, such as R. Ya'akov Breisch (Responsa Chelkat Ya'akov, Yoreh Deah, 188) and R. Asher Weiss (Minchat Asher, Bereishit 20:4), differ from many of the prior discussions on this point by asserting that while a phone call is valuable, it is decidedly not the commandment of bikkur cholim. In this view, bikkur cholim is a specific mitzvah and must be understood as such; thus, theorizing as to its purpose does not give one license to deviate from the literal terms of the obligation. Thus, even if a phone call were to accomplish all suggested objectives of bikkur cholim, it still cannot be called a "visit", and accordingly the value it has should be categorized under the general rubric of "chesed" while not making the standard of bikkur cholim. Conversely, R. Yitzchak Hutner's opinion (Pachad Yitzchak: Iggerot U'Khtavim, 33) diverges in the other direction, as he considers a phone call to be essentially a complete fulfillment of bikur cholim. This emerges from his understanding of the obligation, which centers on interpreting the word bikkur as a looking into, with the intent of providing assistance. Accordingly, this can be accomplished completely over the telephone. (In another context, but of possible relevance, R. Yitzchak Huberman (Ben L'Ashrei Berakhah Meshuleshet to Bereishit (18:1) cites the work Rachshei Lev as asserting that one is not in fulfillment of bikkur cholim if he inquires about the patient without making himself visible to him. This is derived from G-d's visit to Abraham; surely G-d knew the details of Abaraham's condition, but found it necessary to visit nonetheless. R. Huberman disputes this proof, noting that the focus is on making sure the patient is aware of the visit. If one comes to see a patient and finds them asleep, and asks the attendants about the patient's condition, the patient will hear about the visit upon awakening and thus will indeed benefit.) R. Yonatan Shteif poses the question of the value of writing a letter to the patient, and assumes that the issue is dependent on the question, discussed by many halakhic authorities, of whether writing can be equated with speech (ketivah k'dibbur). (A lengthy exchange on this topic between R. Shimon Baruch Ohayoun and R. Ovadiah Yosef is print

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