Nishmat's Women’s Health and HalachaIn memory of Chaya Mirel bat R' Avraham

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Cancer & Halacha


Cancer diagnosis and treatment are unfortunately all too common, and often confront a couple with a range of halachic questions. Here is a summary of some of the more common halachic guidance that couples facing cancer seek. Many of these points are also relevant following prophylactic procedures.

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Illness

Someone with cancer has the halachic status of an ill person whose life is in danger (cholah she’yesh bah sakanah). The preservation of life takes halachic priority over almost all other mitzvot. This approach applies to any potentially life-saving treatment for cancer, even if it involves actions that would be halachically prohibited under ordinary circumstances. Stress and distress levels must also be taken into account in assessing what is life-saving, as they can affect health outcomes.

Shabbat: While a cancer patient generally has the status of a person whose life is in danger, that does not come directly into play with every Shabbat question that arises. Sometimes Torah-level prohibitions may be pushed aside, while at other times, alternatives should be pursued. Rulings about Shabbat must be sensitive to the specifics of the situation, so we encourage couples to ask individual questions.

Two common questions that arise with cancer care on Shabbat are the permissibility of measuring fluid in drains and of taking temperature. Both are permissible as necessary. It is preferable to use a glass thermometer (rather than a digital one) to take temperature.

Fasting: Someone with a cancer diagnosis is usually exempt from fasting on minor fast days and Tish’a B’Av. An individual question should be asked regarding an exemption from fasting on Yom Kippur.

Pregnancy: A pregnant woman’s life takes halachic priority over the life of a fetus. Every step possible should be taken to prevent harm to a fetus during cancer treatment, but a woman should not forgo potentially life-saving treatment out of concern for her fetus.

Harchakot: When a woman is ill, her husband is permitted to assist her and to be lenient with harchakot that don’t involve direct touch. When no one else is available (including when this is simply unaffordable), a husband can touch his wife through a garment, as necessary. See our page here for more detailed information about the halachot of caring for an ill spouse.

Tattoos

While the Torah prohibits tattooing, this might only apply to a tattoo with a symbol or letter or to a tattoo with idolatrous purpose. Tattooing as part of breast reconstruction is usually considered to be a rabbinic prohibition that may be pushed aside for human dignity (kevod haberiot) and relieving distress associated with a mastectomy.

Radiation tattoos are permissible when medically necessary, though alternative methods such as markers are preferred when they can suffice.

Cycle Changes and Bleeding

Cancer and its treatments, including chemotherapy, Tamoxifen, aromatase inhibitors, and radiation, can all affect menstrual patterns. Possible effects include cycle changes, irregular bleeding and long breaks between periods. Sometimes a woman may have years without bleeding, followed by a resumption of uterine bleeding that can make her niddah. Effects differ with each treatment and with each patient, and are difficult to predict.

Additionally, some medicines may cause thinning of the vaginal wall, which can lead to vaginal bleeding. Such bleeding, once identified, is categorized as dam makkah, and does not make a woman niddah.

Women with a cancer diagnosis or undergoing treatment should not hesitate to ask halachic questions about niddah. We especially recommend reviewing the laws of stains here and here, to avoid becoming niddah unnecessarily.

Mikveh

Safety Immersion is only permissible when considered medically safe. A woman can often arrange to be the first to immerse after the water has been treated, to reduce risk of infection. It is also permissible to dip only once, even if a woman usually dips multiple times.

Support When physical support is needed during immersion, another woman can wet her hand in the mikveh and then support the woman immersing, just not with a very tight grip. The woman immersing can also support herself by holding onto a handbar or a wall under the water, and she need not lift her feet off the floor of the mikveh.

Timing Daytime immersion from the ‘eighth day’, preferably later in the day, is permissible when nights are difficult for a woman due to illness or treatment. In such cases, relations should usually be delayed until nightfall, though a question should be asked if that, too, is difficult. Women are encouraged to immerse even when relations will not take place, to permit other forms of physical affection and intimacy.

Preparation A woman preparing for immersion should not clean off a marker in place for radiation.

Someone whose hair is fragile or falling out should seek individual advice regarding how to clean her hair and untangle knots before immersion.

Someone with sensitive skin from radiation should forgo a bath and may suffice with a shower (or even a washcloth or wipes). Oil or an ointment that is absorbed into the skin may be left in place to protect the skin or used to soften scabs. Peeling skin is not a chatzitzah and need not be removed.

Chatzitzah These are some initial halachic guidelines for common scenarios. Women should not hesitate to ask individual halachic questions. A woman should discuss the safety of mikveh immersion after surgery, or with a medical device in place, with her healthcare provider.

  • A woman may immerse with a surgical drain if it must remain in place for at least a week following immersion.
  • Self-dissolving stitches are not considered a chatzitzah. The status of other stitches or medical glue is decided on a case-by-case basis, with more room for leniency if they must remain in place for at least a week following immersion.
  • A port-a-cath (port) is not considered a chatzitzah because it is under the skin. It is halachically preferred to a PICC line or Hickman catheter when it’s an equally good or better medical option.
  • A PICC line or Hickman catheter is subject to halachic debate. This site’s Rabbinic Supervisor, Rav Kenneth Auman, rules that it is not a chatzitzah because it is in place long term and can only be removed by a professional.
  • Caps on a tube are not considered to be a chatzitzah.
  • Rav Auman follows the view that Tegaderm is not a chatzitzah, though this is debated.
  • Additional coverage to protect a line or catheter may be considered a chatzitzah, and an individual question should be asked.

 

Attendant In general, halacha requires an attendant to observe a woman’s immersion and confirm that all her hair is submerged. A woman may ask for the attendant to wait outside the room until she enters the water, or she can request to bring her own attendant (any Jewish woman over 12) along with her.

Some women during or after cancer treatment or prophylactic procedures strongly prefer to immerse without anyone else present. In that case, if a woman has no hair, or very short hair that cannot float above the water when her head is submerged, then it is permissible for her to immerse without an attendant present. A woman with longer hair can use a loose hair net (with no elastic on the netting and cutting the elastic of the band) to ensure the hair is fully submerged. Alternatively, she can hold her hair with her hands as she enters the mikveh, and then let go of her hair under the water.

Prayer

Prayer can be a powerful part of the process of facing cancer. We encourage women in times of distress to recite Tehillim or any prayer that is meaningful to them, including their own personal prayers. Mikveh in particular is considered an opportune time for prayer.

This is a classic Talmudic prayer to recite prior to a medical procedure:

יהי רצון מלפניך ה’ אל-הי שיהא עסק זה לי לרפואה ותרפאני, כי א-ל רופא נאמן אתה ורפואתך אמת

Yehi ratzon milefanecha Ado-nai Elo-hai, sheyehei esek zeh li lirfuah, vetirpaeini. Ki E-l rofei ne-eman ata, urfuatecha emet .

“May it be Your will, Lord my God, that this matter be healing for me and that You heal me. For You are God, a Faithful Healer, and Your healing is true.” (Berachot 60a)

When treatment is successful, reciting birkat ha-gomel is a way to thank God, to spread cancer awareness, and to share a message of hope. A woman may recite it following treatment that has left her with no evidence of disease, even if treatment isn’t complete. It may be permissible to recite it even when there is still evidence of disease but treatment has left a woman feeling well and active. It is best recited in the presence of a minyan, as soon as possible after reaching a point when thanksgiving is appropriate.

This page was updated on 31 January, 2024.


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All health and health-related information contained within Nishmat's Women's Health & Halacha Web site is intended to be general in nature and should not be used as a substitute for consulting with your health care professional. The advice is intended to offer a basis for individuals to discuss their medical condition with their health care provider but not individual advice. Although every effort is made to ensure that the material within Nishmat's Women's Health & Halacha Web site is accurate and timely, it is provided for the convenience of the Web site user but should not be considered official. Advice for actual medical practice should be obtained from a licensed health care professional.


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