The harchakot can present a particular challenge in cases of significant illness, injury, or disability.
When one spouse needs to give care to the other, the couple can be lenient with harchakot that do not involve direct physical contact (e.g., passing objects directly, serving food, pushing a wheelchair, or putting on shoes).
A caregiving spouse still should not perform certain specific services that halacha views as conveying special affection. Thus, one should not wash one's spouse's face, hands or feet unless absolutely necessary. One should not make one's spouse's bed in his or her presence; if the spouse's presence in the room is unavoidable, the ill spouse should turn away if possible, so as not to see the bed being made.
Whenever possible, a relative, friend, or professional caregiver should provide assistance requiring direct physical contact in place of the spouse. Since halacha is more stringent in this regard when the husband is the caregiver, even greater effort should be made in that case to find an alternative caregiver.
Where no one else is available to help and direct physical contact is absolutely necessary, the spouse may provide care and assistance as needed. The couple should make every effort to minimize touch and, when touch is unavoidable, to touch only indirectly, as through a blanket or garment or while wearing gloves.
In the case of an emergency or a dangerous illness, chas v'shalom, saving a life (pikuach nefesh) takes precedence over other halachic considerations.
These are general guidelines. The halachot in this area are complex and depend on the precise situation and the nature and severity of the illness or disability. Therefore, a couple should ask specific halachic questions about their situation.
It is especially important to ask questions if the harchakot may exacerbate the discomfort or inconvenience caused by the illness. A spouse who is ill and needs help should not be allowed to suffer needlessly. A halachically acceptable solution can usually be found.
For more practical guidance and specific suggestions, please see our article on Harchakot, Disability, and Illness: An Occupational Therapy Perspective.