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Hospice care helps with final spiritual journey
July 30th, 2004
This is the first in a two part series about hospice care.
I was visiting a dying woman who many years earlier around the time her son was to become a bar mitzvah had a misunderstanding with a rabbi and could not come to an agreement about a financial matter.
She felt very hurt and refused to set foot in a synagogue for her own needs for the rest of her life, said Rabbi Leonard Lewy, a former hospice rabbi.
She was being treated for physical pain ... I was able to establish a connection with her and listen to her pain, he said.
I saw [this woman] for three months or more . One day she said, Rabbi, you are my rabbi and you have given me back my religion, said Lewy, now director of the Jewish Chaplaincy Program of Milwaukee, a program of the Milwaukee Jewish Federation in cooperation with Jewish Family Services.
Whether you are able to fix their terminal illness or not, you can often help people heal spiritually and [this woman] was able to find peace, he said.
Lewy attributes that reconciliation with Judaism to the benefits of hospice, which was defined, in its original meaning, as a shelter or resting place for travelers. In the medical and religious communities, the metaphor is apt for a newer meaning of the word a respite from the storm in the end-of-life journey.
Hospice is a philosophy and a medical reimbursement system. The focus is on palliative [alleviating pain and suffering] not curative care, said Dr. David Weissman, director of the Medical College of Wisconsins Palliative Care Center.
Hospice is not a place, but a program of care in which a team of caregivers provides services beyond the usual medical care that aims to cure the sick, explained Dr. Charles Tiber, oncologist and director of Columbia St. Marys Hospice, one of only three residential hospice facilities currently operating in the Milwaukee area.
The Sarah Chudnow Campus, which is set to welcome its first residents in February 2005, will have a designated wing for five hospice suites. The Mequon facility will provide a continuum of care for seniors, according to Jeri Stroiman, marketing manager of the Jewish Home and Care Center, Chai Point and the Chudnow Campus.
The beauty of hospice is that a person has time to make amends with G-d and family, said Rabbi Brian Comrov, a chaplain working for Horizon Health Care, a private in-home health care agency.
Most hospice patients are cared for in their own homes by family members and supported by hospice caregivers. Some, who do not have homes or family members able to care for them, or who have less easily controlled symptoms, receive hospice services in a hospital, nursing home or residential hospice facility.
The care-giving team includes doctors and nurses, who manage the pain and other symptoms; social workers, who handle financial issues and sometimes, grief counseling; and a rabbi or chaplain, whose role is to walk with the patient down [the] road [to death], said Comrov.
The hospice care movement began in England, in a Christian context, in the 1970s, but the idea of lightening a patients pain also appeals to Jews.
Conceptually, there is a tremendous halachic obligation to make a [sick or dying] person as comfortable as they can possibly be, said Rabbi Benzion Twerski of Congregation Beth Jehudah.
Nevertheless, hospice care has not been widely embraced by the Jewish community. According to Twerski, some Jews are suspicious of it because some in the hospice movement believe in euthanasia and actually practice it.
In such cases there is certainly a conflict with Jewish law, said Twerski. We cannot hasten death in any way; we cant kill people.
But, Twerski said, when he has had contact with in-home hospice care services in the Milwaukee area, they have been very deferential and have stayed in contact with him by telephone, in order in ensure compliance with Jewish law and values he said.
Lewy, ordained by the Conservative movement, sees hospice care as compatible with Jewish values. Judaism places an emphasis on every moment of life being precious, but we Jews are realists and we recognize that life ends and we dont believe in needless suffering, said Lewy.
Although some people who support the hospice movement do also believe in euthanasia, the two are separate issues, said Lewy. Euthanasia, which is only permitted by law in the state of Oregon, is not consistent with Jewish law, he said.
The hospice movement has grown in the U.S. as a result of the passage of the Medicare Hospice Benefit in 1982. This allows any American aged 65 or older, or who has been disabled for at least two years, to be eligible for coverage of all hospice care costs (except room and board) under Medicare. Most private medical insurance plans also provide for these costs.
To qualify for hospice care benefits two conditions must be met. A physician must sign a statement that says, assuming a disease follows the expected course, a patient will not likely live for more than six months, and the treatment goal must be palliative not curative.
Weissman said that getting people who are dying to talk about their death is one of his most important jobs. Lewy and Comrov agreed that that listening to their patients is a crucial part of the process.
This is a time when artifice can be stripped away and people can tell their loved ones the last important things they have to say, as well as throwing away a lot of garbage hurt and anger, said Comrov.