This article is being printed in response to interest generated by the article on Jewish hospice care in the Jan. 19 issue of The Chronicle.
Baltimore — A few years ago, a new program was introduced to the Baltimore Jewish community by Jewish Family Services, known as the Jewish Hospice Program of Maryland.
During the more than 20 years I have worked in hospice programs, here and in other cities, I have come across an attitude on the part of some people and families that I feel deserves attention.
It seems the concept of hospice rings an alarm in the minds of Torah Jews, who believe in the value and the preciousness of every moment of human life. Hospice? Jewish? How can that be? There is an unfortunate perception that hospice is a place where people go to die.
This suspicion arises from a lack of understanding as to what hospice is about. Can something that is not perceived to be kosher be, in fact, kosher, permitted and actually endorsed by halacha ?
Webster’s dictionary defines hospice as a “shelter for travelers, or the destitute, maintained by a religious order.” Is not that definition familiar to every Torah Jew? What are hachnasas orchim (hospitality to guests) facilities all about?
Have we forgotten that it is our Torah and the teachings of our sages, that have laid the fountain for all “mitzvos,” or good deeds, done by anyone of a religious faith? Whatever terminology you use, the concept of hospice is, first and foremost, a Jewish concept.
Hospice is a philosophy of care, which posits a holistic approach to addressing the physical, emotional and spiritual, needs of terminally ill patients. These are patients who are no longer receiving curative treatment. For them, the primary focus of care becomes maintaining them in comfort and managing their pain.
A person or family opts for hospice care after being told by their physician that there is nothing more that can be done medically for the patient. (In cases where experimental therapy is a possibility, this should be discussed with a competent halachic authority, since such therapy can hasten a patient’s demise.)
Choosing hospice care simply means acknowledging that our ultimate healer is the Master of the Universe. We turn ourselves over to Him and say, “We have used Your shluchim [messengers], and now we come to you for the ultimate decision as to what will happen to our lives.”
Patients often plead with physicians and family members to remain in their home. At present, the Jewish Hospice Program is only given in private homes or nursing homes, although we are working on establishing an in-patient Jewish hospice facility for those patients who cannot be maintained at home.
Hospice care is provided by an interdisciplinary team of professionals, including physicians, nurses, social workers, home health aides and trained volunteers.
In keeping with our Torah hashkafa (outlook), our hospices are designed to be life-affirming, and we are guided by halacha. We encourage a family’s personal rabbi to be actively involved in the interdisciplinary teams decision-making process.
Why ‘Jewish’ hospice?
While all hospices take compassionate and respectful care of dying people, there are differences between a non-Jewish and a Jewish hospice.
For example, a Torah Jew cannot accept the concept of “death with dignity.” There is no dignity in dying; we live with dignity, and it is our obligation to see to it that each and every Jew is treated in all situations with dignity as a creation of the Holy One, Blessed be He.
Everyone realizes that death is inevitable. Torah Jews resist death as long a possible so they can have an opportunity to fulfill more mitzvos, though once the time approaches, we must no longer be afraid.
Patients need not be told they are entering into hospice care if the family feels that this will create a situation where they may lose their will to fight their illness. There is a legitimate controversy as to whether a critically ill patient should be told that he or she may die. Though I have come to learn that most seriously ill people sense what we think are secrets, we must be sensitive to the rational requests of a family.
The Shulchan Aruch (Yoreh Deah 3:38) teaches that if one is about to die, we tell him to confess. We explain that many have confessed and have not died, and many have not confessed and yet have passed away. (Indeed, in my many years of working in this field, I have seen a number of hospice patients being discharged because their illness subsided and they showed a new burst of strength.)
In the text of the prayer of vidui (confession) itself, we say, “I admit before you, Hashem my G-d, and G-d of my ancestors, that my cure and my death are in your hands. May it be Your will that You heal me with a complete healing. And if I die, my it be an atonement for the sins, transgressions, and violations, which I have sinned, transgressed, and violated before You. And place my portion in the Garden of Eden, and let me merit the world to come which is reserved for the righteous.”
The ill person first asks Hashem to heal him. Only then does one consider the alternative — that he or she may not recover.
We have a responsibility to make the dying person as comfortable as possible, to relieve as much pain as possible. One may pray to Hashem to have mercy on the dying, to spare them further suffering. But, of course, we may never hasten the death of an ill person by any physical acts.
Family members, as well as others who visit, must always be sensitive to a living individual who is dying. I remember a patient once telling me, “Rabbi, I do not need help with dying, but I need help with living until I die.” It is our obligation to meet that need.
Hospice, with an extremely caring group of professionals, can assist in a Torah way — which is, in fact, the only way to accomplish the goal.
Former Milwaukee community chaplain Rabbi Dr. Tsvi G. Schur is the Jewish community chaplaincy coordinator at Jewish Family Services in Baltimore and director of the Jewish Hospice Program of Maryland. This article originally appeared in the Nov. 1999 issue of the journal “Where What When.”
Many of the “Jewish Hospice components” embodied in Rabbi Dr. Tsvi Schur’s fine article are in the process of being implemented through a coordinated approach by the Jewish Chaplaincy Program working with Jewish Family Services and local rabbis and cantors.
Good hospice care is available in Milwaukee. Through the Jewish organizations mentioned and with the community’s support, “good Jewish hospice care” will be increasingly available.
For more information contact your rabbi or Rabbi Leonard Lewy, Jewish Chaplaincy Program Director at 219-6070 or info@milwaukeejewish.org. Additional information on these efforts can be found in Jan. 19 and 26 issues of The Chronicle.
Rabbi Leonard J. Lewy, Director
Jewish Chaplaincy Program
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