An 83-year-old nonobservant Jewish woman with a rapidly failing heart is being kept alive with a feeding tube. While she may not desire to be kept on such life support, she cannot communicate her wishes. But her son, who is making end-of-life decisions at her bedside in a hospice, is an Orthodox Jew whose religious principles forbid him from allowing doctors to end her treatment under these circumstances.
It is a scenario that is played out many times a year at hundreds of hospices.
This was the dilemma that was the focal point of physician Barry Kinzbrunner’s talk as he kicked off the National Institute for Jewish Hospice Accreditation Conference on Nov. 10 at the Newark Airport Renaissance Hotel.
Dr. Kinzbrunner, ordained as an Orthodox rabbi, is chief medical officer of Vitas Innovative Hospice Care, which operates 34 inpatient hospice units in 17 states.
He spoke before a multifaith audience of some 300 chaplains, social workers, and medical personnel seeking NIJH accreditation for their hospices in 15 states.
Fifty-three American hospices are currently accredited by NIJH.
“Our organization trains professionals on how to care for the Jewish terminally ill,” said Shirley Lamm, its executive director. “We want to train the non-Jewish, because they are the workers, the nurses, the helpers. Many hospices have no Jewish chaplains, but they have other clergy who try to fill in.
“NIJH is so important because there are many chaplains here who are not Jewish and are learning about the Jewish faith.”
‘An overwhelming time’
In his talk focusing on the issue cited above, Kinzbrunner emphasized the need for chaplains to consult a rabbi steeped in Jewish legal guidelines when patients are themselves observant.
“According to Jewish law,” said Kinzbrunner, withholding care from a hospice patient is permissible only “when the active intervention will delay the dying process” or will not relieve the patient’s pain and suffering.
“We voluntarily limit our autonomy to make health-care decisions that are consistent with God’s law. One needs a rabbi who is an expert in both Jewish law and health-care issues to make those decisions and help make those decisions with a patient and family,” he said.
In the absence of any written or oral medical directives from the patient, Kinzbrunner’s suggestion was to hold a “big meeting” with family members, the rabbi, and the patient’s physicians.
“You’ve got to include the rabbi in the conversation,” he insisted.
Karen Kilmer, clinical director of the Care Alternatives Hospice in Cranford, told NJJN said her institution consults Orthodox rabbis, unless a patient requests clergy of a different denomination.
Would a rabbi have any special clout in the decision-making process on when to terminate a life?
“Absolutely. It would be the patient and rabbi,” she said.
Jane Yoder is nurse liaison at the Martin and Edith Stein Hospice in Somerset, a Jewish facility that has an Orthodox rabbi as its chaplain but accepts people of all religions. She said potential end-of-life conflicts are discussed at weekly team meetings involving the rabbi as well as family members, physicians, and hospice staff members.
“There is a religious factor, I agree,” said Yoder. “Every patient is treated as an individual, and we have our rabbi to refer to.”
Another speaker was Sharon Rosen of West Palm Beach, Fla., who founded a website called www.ShivaConnect.com after her mother’s death a year ago.
It features aids for funeral planning, e-mail notifications for shiva services, directories of hospices, help with food delivery, and individual registries to direct mourners to the times and places for visiting bereaved families.
“Once we stared to sit shiva it became a very overwhelming time for me,” she said. “I decided there has got to be a way to help people through this difficult time and help them coordinate this with one place where they can get answers to all the questions they may have.”
Despite the somber nature of most of the day’s discussions, the organizers of the conference told NJJN there can be joy in the final days of a terminally ill person’s life.
“People tend to think that hospice is all sadness because few people die at home. Hospice is for raising the spirits. Hospice is for laughter,” said Rabbi Maurice Lamm, the president of NIJH.