Facing the End Like a Mensch
Towards the end of the Book of Genesis, the patriarch Jacob lies dying, and his children gather at his bedside to receive his final words. He offers each of his sons a blessing, then gives them specific instructions regarding his burial wishes. “When Jacob finished instructing his sons,” we are told, “he drew his feet into the bed and, breathing his last, he was gathered to his people” [49:33].
This biblical account has been called the first description of a “hospice death,” because it expresses the hospice goal of allowing an individual to leave the world prepared, pain-free and with a peaceful spirit, having bid farewell to loved ones and said whatever needed to be said.
In my view, hospice programs are one of the great gifts available to us in the modern world. Yet many families are reluctant to take advantage of hospice services – often because of misconceptions. For example:
Many see hospice as “a place you go to die.” In fact, hospice is a philosophy of patient-centered care, tailored to the needs of each patient and family, which provides a range of helpful services to individuals with a life-limiting diagnosis.
Many believe that entering hospice means that illness will no longer be treated. In fact, hospice programs are required to provide all appropriate medical interventions to manage the symptoms of a terminal illness. The focus is on improving the ill person’s quality of life, increasing comfort and relieving pain. Others mistakenly believe that one cannot enter hospice care if they are unwilling to accept a “DNR” (do not resuscitate) order; this is not true. Still others believe that receiving hospice care means hospitalization; in fact, most hospice care is provided within the patient’s own home, amid the comfort of familiar surroundings.
Some adult children feel guilty about arranging hospice care for their parents, believing that they are abandoning their parent by ceasing to pursue treatment. The contrary is true, writes Rabbi Maurice Lamm, an Orthodox authority on Jewish medical ethics. “Arranging hospice care for one’s parents and working closely with hospice caregivers to make sure a parent’s needs are met is, in fact, a very special way of honoring one’s parents.”
Perhaps the most serious barrier to hospice care is the perception, by many of those battling a serious illness, that entering hospice care means “giving up.” In my view, it is not giving up, but taking an affirmative step to insure that whatever time remains will be of the highest quality and value.
It is true that those who choose hospice care must reach what Dr. Elizabeth Kubler-Ross famously defined as the final stage of dying: “acceptance.” Acceptance of death does not mean that we relinquish hope, interest in life or the desire for continued life. It does mean that we acknowledge that the decision is out of our hands, that a cure is unlikely, and that it is time to prepare for the end of life. Accepting death need not cause depression or grief; in some cases, those who achieve acceptance feel serene or even cheerful. After months of struggle, denial, pretending and disguising the reality of dying, acceptance can come as a relief.
I believe that hospice care embodies core Jewish values in its approach to the dying person.
First: It focuses on “anguish control” – not only alleviating physical pain, but attending to the emotional and spiritual pain faced by the patient and his or her family. Members of the hospice team are trained to help those involved in the end of life deal with fear, confusion, exhaustion and heartache. They will also help counsel and comfort the grieving survivors.
Second: Hospice care is based on truth-telling. Gently and sensitively, terminally ill patients and their families are helped to understand the implications of their illness at their own pace, and to make whatever final arrangements will ease their mind.
Third: Hospice care is person-centered and it works to combat isolation. Often those who have a terminal illness feel abandoned by their physicians once a cure is no longer being pursued; some feel neglected by friends. Hospice is based on the philosophy that, “the dying person suffers through the most critical transition of a lifetime, and should be allowed to do so with dignity, tenderness, and humanity – to die as a ‘mensch’ ….This is basic hospice thinking, and it is a basic Jewish attitude” [“The Jewish Hospice Manual: A Guide to Comprehensive End-of-Life Care for Jewish Patients and Their Families”].
If you have questions about end-o- life care, I’d be happy to meet with you or to refer you to hospice professionals within our own congregation. In addition, compassionate volunteers are available to provide emotional support through our Tikvah (Hope) and Gesharim (Bridges) programs.