Monday, August 25, 2008

A Jewish Approach to End-of-Life

On Sunday, September 14, 2008, from 9 a.m. to 3 p.m., Yeshiva University, in New York City, will conduct a seminar entitled "The Sanctity of Life: A Jewish Approach to End of Life Challenges Adult and Pediatric End of Life Challenges."

This is the purpose of the conference:

The conference will provide a unique opportunity to interact with rabbis and physicians who are leaders in this area of medical ethics.

By enriching our education, raising our awareness, and deepening our sensitivities, the YU Student Medical Ethics Society hopes to promote continued discussion, thus enhancing the community’s ability to deal with these issues in an effective manner that holds true to the highest moral standard. * * *
The conference speakers will address the medical, psychological, social, & religious (under Jewish law) issues arising in end-of-life situations:
With expert speakers representing the medical and rabbinical professions, the conference will address the wide range of medical, ethical, psychosocial and halachic (Jewish legal) issues that arise at the end of life.

The opening plenary session of the day will begin with a general introduction to the medical background and ethical issues that are pertinent to adult terminal illness.

Presented by leading physicians, ethicists, and rabbinic authorities with extensive experience, this session will explore how medicine and halacha interact in the modern hospital setting, and will highlight some of the most pressing issues that have come up in recent cases. * * *
I highlight this conference, since it studies end-of-life issues from this religion's viewpoint:
  • Pediatric end-of-life challenges
  • Adult end-of-life challenges
  • Health care proxy
  • Assisted suicide and the value of life
  • Hospice care
  • Pain management
Further event information and registration arrangements are available online here.

The need for decisions at the end-of-life, is real; and such decisions should be made with reference to the patient's beliefs. Otherwise, the decisions rely more on medical possibilities, however fruitless, and familial expectations, however hopeless.

For one physician's perspective on the need for reference to concerns other than medical diagnoses & prognoses, read "
As death draws near, patients and families face agonizing decisions [in] End-of-life care", by Dr. Patrick Neustatter, a family practitioner in North Stafford, Virginia, posted by The Free Lance-Star (Fredricksburg, VA) on August 24, 2008.

He related that "deciding whether to fight for life at all costs, or prepare for death, is a heart-wrenching decision some patients face."

It's bad enough to be dying of terminal cancer, but when your medical specialists are pulling you in opposite directions, advising conflicting treatment plans, it generates more anguish and requires the patient and the family to make some heartfelt decisions.

A patient I'll call Mr. X already went through surgery and radiation therapy for his cancer. Now, unfortunately, the biopsy of the lump that recently appeared shows recurrence.

He is in the care of an enthusiastic, dare I say gung-ho, surgeon who is urging him to have surgery. But his oncologist, together with his daughter, is asking him: "Is another five years of life, but in a nursing home with a feeding tube, really what you want?"

In cases like these, quantity is pitted against quality. Stay alive at any cost, or prepare for the inevitable sooner with less intervention? It's a decision that can put a terrible strain on the bravest patient and most devoted of families and medical staff. * * *
In concluding with his recommendation for patients to prepare, in advance, a "living will" to address medical decision-making, Dr. Neustatter referenced the need to implement the patient's wishes, not rely upon medical possibilities regardless of pain:

At church the other morning, one of the congregants told of her father-in-law just having finally died after a long illness.

She described the heartache her husband had gone through arguing with the other siblings over the whole business, and closed with the question, "Where's the Hemlock Society -- or whatever it's called now -- so my death is not like that?"

The principle of making some preparation for your death is a sound one.

With the aid of a living will, in which you can spell out what medical efforts you do or don't want taken in your final days, you may save untold heartache amongst the family members -- not to mention possibly massive savings on futile medical expenses.

The conference at Yeshiva University will address the concern that "my death is not like that" from a Jewish perspective.