Why, on a beautiful morning, would people crowd a room for an intimate discussion of Jewish perspectives on death and dying?
Because, as Hadassah spokesperson and panel moderator Eleanor Dickman says, "technology is outstripping ethics, making choices more difficult and solutions less obvious."
And, death is not optional.
In this era of Dr. Jack Kevorkian-assisted suicides and right-to-die initiatives, panelists examined how patients could prepare to face death with dignity and in accordance to Jewish law.
Rabbi Daniel Pressman, of Congregation Beth David, reminded the audience that "death is morally neutral." However, he said, Judaism clearly teaches that life has infinite value and that because the body belongs to God, one is mandated to take care of the body. Thus, murder is prohibited in all cases.
While this prohibition extends to assisted suicide and other forms of euthanasia, Pressman said, halachah permits easing a patient's suffering. That may include the withdrawal of life support systems.
"It's a question of intent," says Pressman. If drugs used to alleviate suffering have a secondary effect of shortening a patient's life, this may be permissible. But if the drugs are being used for the express purpose of shortening the life, then this is impermissible, he said.
Pressman said Judaism recognizes there is a "time to let go and that part of our being and essence is that we die."
While all panelists agreed on this point, each brought a particular expertise to this intimate dialogue.
Dr. Elizabeth Menkin, a geriatric specialist and hospice physician with Kaiser Permanente, said she views medicine as a "tool" to help one have a life, but does not think medicine should "become one's life."
Patients and family members need to ask how a recommended treatment would help the patient "get something" out of life, Menkin said, cautioning people not to let the medical goal (for example, lowering blood pressure) take over the patient's personal goals.
Menkin also emphasized the need for patients to be kind to surviving family members, by completing a durable power of attorney and discussing well in advance what types of treatments would be intrusive to the patient.
Marcia Kaplan, an attorney practicing health law with her physician/attorney husband, reminded the audience that durable power of attorney forms could be completed easily and without the assistance of an attorney. This enables someone of the patient's choice to make daily decisions regarding medical care that affect the patient.
Having the durable power of attorney may resolve conflicts among family members who disagree on appropriate medical care.
As a case in point, one audience member spoke of a conflict between two family members, from two different schools of Judaism, who differed greatly on how they thought the patient should be treated. There was no durable power of attorney, which would have clearly identified which family member should act on the patient's behalf.
Pam Umann, a social worker with MidPeninsula Home Care and Hospice, emphasized that death often eases suffering and that families and children need to work together to cope with their loss and bereavement. This hospice philosophy was viewed as consistent with Jewish teaching, as it understands that the "whole family" is sick and not just the patient.
Ken Kaye, an estate planning attorney, spoke from personal experience of the many roles he took on during a "labor of love" — attending to the day-to-day medical care of his wife, who died in 1990. Even when you make attempts to prepare for death, he said, "it's never enough."
Panelists discussed initially withholding particular types of treatment, such as intravenous feeding, versus attempting to withdraw the treatment at a later date. "The burden is on you," Kaye said, "to raise the issue as to whether it is a `treat or not treat' situation."
According to Rabbi Pressman, when a patient is in the final stages of life, intravenous feeding could be considered a medication, rather than a feeding.
The virtues of organ donation were also discussed. Although there is some disagreement within the Jewish community, material was presented illustrating that Jewish law allows organ donations. "Helping a life is dominant," said Pressman.