Tuesday, September 16, 2008

“End of Life” issues and Rabbinic Insecurity

Chana at Curious Jew has done a great job here providing a sense of the September 14th “End of Life” medical ethics conference held by Yeshiva University/Center for the Jewish Future. I wanted to attend but could not make it, so I’m glad to have this summary until any audio recordings are disseminated on-line.

I was particularly interested in Dr. Beth Popp’s comments about why families, synagogue rabbis (as opposed to major halachic authorities) and physicians rarely communicate about these issues. My own experience has matched her observations, although I would add this:

A lot of it comes down to the rabbi’s own insecurity, which leads him not to volunteer counsel, both before the fact and in the heat of the moment.

*Rabbis often feel unequipped to answer these major questions, and are reluctant to put themselves in this tough situation unasked.

The best solution for this, in my experience, is for the rabbi to attach himself to a major authority, to whom he can ask any question. I have been blessed with the opportunity to do this with a doctor/posek considered by many to be the last word on these issues. He has been wonderful; he is in Israel, but he answers emails within hours, with clear and detailed responses. His medical knowledge is so complete that he can tell me what I am describing and add in further medical information, correct information I have been given, and predict what will happen and what the next question will be, etc. And always with the utmost patience and respect. A true gadol.

*Rabbis often fear that families will not be receptive to their advice, and do not want to set up an opposition with them.

Many rabbis – hopefully most of us – enter this field to help people. We don’t want to create conflict, particularly with people who are experiencing the pain of losing a spouse, a child, a parent, a friend.

Rabbis are particularly fearful of volunteering counsel when they are not confident that their advice is accurate – which brings me back to point #1 above.

*Rabbis sometimes encounter physicians who appear unreceptive to rabbinic involvement, and that preys on the rabbi’s own insecurity.

Clergy in hospitals, including professional chaplains, often feel that they are second-class citizens in the hospital atmosphere. Eleven years ago I sat at a clergy conference in a Veterans Hospital in Rhode Island and heard Father Crowley speak on precisely this point; many physicians don’t respect the role of spiritual inspiration for patients, let alone the guidance of religious law.

In truth, sometimes the perception of physician resistance is only projection, but sometimes it’s a reality. I have faced physicians who have actually lied to families in order to convince them to “pull the plug.” I’m not talking about oversimplifying medical facts; I’m talking about outright falsehood, as in, “We need this bed for a patient in the ER,” when such was not the case.

All of these problems can and must be solved as rabbis do the research, gain experience, and consult with leading authorities. Gd-willing more rabbis will learn about this in-depth and develop the expertise needed.

Saying שב ואל תעשה, to say nothing rather than risk error, is inappropriate; a rabbi should never pasken when he doesn’t know, but it’s equally criminal to withhold psak when he does know.

[This week's Haveil Havalim is here.]


  1. Thanks for mentioning HH, though I wonder how many readers made it to the end of this very important post.

  2. Hi muse,
    I do usually put the link in the beginning, but it felt odd to do that for a post with a topic like this one...

  3. And some times it is those faced with impossible decisions to make who cavil at getting a rabbi involved, because of that old piece of folk wisdom: "az mah freigt a shailoh iz is treif"--if you ask those difficult questions of a rav you may discover that your options are not allowed.

  4. I am very blessed to work in a department where the physicians treat families' religious leaders very seriously and respectfully.

    The issues are very complex and heartwrenching, and though similar questions come up daily, no two situations are ever the same. Accompanying a family who is losing someone, especially a child, brings out the deepest emotions in everyone involved. Having an expert in the field of both medicine and halacha is a blessing. Over the past decade, the world of halacha has made amazing strides in the area of medical ethics, an accomplishment we can be proud of.

    Working in the field day after day provides a certain perspective that nothing else can, but it can come at a heavy emotional price, and it is crucial to have a support system in place.

  5. ProfK-
    Very true. (And the aphorism is often true, as well.)

    It's great - and not the rule - to have a department that recognizes this. Your patients are fortunate.