I saw an interesting question the other day: What Jewish reading material would you recommend for someone elderly, who is contemplating his eventual death?
I'm not at all sure how to approach this; clearly, a lot depends on the person.
I suppose that one should really begin by asking what question the person is looking
to answer. Is the person looking for information about Jewish belief
regarding the afterlife? Is the person looking for ways to deal with the
end of his presence here? Is the person looking for ways to cope with
fear, or to manage disappointment, or to develop acceptance?
Koheles might be a reassuring read for some, and frightening for others.
Some might benefit from Rabbi Maurice Lamm's The Jewish Way in Death and Mourning, I suppose.
Others might want to read Rabbi Aryeh Kaplan's works on Jewish beliefs.
And others might want Breslov works on emunah.
I'm not sure what to do with this; what would you recommend?
Showing posts with label Judaism: Death. Show all posts
Showing posts with label Judaism: Death. Show all posts
Monday, December 24, 2012
Tuesday, November 13, 2012
Scott Routley could change everything
One of the most difficult situations a Rabbi enters is the "end of life"/"quality of life" debate.
* Families can be torn apart as they debate the patient's best interests and preferences;
* Doctors are conflicted between their mission of preserving life, their responsibility to the overall healthcare system, and their personal feelings about the patient's state and prospects;
* Rabbis don't know which way to turn.
One of the hardest such cases is the persistent vegetative state. In many cases the doctors aver that the patient has no consciousness and will never have any consciousness. Family members might interpret certan physical movements as signs of consciousness, while medical staff will explain those movements in other ways. Everyone will debate what the patient wanted, or would have wanted. And various players will point to the cost of maintaining healthcare, insisting that there is no point in persisting - while traditional halachah insists that we are obligated to provide certain basic elements so long as we are not prolonging a painful death.
One of the critical questions involved, and perhaps the most critical, is this: Is the patient conscious?
As of this moment, CNN.com and NYtimes.com have not picked this up - but they will, it was only published 24 minutes ago:
Vegetative Ontario man Scott Routley ‘talks’ to researchers through brain scans
Severely brain-injured Scott Routley hasn’t spoken in 12 years. But scientists using an MRI to peer into his brain, can “see” what he’s thinking as various parts of his brain light up.
Essentially, his brain is doing the talking for him, say leading scientists at the University of Western Ontario’s Brain and Mind Institute.
As a result of breakthrough work on brain activity, the 39-year-old motor vehicle accident victim from London, Ont. has responded to a series of questions, including letting researchers know that he is not in pain.
“It became very clear that Scott had some awareness and he could respond in the scanner to the task we asked him to do while he was in there,” British neuroscientist professor Adrian Owen, who leads the research team, told the Toronto Star Tuesday.
“What we have done here for the very first time is ask a patient a question that is actually relevant to their clinical care.
“Asking somebody whether they are in pain in tremendously important, because of course if the answer had been yes, we could do something,” he said.
Owen said there is no doubt that being able to communicate in this way with a person thought to be a vegetative state is a first and it is hoped will lead to routine communications with at least one in five people in this uncommunicative state.
“That’s where we are trying to get to. We are trying to create what’s called a brain computer interface … some form of a machine that could allow somebody like Scott to routinely communicate with the outside word . . . We would like to give these patients a voice to enable them to actually communicate their wishes and needs,” he told the Star.
By using a functional magnetic imaging procedure he said they can tell by how different parts of Routley’s brain light up that he is responding to suggestions and questions.
“We put him in an MRI scanner and while he is in the scanner we ask him to imagine doing certain things in his mind . . . for example, we ask him to imagine using his arms. Scott is unable to use his arms in reality but it turns out he is perfectly able to imagine moving his arms. And we can pick that up on the scanner and we can tell he’s doing what we ask him to do,” Owen said.
The professor noted in an earlier interview with the Star that while functional magnetic resonance imaging machines, or fMRI images are the gold standard, they are expensive — machines can cost up to $2 million — and it is both costly and disruptive to move patients to the scanners in hospitals.
Owens says it’s quite possible that a portable high-end EEG machine, costing about $75,000, can be used at a patient’s bedside. An EEG uses scalp electrodes to measure the electrical signals coming from neurons in the brain.
Owen said command-following is a routine method of telling if a person is conscious and aware, “and with Scott we can tell he is activating his brain when we ask him to do so.”
“And when we say ‘now stop doing that imagining’ and then we see the little blob in the brain disappear. But when we say start it again now the blob lights up again,” he said.
Owen said Routley on two occasions through a series of question and commands “responded that he wasn’t in any pain.”
This research also raises ethical questions about whether these patients, once they are able to communicate, should be able to direct their care — and the end of their lives.
* Families can be torn apart as they debate the patient's best interests and preferences;
* Doctors are conflicted between their mission of preserving life, their responsibility to the overall healthcare system, and their personal feelings about the patient's state and prospects;
* Rabbis don't know which way to turn.
One of the hardest such cases is the persistent vegetative state. In many cases the doctors aver that the patient has no consciousness and will never have any consciousness. Family members might interpret certan physical movements as signs of consciousness, while medical staff will explain those movements in other ways. Everyone will debate what the patient wanted, or would have wanted. And various players will point to the cost of maintaining healthcare, insisting that there is no point in persisting - while traditional halachah insists that we are obligated to provide certain basic elements so long as we are not prolonging a painful death.
One of the critical questions involved, and perhaps the most critical, is this: Is the patient conscious?
As of this moment, CNN.com and NYtimes.com have not picked this up - but they will, it was only published 24 minutes ago:
Vegetative Ontario man Scott Routley ‘talks’ to researchers through brain scans
Severely brain-injured Scott Routley hasn’t spoken in 12 years. But scientists using an MRI to peer into his brain, can “see” what he’s thinking as various parts of his brain light up.
Essentially, his brain is doing the talking for him, say leading scientists at the University of Western Ontario’s Brain and Mind Institute.
As a result of breakthrough work on brain activity, the 39-year-old motor vehicle accident victim from London, Ont. has responded to a series of questions, including letting researchers know that he is not in pain.
“It became very clear that Scott had some awareness and he could respond in the scanner to the task we asked him to do while he was in there,” British neuroscientist professor Adrian Owen, who leads the research team, told the Toronto Star Tuesday.
“What we have done here for the very first time is ask a patient a question that is actually relevant to their clinical care.
“Asking somebody whether they are in pain in tremendously important, because of course if the answer had been yes, we could do something,” he said.
Owen said there is no doubt that being able to communicate in this way with a person thought to be a vegetative state is a first and it is hoped will lead to routine communications with at least one in five people in this uncommunicative state.
“That’s where we are trying to get to. We are trying to create what’s called a brain computer interface … some form of a machine that could allow somebody like Scott to routinely communicate with the outside word . . . We would like to give these patients a voice to enable them to actually communicate their wishes and needs,” he told the Star.
By using a functional magnetic imaging procedure he said they can tell by how different parts of Routley’s brain light up that he is responding to suggestions and questions.
“We put him in an MRI scanner and while he is in the scanner we ask him to imagine doing certain things in his mind . . . for example, we ask him to imagine using his arms. Scott is unable to use his arms in reality but it turns out he is perfectly able to imagine moving his arms. And we can pick that up on the scanner and we can tell he’s doing what we ask him to do,” Owen said.
The professor noted in an earlier interview with the Star that while functional magnetic resonance imaging machines, or fMRI images are the gold standard, they are expensive — machines can cost up to $2 million — and it is both costly and disruptive to move patients to the scanners in hospitals.
Owens says it’s quite possible that a portable high-end EEG machine, costing about $75,000, can be used at a patient’s bedside. An EEG uses scalp electrodes to measure the electrical signals coming from neurons in the brain.
Owen said command-following is a routine method of telling if a person is conscious and aware, “and with Scott we can tell he is activating his brain when we ask him to do so.”
“And when we say ‘now stop doing that imagining’ and then we see the little blob in the brain disappear. But when we say start it again now the blob lights up again,” he said.
Owen said Routley on two occasions through a series of question and commands “responded that he wasn’t in any pain.”
This research also raises ethical questions about whether these patients, once they are able to communicate, should be able to direct their care — and the end of their lives.
Monday, April 20, 2009
Death hurts, but it's not unfair
It’s been another deathfest these past couple of weeks, after a good two months in which, thank Gd, people stayed mostly healthy. I’ve lost some great friends and role models.
And, as inevitably happens at these times, I’ve heard people say, “It’s unfair.”
I have to disagree (although I would never say so aloud; to insult a mourner in his time of grief would be the cruelest stupidity).
I, too, am stabbed by pain. I hate eulogizing people, I am tired of the grieving process. Why do we have to lose anyone, let alone such good people? They were in the prime of life, or they were just about to enjoy retirement, or they were anticipating the birth of a grandchild, or they were doing good things, or they didn’t have a chance to say Goodbye…
But I do disagree with the “unfair” label.
Of course, from a Jewish perspective I disagree because we are taught to say ברוך דיין האמת, Blessed be the Judge of Truth, upon hearing of a death. We express this religious sentiment, which we hope we will come to feel in the course of the grieving process. We long to heal the ruptured relationship with Gd, to see through the immediate grief and agony and appreciate the good we were given.
But, beyond that longing for reunion with Gd, I think saying “it’s unfair” is illogical.
I see four logical arguments regarding Gd’s role in life and death:
1. Gd creates life as well as death.
2. Gd creates life, and not death.
3. Gd creates death, but not life.
4. Gd neither creates life nor death.
There may be gray areas in between, such as the idea that Gd is responsibility for “big picture” but not for details, but I don’t see that those shaded ideas contribute anything new here, so I omit them.
View #2 (possibly supported by Rava in Moed Katan 28a) says that death is the agent of unknowing fortune, and so it can hardly be termed “unfair” – “unfair” suggests a decision was made.
Similarly, View #4 assumes that no decision was made, and so death cannot be “unfair.”
View #3 strikes me as entirely against any idea of Gd I might conceive. I could sooner understand total atheism. So I discount this as well.
That leaves me with only View #1, which is the traditional Jewish view. If View #1 is true, then everything we received until this point is a gift… and how can I call rescension of a gift “unfair”?
I am in pain, but I concede that I have received far too much to ever say that the end of this gift is unfair.
ברוך דיין האמת.
[This week’s Haveil Havalim is here.]
And, as inevitably happens at these times, I’ve heard people say, “It’s unfair.”
I have to disagree (although I would never say so aloud; to insult a mourner in his time of grief would be the cruelest stupidity).
I, too, am stabbed by pain. I hate eulogizing people, I am tired of the grieving process. Why do we have to lose anyone, let alone such good people? They were in the prime of life, or they were just about to enjoy retirement, or they were anticipating the birth of a grandchild, or they were doing good things, or they didn’t have a chance to say Goodbye…
But I do disagree with the “unfair” label.
Of course, from a Jewish perspective I disagree because we are taught to say ברוך דיין האמת, Blessed be the Judge of Truth, upon hearing of a death. We express this religious sentiment, which we hope we will come to feel in the course of the grieving process. We long to heal the ruptured relationship with Gd, to see through the immediate grief and agony and appreciate the good we were given.
But, beyond that longing for reunion with Gd, I think saying “it’s unfair” is illogical.
I see four logical arguments regarding Gd’s role in life and death:
1. Gd creates life as well as death.
2. Gd creates life, and not death.
3. Gd creates death, but not life.
4. Gd neither creates life nor death.
There may be gray areas in between, such as the idea that Gd is responsibility for “big picture” but not for details, but I don’t see that those shaded ideas contribute anything new here, so I omit them.
View #2 (possibly supported by Rava in Moed Katan 28a) says that death is the agent of unknowing fortune, and so it can hardly be termed “unfair” – “unfair” suggests a decision was made.
Similarly, View #4 assumes that no decision was made, and so death cannot be “unfair.”
View #3 strikes me as entirely against any idea of Gd I might conceive. I could sooner understand total atheism. So I discount this as well.
That leaves me with only View #1, which is the traditional Jewish view. If View #1 is true, then everything we received until this point is a gift… and how can I call rescension of a gift “unfair”?
I am in pain, but I concede that I have received far too much to ever say that the end of this gift is unfair.
ברוך דיין האמת.
[This week’s Haveil Havalim is here.]
Monday, September 22, 2008
Until 120… NOT!
[This week's Haveil Havalim is here!]
עד מאה ועשרים שנה!
Bit a hundred un svuntzik (or however that should be transliterated)!
You should live to be 120!
Yes, there's even a website: till120.com.
Not for me, though, sorry.
First, I am mortophobic. Deathly so, even.
Second, because I have never seen a source for the 120 limit in mainstream Jewish tradition (I do recall seeing one edition in Bereishit Rabbah many years ago, but not since) and I have seen mainstream sources militating against it.
So far as I can tell, this concept of human life being limited to 120 years arose from a decidedly minority reading of a pasuk in chumash and a passage in the gemara, and it is entirely at odds with at least one gemara. (Aside from the significant number of people in our own day who are recorded to have passed the 120 mark...)
The first source people cite to justify this artificial endpoint is Bereishit 6:3 לא ידון רוחי באדם לעולם בשגם הוא בשר והיו ימיו מאה ועשרים שנה. Before bringing the Flood, Gd declares that there will be an end to Divine patience with man's corruption, "and his days will be 120 years."
This source seems compelling, until we realize that the Torah records all sorts of people living long past 120 years, both before and after this decree. Indeed, the Talmud Yerushalmi (Nazir 7:2) asks this question explicitly.
The Yerushalmi explains that the Torah's sentence is not referring to human lifespan, but rather to the length of time it takes flesh to reach a certain stage of decay. Avot d'Rabbi Natan (v.1 #32) offers a different answer, which Rashi cites on the Chumash, that there will be 120 years from that moment until the Flood.
Either way, though, Jewish tradition does not accept the idea that this biblical verse limits man to 120 years - and we will soon see sources which say fairly clearly that we are not limited to 120 years.
The second source people cite is regarding Moshe.
Moshe informs the Jews, as he is about to deliver his last speech on the last day of his life (Devarim 31:2), בן מאה ועשרים שנה אנכי היום, "I am 120 years old today." The sages noted Moshe's emphatic "Today," and they explained (Rosh HaShanah 11a) that this was both Moshe's birthday and the day of his death, demonstrating that Gd "completes the days and years of the righteous." (Parenthetically, this is perplexing given that the Torah says Moshe's life was foreshortened as a specific Divine punishment!)
So some take this as an indication that a complete life is 120 years - an idea which is buttressed by the gemara's statement that R' Akiva and R' Yochanan ben Zakkai both lived 120 years.
However, that is clearly not the import of this gemara; the gemara's point is that Moshe gets a full year, dying on his birthday.
In fact, the gemara indicates that even post-Tanach, we have no limit of 120 years. Megilah 28a records that on his deathbed, R' Yehoshua ben Karcha gave Rebbe a blessing: "You should live half as long as I have lived."
As Tosafot (Bava Batra 113a ומטו) notes, that isn't much of a blessing, assuming a standard lifespan for R' Yehoshua ben Karcha. Even at 100 years old, who would say, "You should live to be half my age?" Rather, Tosafot says, R' Yehoshua ben Karcha must have been at least 140 at that point.
Tosafot there is not discussing age limits; his comment is part of a separate discussion about whether R' Yehoshua ben Karcha could have been the son of R' Akiva. But without batting an eyelash, he assumes that R' Yehoshua ben Karcha lived to be at least 140. And none of the supercommentaries jump on Tosafot to demand an explanation of this anti-120 heresy.
So, to me, it seems clear that we need not limit ourselves to 120. Mind you, I've sat at enough deathbeds with people who were grateful to pass on, and I have had plenty of elderly people tell me that the old punchline, "It's better than the alternative," is not eternally true. But, for me, I'd prefer you not use עמו"ש after my name.
שליט"א will do nicely...
עד מאה ועשרים שנה!
Bit a hundred un svuntzik (or however that should be transliterated)!
You should live to be 120!
Yes, there's even a website: till120.com.
Not for me, though, sorry.
First, I am mortophobic. Deathly so, even.
Second, because I have never seen a source for the 120 limit in mainstream Jewish tradition (I do recall seeing one edition in Bereishit Rabbah many years ago, but not since) and I have seen mainstream sources militating against it.
So far as I can tell, this concept of human life being limited to 120 years arose from a decidedly minority reading of a pasuk in chumash and a passage in the gemara, and it is entirely at odds with at least one gemara. (Aside from the significant number of people in our own day who are recorded to have passed the 120 mark...)
The first source people cite to justify this artificial endpoint is Bereishit 6:3 לא ידון רוחי באדם לעולם בשגם הוא בשר והיו ימיו מאה ועשרים שנה. Before bringing the Flood, Gd declares that there will be an end to Divine patience with man's corruption, "and his days will be 120 years."
This source seems compelling, until we realize that the Torah records all sorts of people living long past 120 years, both before and after this decree. Indeed, the Talmud Yerushalmi (Nazir 7:2) asks this question explicitly.
The Yerushalmi explains that the Torah's sentence is not referring to human lifespan, but rather to the length of time it takes flesh to reach a certain stage of decay. Avot d'Rabbi Natan (v.1 #32) offers a different answer, which Rashi cites on the Chumash, that there will be 120 years from that moment until the Flood.
Either way, though, Jewish tradition does not accept the idea that this biblical verse limits man to 120 years - and we will soon see sources which say fairly clearly that we are not limited to 120 years.
The second source people cite is regarding Moshe.
Moshe informs the Jews, as he is about to deliver his last speech on the last day of his life (Devarim 31:2), בן מאה ועשרים שנה אנכי היום, "I am 120 years old today." The sages noted Moshe's emphatic "Today," and they explained (Rosh HaShanah 11a) that this was both Moshe's birthday and the day of his death, demonstrating that Gd "completes the days and years of the righteous." (Parenthetically, this is perplexing given that the Torah says Moshe's life was foreshortened as a specific Divine punishment!)
So some take this as an indication that a complete life is 120 years - an idea which is buttressed by the gemara's statement that R' Akiva and R' Yochanan ben Zakkai both lived 120 years.
However, that is clearly not the import of this gemara; the gemara's point is that Moshe gets a full year, dying on his birthday.
In fact, the gemara indicates that even post-Tanach, we have no limit of 120 years. Megilah 28a records that on his deathbed, R' Yehoshua ben Karcha gave Rebbe a blessing: "You should live half as long as I have lived."
As Tosafot (Bava Batra 113a ומטו) notes, that isn't much of a blessing, assuming a standard lifespan for R' Yehoshua ben Karcha. Even at 100 years old, who would say, "You should live to be half my age?" Rather, Tosafot says, R' Yehoshua ben Karcha must have been at least 140 at that point.
Tosafot there is not discussing age limits; his comment is part of a separate discussion about whether R' Yehoshua ben Karcha could have been the son of R' Akiva. But without batting an eyelash, he assumes that R' Yehoshua ben Karcha lived to be at least 140. And none of the supercommentaries jump on Tosafot to demand an explanation of this anti-120 heresy.
So, to me, it seems clear that we need not limit ourselves to 120. Mind you, I've sat at enough deathbeds with people who were grateful to pass on, and I have had plenty of elderly people tell me that the old punchline, "It's better than the alternative," is not eternally true. But, for me, I'd prefer you not use עמו"ש after my name.
שליט"א will do nicely...
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