Until the current global pandemic made the angel of death an all too evident and unwelcome visitor in our midst, most people would have agreed with Roger Rosenblatt’s observation that “Death is something that happens to others, you think, until it happens to you.”
It seems we are biologically as well as psychologically oriented to deny our mortality. That’s because, researchers say, our brains do their best to keep us from dwelling on our inevitable demise. A study found that the brain shields us from existential fear by categorizing death as an unfortunate event from which we ourselves are exempt. “The brain does not accept that death is related to us,” in the words of Yair Dor-Ziderman, at Bar Ilan University in Israel. “We have this primal mechanism that means when the brain gets information that links self to death, something tells us it’s not reliable, so we shouldn’t believe it.”
Unfortunately, death is all too real. All of us will die. And as has become tragically clear in the past few months it can come without warning, condemning the young as well as the elderly, the perfectly healthy together with the infirm and the sickly.
Strange then that so little preparation is made for a universal encounter which cannot be avoided, especially during this time of coronavirus when death’s sudden appearance comes without allowance for preparation or prior discussion.
Dr. Laura Schellenberg Johnson, a palliative care doctor for Covid-19 victims, wrote of the difficulty in determining methods of care for those who become too sick too fast to make their own healthcare choices. “Recently, the son of a critically ill patient asked that we postpone major decisions about his father’s care until he had improved enough to participate in the conversations. ‘I’m not sure what he would want,’ the son said. ‘We never talked about it.’ ” Dr. Johnson concludes: “It is hands down the most common thing I hear from families.”
Consider this:
- 90% of people say that talking with their loved ones about end-of-life care is important. Yet, only 27% have actually done so.
- 80% of people say that if seriously ill, they would want to talk to their doctor about wishes for medical treatment toward the end of their life. Only 7% report having had this conversation with their doctor. (Survey of Californians by the California HealthCare Foundation, 2012)
- Research shows that as many as one third of seriously ill, hospitalized older people are receiving invasive treatments they don’t want at end-of-life, because no one has talked to them about their wishes for future care.
That is why, although the subject matter may be highly distasteful to many, I urge people – especially now – to make time for these three important talks:
1. Talk to Your Rabbi
Jews are very much aware that a fundamental tenet of Judaism is the sanctity of human life. The Sabbath, Yom Kippur, and almost all other religious laws may be violated to save and even to extend life or a brief period of time. From this many believe that according to halachah, Jewish law, all measures need to be taken to extend the dying person’s life regardless of the prolonged suffering of the patient, financial cost, or emotional burden to family. In fact, in the case of a terminally ill patient, particularly one in pain, such life extending measures may not only fail to be mandatory but at in certain circumstances may even be forbidden.
It is not within the parameters of a short article with a wide and varied audience such as this to address serious life-and-death issues nor to render halachic decisions, but readers should at least be aware that Jewish law seriously considers a balance between preserving life and alleviating suffering. Rabbi Moshe Feinstein, the preeminent halakhic authority of the twentieth century, among others, allows for a significant role for patient autonomy. Factors to be considered include risks assessment and the emotional well-being of the patient.
Inasmuch as suffering is always the subjective experience of the person himself, all authorities agree that a terminally ill patient can choose to tolerate suffering and to take interventions that will extend life. But in a case in which he would prefer a quick death or we cannot know his desires, some leading rabbis rule that one can allow natural death to take its course, and that one is not required to intervene in such a case.
Jewish law seeks to balance personal autonomy with the ideal of the priority of life. The delicate balance between the two needs to be formulated as result of a serious discussion with a knowledgeable rabbi.
2. Talk to Your Doctor
Once you know the halachic parameters for death and dying, it is imperative to convey your religious beliefs to your doctor. Ideally this ought to be a conversation begun well before any signs of sickness. It should be part of your personal profile – and something well known to your family and loved ones to be used in the event that you are incapable of offering guidance for your wishes.
Unless instructed otherwise, doctors are very often guided either by their personal views about death and dying or fears about being criticized (or sued) for not following standard medical practice. Remarkably what doctors do for patients is in most cases not what they would choose for themselves. A 2013 JAMA study of Medicare patients found that despite the fact most seniors want to die at home or in the home of a loved one, only a third actually do. Many more die in nursing homes, hospitals or intensive care units hooked to machines and feeding tubes. Of those who do make it to hospice care, one third are there for less than three days before dying. Until then, many are subjected to aggressive end-of-life treatment.
Only if you have made clear to your doctor how you want to die – and that that is in accord with your religious values as per discussion with a knowledgeable rabbi – can you rest assured that you will pass away in peace, faithful to your Jewish values till the very end.
3. Talk to Your Children
Perhaps the saddest aspect of countless coronavirus deaths was their suddenness which prevented any meaningful parting words.
How precious were the deathbed scenes of Jacob and of Moses. To have some time with loved ones to give final instructions and blessings, to pass on the legacy of a lifetime’s wisdom, to summarize values which gave meaning to one’s life to the next generation – that is a divine gift which the Torah beautifully illustrates in the last stories of Genesis and Deuteronomy.
Yet none of us can be assured that death will allow us a final scene of parting.
That’s why we have a beautiful tradition going back many centuries. Just as the world has made it a universal practice to write wills legislating proper dispersal of financial assets, Jews have for the longest time written ethical wills to their children sharing their wealth of wisdom as well as spiritual lessons they have learned over their lifetimes.
What a magnificent idea for the modern world. We hardly ever have time today for meaningful conversations. Children no longer sit and share meals with parents and if they do their cell phones take precedence over those sitting alongside of them. They may never know what was most meaningful to us, or our goals and our dreams, our hopes and our inspirations.
What if we were to suddenly die – and never have an opportunity to tell them?
Talk to your children by leaving a legacy of words in an ethical will, just as the sages of the Talmud, the wise men of the Middle Ages and victims of the Holocaust managed to do – and in that way to survive through their descendants.
These are the three talks I urge you to have because we are all mortal, yet through them we can gain a measure of immortality.