Palliative Care and Hospice

Reference: Duke Divinity School

By Rabbi Mark A. Popovsky

The terms “palliative care” and “hospice care” are poorly understood not only by patients but also by many healthcare professionals. Clinicians may want to emphasize some of the following talking points when explaining these concepts to Jewish patients and families who may harbor significant misconceptions about Jewish perspectives on the matter.

Regarding palliative care:

• Jewish tradition emphasizes the profound interconnection between healing of the body and healing of the soul— refuat ha-nefesh and refuat ha-guf. This dovetails well with palliative care, which addresses a patient’s emotional and spiritual needs as well as physical concerns. Palliative care medical specialists work closely with social workers and chaplains to provide highly integrated care.

• Palliative care specialists work closely with the patient’s admitting or primary care physician in same way any other specialty service would. Instead of reducing medical care, the involvement of a palliative care team adds to the patient’s overall treatment.

• Many people mistakenly assume that palliative care means shortening life, which is why they are resistant. Patients and families need to be reassured that palliative care does not interfere with curative treatment. Moreover, some data suggests that palliative care prolongs life in addition to improving its quality.

• Proper palliative care in a Jewish context is careful to avoid any intervention which might actively hasten death.

Regarding hospice:

• While Judaism helps people to maintain hope even as death is approaching, Jewish tradition does not encourage false or unrealistic hope. Contemporary hospice care reflects the values that Judaism has traditionally demanded of caregivers at the end of life: pain management, maximizing function, respecting dignity, facilitating lucidity and providing peace. So, accepting hospice when curative treatment is no longer effective becomes a means not to abandon life but to hold on to it while maintaining appropriate hope.

• By treating symptoms and pain without introducing invasive procedures unlikely to benefi t the patient, hospice allows the dying person to use his or her final days to complete the great spiritual, emotional and relationship tasks at hand in a setting better-suited to the project. In this way, hospice allows the individual to reaffirm life, as Jewish tradition demands when death is approaching.

• It is often Jews without a strong religious affiliation who are most resistant to hospice. They tend to be unaware of many Jewish teachings that call for accepting the reality of death when it is imminent. All movements in American Judaism recognize a place for hospice at the end of life. When religious concerns present as the primary obstacle to accepting hospice, a patient and family should be directed to a certified chaplain or local rabbi with appropriate training and relevant experience.

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