CONTENTS

1) First impressions

2) Not emphasized

3) A conversation with the medical director

4) The blind spot

5) Some thoughts – an action plan

6) Outcomes

FIRST IMPRESSIONS

I attended an important national scientific conference with presentations from experts in the field of eldercare and an audience including many professionals and academicians. Over the years, I have had the honor of presenting to this group of professionals and academicians the following: Designing a Jewish Hospice Program, the Na tional Jewish Caregiver Burden Survey, Adult Day Programming, COVID-19 Vaccination in the Orthodox Jewish Community, Emergency Care of the Elderly: Experience of an HMO, among other topics.

My objective this time was to learn. I wanted to best assist members of our community who call us, the LOY Center, for assistance.

I decided to attend the session Law, Ethics, and the Issues Concerning Healthcare Decisions for the Elderly.

A prominent and highly credentialed physician presented this session. The PowerPoint outline, as well as the abstract I had read earlier, addressed areas of particular interest, especially end-of-life care.

The presenter was engaging and well organized. He impressed me as a very competent and knowledgeable professional.

He followed the outline, reviewed demographic data and what elders want – health, security, respect, love – and was attentive and respectful of religious beliefs. He underscored that end-of-life should be consistent with one’s faith. Ethical Principles include autonomy, beneficence, non-maleficence, and justice. The importance of advanced directives and the availability of the Long-Term Care Ombudsman were highlighted as well.

He dazzled the large audience by peppering the presentation with cartoons and quotes from Eubie Blake, Emily Dickinson, Edgar Allan Poe, and even Woody Allen.

I was looking forward to the next section: “Death and Afterlife: Religion and Culture.”
However, when I saw the next slide, my jaw dropped.

Judaism does not emphasize afterlife? It is vague regarding its existence?
How could such an intelligent, well-read professional make such a serious oversight?!

The presenter was Jewish. The concept of life after death is a fundamental tenet of Jewish tradition. It directly and indirectly impacts all our actions.

It was difficult for me to wrap my head around the statement.

NOT EMPHASIZED?!

As an ordained rabbi, I am aware of the span of Jewish rituals and beliefs, from modern to centrist to far right ultra-orthodox. Afterlife is a fundamental component of everyday Jewish religious practice. It permeates every action we take. It appears, is referenced, and is described in our daily prayers, in the Bible, Prophets, Psalms, Midrash, Mishnah, Talmud, and in volumes upon volumes of classical works. Elementary school children are familiar with the term and its implication. Here are but a few examples:

► The widely attended Yizkor prayer of the High Holy Days is designed to provide a venue for giving charity that will improve the status of the souls of the departed in the Heavens. Living children maintain a spiritual connection to their departed parents. The behavior of children offers an opportunity for the deceased to attain greater degrees of spiritual holiness. (Recitation of the Kaddish prayer is another aspect of this same concept.)
A symbiotic relationship exists between the deceased and the living family. The good deeds of the children benefit parents who are no longer living. At the same time, the actions of parents while living will impact children’s well-being after their parents have departed this world.

► In Ethics of the Fathers, we find the following advice from a first century BCE Great Sage:
“Focus on three maters to avoid transgression: 1)… 2)… 3) Before Whom you will ultimately have to give an accounting and reckoning – before the Supreme King of kings, the Holy One.”

► The Bible presents the same message in the book of Leviticus, 18:5. “Keep My decrees and laws, since it is only by keeping them that a person can live in tranquility.” We are taught that the life referred to here is the hereafter, the World to Come, afterlife.

Here are a few selected audio clips on the topic from the presentations made to a Jewish audience by two acclaimed and internationally respected rabbinic leaders: Rabbi Manes Friedman and Rabbi YY Jacobson.
Transcriptions of these recordings can be found HERE.

To summarize, Jewish religion strongly believes in the afterlife.

Indeed, it can be argued that the term “afterlife” is a conundrum, as the soul existed prior to birth and continues living after the body expires.
It is a fundamental tenet of daily religious practice and thought.

Again, how do we explain that this respected Jewish scholarly clinician came to present such a serious oversight at this public forum?

A CONVERSATION WITH THE PRESENTER

I certainly followed up with the lecturer. Rather than raise my concerns publicly, I engaged with him after he completed his presentation. I introduced myself, offered him a copy of my book, You are Your Parents’ Keeper, and briefly advanced the Jewish tradition’s perspective on the topic. We agreed to continue communicating after the conference, which we did.

Viewing other segments of his lecture, he clearly was well-read and scholarly. When he learned the traditional Jewish view regarding afterlife, he was dumbfounded. How was it that he had never heard about this before? He was raised in a Conservative congregation, studied through post-confirmation classes throughout high school, and is currently an active member of a progressive Reform congregation…

In this situation and similar experiences, I have found that once these beliefs are explained to health care professionals, they understand and respect these observances.

A similar incident that comes to mind occurred at a Round Table session I attended on the topic of end-of-life care. A clinician on staff of an internationally recognized New York tertiary care medical center – very popular among the Orthodox Jewish community – who was leading the talk, took me aside and said that she was exasperated. In her frustration, she exlaimed, “I don’t understand them. Why doesn’t the Chassidic family of my hospice patient just let her go?! I spoke to her. She said she wants to end it. What is wrong with them?!”

I explained our beliefs – that for us it is not a personal decision to be made. It is a religious matter requiring the advice of rabbinic scholars knowledgable of medical matters and end-of-life care. I expressed that the family undoubtedly had reached out to such expertise and was following the provided advice.

She thanked me, became sanguine, and expressed appreciation for my sharing this information so she could learn about and better understand our traditions and practices.

THE BLIND SPOT

Upon investigation, I found this absence of knowledge not unique to this provider.

What seemed to me to be an anomaly turns out to be the norm. A large number of Jews, likely the majority, are unaware of our beliefs. This being the case, non-Jewish health care professionals certainly cannot be expected to know them.

► A Jewish Long Island resident whose membership spans Reform and Conservative congregations, upon learning the Jewish views of afterlife, was astounded.
“I’ve been going to synagogue for 60 years, and I don’t think I ever heard a rabbi speak about the World to Come."

► A married middle-aged couple visiting from Australia indicated that this topic is not brought up in their Jewish education system, though they had heard about it at
funerals.

► A senior Instructor of Religious Text and Practices at an established Solomon Schechter school could not affirm that the topic was included in his curriculum, nor
discussed or taught in his school.

Many of us practicing traditional Judaism assume that the majority of members of our faith are very knowledgeable, comfortable, and familiar with the concepts noted above (the relationship of body and soul). We learn about it from childhood onward.

The opposite is true. A great number of Jews have no knowledge of this area.

A recent Pew Research Center survey found that over half of all U.S. Jews (54%) belong to the two long-dominant branches of American Judaism – Reform and Conservative. The beliefs described above are unlikely topics presented through their formal and informal educational vehicles.

The two internationally acclaimed rabbinic leaders cited above acknowledge the void. Rabbi Manes Friedman began the speech excerpted above describing the college student worried about Hell, and followed with an anecdote regarding a Jewish woman who came a great distance to see him for the Jewish view regarding afterlife. She had lost her husband early on. Her two daughters, now a bit older, were asking, “Where’s Daddy?” She did not know how to respond and wanted a direction from a reliable source.

Rabbi YY Jacobson also notes, “Many Jews don’t know what Judaism says about the afterlife. Many Jews don’t even know that Judaism believes in an afterlife … And that’s a problem…”

What is encouraging is that in both instances there was genuine eagerness to learn, to know, and to respect rabbinic guidance.

The dearth of knowledge among Jews and non-Jews regarding the Jewish perspective on afterlife has serious implications.

The misguided impression that in Judaism afterlife is not emphasized may:

► Cause tension and stress in end-of-life care management between families adhering to our beliefs whose loved ones are in hospice and palliative care programs and
their Jewish and non-Jewish providers.

► Influence the incidents of self-inflicted death – suicide – among the Jewish population.

► Legitimize the selection of cremation – heretical to the Jewish belief of G-d-given body and soul – as a reasonable alternative to burial.

If left unattended, clinicians and others will continue to propagate this misinformation.

SOME THOUGHTS — AN ACTION PLAN

This misrepresentation has dramatic consequences, but it can be corrected.

Here are some strategies to consider:

► Initiate multi-pronged campaigns to teach, share, educate, and instruct both the Jewish population and health care providers regarding the Jewish view of
afterlife.

˃ Community organizations – large and small, national and local – are positioned to respond to this challenge.

˃ They routinely provide seminars, lectures, webinars, newsletters to engage and inform their constituents. This topic can be added.

˃ Many, such as the OU and Agudah, have established Advocacy divisions. Others, such as the Bikur Cholims and Vaads across the country could also introduce the topic in their programming.

► In-services should be held at all levels of the health care delivery system (especially hospice) for all long-term care providers.

► Include the topic among Nursing, PA, and Medical School cultural competence curriculum.

► Hospital and Rehabilitation Center chaplains need to orient clinical staff at their facility.

► Chaplains of the armed forces can share their knowledge at appropriate venues.

► College campus Bnai Brith, Hillels, Chabads, NCSYs, and Jewish fraternities and sororities are also important platforms for dissemination of this information.

► Women sisterhoods, men’s clubs – the full breadth of the Jewish experience should be alerted and mobilized.

► Include the topic in religious education of all denominations.

► Jewish organizations concerned with high incidents of cremation should consider actively committing resources towards this initiative.

Sharing this article with all affected parties will also be helpful.

OUTCOMES

The effective implementation of an action plan promises to:

► Reduce tension and conflict among Jewish families and their clinicians regarding end-of-life care management of a loved one.

► Achieve an understanding among health care professionals and others of the Jewish belief that both body and soul are G-d’s creations.

► Reduce the incidents of self-inflicted deaths – suicide – among the Jewish population, a Jewish law prohibition.
Even ending a person’s life who is only moments away from inevitable death is an abrogation of the notion that both body and soul are G-d’s creation. The societal
concept of personal autonomy is the antithesis of this view.

► Reduce the selection of cremation as an acceptable alternative to burial.
In addition to affirming the lack of belief in G-d’s creation, cremation establishes a divide, hindering family and friends from enjoying the spiritual rays of beneficence
of loved ones to the living. Further, it is deemed as grievous as the burning of a Torah scroll. The body is holy. It is the receptacle of all the good deeds performed over a
lifetime.

Improve overall cultural competence among health care providers.

Finally, invited renowned professionals presenting on the topic
Law, Ethics, and the Issues Concerning Health Care Decisions for the Elderly
will know to replace

with