Please, Please, Have This Vital Conversation

I do not know of any colleague who has not, at one time or another, sat with a family as a loved one neared the end of life. It can be a heart-wrenching, spiritual, troublesome, anxious and fulfilling encounter — all at the same time. Sadly, too many families find themselves alone and adrift in a sea of medical terminology and health care controls. The physician, having tried “the arsenal of medical technology,” may ask what the family wishes to do next.

This month’s edition of Atlantic Monthly includes a thought-provoking piece on the need for “The Conversation.” Author Jonathan Rauch examines a situation where we see the division between what he calls “futile care” and “unwanted care.” Rauch suggests that “people getting medical interventions, that if they were more informed, they would not want,” is “the most urgent issue facing America today.” Rauch continues: “It happens all the time….Unwanted treatment is a particularly confounding problem because it is not a product of malevolence but a by-product of two strengths of American medical culture: the systems determination to save lives, and its technological virtuosity.”

A few weeks ago I had the opportunity to discuss this topic with Nathan Kottkamp, the founder of National Healthcare Decisions Day, an annual day set aside to focus on the need for families to have serious discussions around end-of-life issues. The latest statistic I saw suggests that only 20% of Americans have an advance medical directive and healthcare power of attorney. Given that today’s medical technology advances allow too many people to exist in life-states of limbo, this is a troubling figure — especially because Jewish tradition, across denominational lines, has a rich textual foundation that addresses these topics, but all too often never is discussed within our congregations. Denying people the opportunity to engage in this conversation denies them the opportunity to know how their Judaism can be a guide and support in a most serious and vulnerable moment.

So here are a few simple suggestions:

  • Schedule an annual educational program in your congregation about these Jewish values and how to incorporate them into end-of-life decisions.
  • Provide advance medical directive and healthcare power of attorney forms.
  • Walk members through how Judaism approaches this issue.
  • Discuss your state’s or province’s laws in this area and, as we just did in my congregation, what laws are exist or are being considered with regard to death with dignity.  (New Jersey has a death-with-dignity bill working its way through the state legislature now.)
  • Most important of all, do not worry about the numbers!  People who come out for such a program are people in need.

In addition to providing practical information, creating a pathway through which individuals can understand how Judaism can be supportive underscores just how much the richness of our tradition can add moments of meaning to our people’s lives.