Wednesday, May 30, 2012

Troubling Trend


Physicans have come under attack for providing comfort and pain control interventions


End-of-life care: Pain control carries risk of being called a killer -Kevin B. O'Reilly


Three decades after hospice emerged as the standard of care for terminally ill patients, the end-of-life treatments that palliative medicine physicians provide are frequently referred to as murder, euthanasia and killing.

More than half of hospice and palliative medicine physicians say patients, family members and even other health professionals have used those terms to describe care they recommended or implemented within the last five years, according to a nationwide survey of 663 palliative care doctors in the March Journal of Palliative Medicine.

Common palliative care treatments such as the use of opiates, sedatives and barbiturates to control pain and other symptoms are enough to draw accusations of murder and euthanasia, the study said. The troubling survey results come nearly six years after the American Board of Medical Specialties approved the hospice and palliative medicine subspecialty certification, and 30 years after the creation of the Medicare hospice benefit.
[American Medical Association]
*

Tuesday, May 22, 2012

Music Therapy Works Magic with Dementia Patients



A moving video on the use of music to enliven Dementia patients

Tuesday, April 17, 2012

Celebrating Stein Hospice Volunteers!

Stein Hospice Volunteers being honored at a Luncheon on Wilf Campus
Click on photo for larger view

Tuesday, April 3, 2012

Hospice Thru Jewish Eyes


Hospice Through Jewish Eyes (Wilf Campus) from Wilf Campus on Vimeo.

The recent event "Hospice Through Jewish Eyes" is captured in the 10 minute video

Tuesday, March 27, 2012

Hospice Aides Receive Awards for 5 Years of Service to Stein Hospice



Stein Hospice Aides Lenny Flores, Moshe Cyviner & Sarah Bangura [left to right, in purple scrubs] received awards for 5 years of service.  Behind them are Rabbi Bryan Kinzbrunner, Chaplain, Sharon Criscione, Clinical Director & Bruce Birnberg, Executive Director [left to right]
 

Passover & Hospice: essay by Rabbi Stephanie Dickstein




When Your Child Asks: Thinking About Important Discussions
Rabbi Stephanie Dickstein From a talk delivered on March 25, 2012

[A] Seder plate is filled with symbols that in themselves and combined with others, offer us so many metaphors for the mixture of bitter and sweet in our lives.  This morning, the egg is of particular interest to me.  It is the symbol of spring, of new life, the cycle of life, and of mourning. 

It is found on another ritual platter of food, along with round bread and lentils.  The egg is an element in the meal of consolation served to mourners when they return from the cemetery.  As Jews, we understand that death is part of our lives and we are guided by rituals which help us to hold the grief and hold the bereaved.  So, too, we have Jewish ways of facing our own mortality and preparing for our own death in the midst of our family and community.

In a powerful 12th century midrash, God is reluctant to tell Aaron that he is dying, and the Holy Blessed one asks Moshe to do it.  Moshe studies the creation story with his brother, indirectly approaching the topic of death, and eventually Aaron asks “is this matter meant for me?”  Aaron accepts his impending death and the brothers can now speak openly.  Together, they prepare along with Aaron’s son Elazar.  Together Aaron’s brother and his son, in the sight of the people, accompany Aaron on his final journey up the mountain. 

Perhaps, you might think that Moshe Rabbenu, having guided and accompanied his brother, would receive the news of his own impending death with similar acceptance.  But, in the imagination of the Rabbinic authors of the Midrash, Moshe argues, begs, pleads, bargins, and threatens, refusing to accept that his time to die has come.  God, grieving the impending loss of this human partner, orders the gates of heaven shut to Moshe’s prayers.  In a magnificent collection of midrashim, the Rabbis struggle, offering all of the arguments they can marshal, not just against the impending death of Moshe, but against their own as well.  And just as profoundly, step by step, they come to terms with death until the moment when Moshe’s soul is taken from his body with a Divine kiss.  Then Israel, and we, mourn, seek comfort and continue the journey. 

Jewish tradition teaches us that life is good, that we are obligated to seek healing when we are ill, that saving a life is one of the paramount mitzvot.  But it also teaches us that we are mortal, that our time to die will come. It advises us to speak with our loved ones and our religious advisors about medical ethics and about our wishes, fears and hopes.  It commands us to always offer comfort and companionship, but it forbids us to prolong dying and to hinder the journey from this world to the next. 

“How can I tell Aaron he is to die?” asks God. 
“Is this matter for me?” inquires Aaron.
“Do you accept death?” wonders Moshe.

Questions are an essential part of being human and being Jewish, and questions are essential to the seder.  The rabbis teach that we can not begin the telling of the seder without a question, any question, first being asked.  Most often, these questions, these conversations are framed in an intergenerational format-  “when your child asks, you shall tell”.  A well known and deeply instructive part of the haggadah is the story of the four children.  Let me use this part of the Haggadah to suggest ways in which we might think about these conversations.

First, although the haggadah presents the four children as unique one-dimensional caricatures, the wise, the wicked, the simple, and the one who does not know how to ask- the text itself actually recognizes that the situation is more complex.  My favorite visual midrash is the picture of the four children found in the Rabbinical Assembly’s Feast of Freedom Haggadah.   Each of the four children is made of a primary color, but each figure also contains the other three colors.  So, too, for us, as we ask our questions at different times along the journey of health and illness and in different kinds of relationships, each of us will at times, be each of those children. 

In the haggadah, it is the children who ask and the parents who answer.  Seemingly, there is a seder, a generational order in this world.  But we all know that death doesn’t come in order.  There are parents, young and old, who must guide their children from this life to the next.  There are older sisters and brothers who step in to care for their younger sibling.  There are friends who accompany when family is gone or unable or unwilling to share the journey.  These are not conversations which can happen in only direction.  All adults need to take responsibility for asking and telling.  And these conversations need to happen multiple times throughout our lives. 

What does the wise child ask:  What are the statutes, the laws and the ordinances which Adonai our God has commanded us and what do you want us to do if you can’t make your own decisions?  You should instruct this child of all the laws, including the idea that the body belongs to God and we inhabit it for a limited time, that we are created in God’s image, that we are obligated to try to heal, that we have some autonomy and should be told the truth, but neither of those are absolute requirements, that organ donation is a mitzvah of the highest level, that we can not commit suicide or euthanasia, but one may pray for death to come and hope for miracles, that there are different legal statuses along the path to death which determine when we may forgo life sustaining treatments, that we can do that which is beneficial, but need not, or should not do that which is “heroic”, that we must provide effective palliative care and treat pain, that we may not prolong dying in a vain attempt to keep someone with a terminal illness at a terminal stage  alive, that hospice is fully within Jewish law.   You should tell this child what is most important to you and guide them in general ways concerning your thoughts about medical treatments that might be offered at some point.

What does the difficult child ask?  What does this all mean to you?  To you and not to that child who desires to be removed from the situation.  To this child, you need to speak of your own experience and be clear on your needs and wishes.  But you must not turn this child away- trying instead to understand the fear, the anger, the grief which separates her from you and to reach out for reconciliation, offering or asking for forgiveness if at all possible.

What does the simple child ask?  Ma zot, what is this all about?  To this child you should speak about the human journey, about your faith, about the values of your life and how you have tried to live them.  You should instruct this child in the guidance that is available and the people who will be resources on the journey, when the time comes.

And for the child who does not know how to ask, you should open the discussion, beginning with love, moving on to trust and speaking about the importance of hope and the fact that there is always something to hope for. 

At the end of the seder, we sing had gadya,  which culminates in our imagining that the Holy One slaughters the angel of death. Until that day comes, Judaism offers us wisdom and guidance for the journey from Mitzrayim, through the narrow places. 

May we all be granted the words and the companionship on the way. 
Rabbi Stephanie Dickstein

Friday, March 16, 2012

Hospice in Uganda: "World of Pain"



This excellent video is worth watching.  The absence of pain killing medicine is featured.