A matter of communication

A matter of communication

Teaneck doctor discusses medicine and halacha

Dr. Moshe Cohn isn’t quite a rabbi.

He started his rabbinical studies at Yeshiva University after earning his medical degree and almost earned his rabbinic degree before returning to medicine. Now he works in the pediatric department of a major Manhattan hospital that he’d rather not name, as he is not allowed to speak to the press without the approval of its public relations department.

His specialty is palliative care, treating patients who are on the verge of dying. That, and his rabbinical training, puts him at the intersection of halacha and medical ethics, a topic he will address in an online lecture Sunday evening for his synagogue, Congregation Rinat Yisrael. (See box).

Dr. Moshe Cohn

Dr. Cohn studied under Rabbi Moshe Tendler, who was both research scientist and a Talmudist; as the son-in-law of Rabbi Moshe Feinstein, a leading halachic authority of the 20th century, Rabbi Tendler was profoundly influential in applied medical halacha.

End-of-life care is a particularly fraught area for ethics in general and halacha in particular. As a palliative care doctor with most of a rabbinical degree, Dr. Cohn is frequently called in to help mediate between a patient’s halachic authority and his or her medical team.

He takes a lesson from Rabbi Tendler as a basic principle in these discussions.

“He made sure to bring Rav Moshe Feinstein to the hospital to make a decision,” Dr. Cohn said. “Because of that, if a family is going to consult a rav, I will ask families to bring the rav to the hospital. There’s a clinical aspect of halacha there.

“Rabbi Tendler saw something important in looking at every situation as an N of 1 — in the medical parlance, a unique case. Even though in medicine we try to use guidelines and we want algorithms — in kitchen halacha there are algorithms for if you put a dairy spoon in a fleishig pot — in medical halacha you can’t do that. The reality is that every patient is unique.”

A common halachic issue Dr. Cohn deals with is giving pain medication to dying patients, “especially if it means the patient will end up sedated. Many of those medications can cause a decrease in your breathing rate. There’s a belief among many Jews that these medications hasten death. There’s nuance there. When someone has a poor prognosis, there are ways to mitigate interventions such that we don’t cause suffering. We have the concept in medicine of palliative sedating, if someone is dying and needs to be sedated to relieve pain. The halacha allows us to do that.

“We are taught that we have to do everything to preserve and prolong our life, but what we’ve learned in medicine, that I think we had already learned in the Gemara, is that life is not necessarily to be prolonged at all costs.

“The way we approach that is what matters. If in medical care, someone says, ‘I want you to do everything,’ I don’t say ‘Yes, of course, we already are.’ I say, ‘What does that mean to do everything?’ It has to be a conversation. We are going to do everything that will have benefit for your loved one, but just because we have technology and medication doesn’t mean it’s appropriate to use it.

“When there’s this sense that we can’t do anything more, many people have a feeling of abandonment. What do you mean you’re giving up? I do something I learned from the social workers and nurses who trained me in palliative care. You reframe it by saying we’re not going to stop treating; we will continue to be aggressive and careful in how we take care of your loved one. We can’t cure the disease, we can’t make it go away, but there’s a lot we can still do: We can relieve suffering, we can bring in a chaplain, we can daven, we can bring in music. There’s a lot we can do.

“It sounds like common sense, but even on the medical side there are things that we do when care for patients who are dying that actually prolongs their life in a good way. I’ve seen people who are dying who are in pain, and their relatives, or even some times staff and certain rabonim are afraid of giving drugs like morphine. They’re afraid it’s going to hasten their deaths. What we see very often is that when you treat someone’s pain adequately, they actually wake up, they’re actually more alert. They’re able to interact. Sometimes they might live longer. Because the pain and suffering drain the body.

“Palliative care is 80 percent talking,” Dr. Cohn said. So too, “most difficulties when it comes to halacha can be solved with good communication, expert communication,” he said.

“Organ donation can sometimes be a topic that a lot of times is educational. It’s not just Orthodox Jews. My own grandparents who were not frum said Jews can’t donate organs, they have to be buried with everything. That’s not true.”

Dr. Cohn praised the communication coming from the Rabbinical Council of Bergen County, which used halacha as it decided to shut down synagogues and require social distancing and isolation before local government officials did.

“I am extraordinarily grateful and impressed by how the RCBC has handled this from the standpoint of halacha, because it is literally saving lives every single day,” Dr. Cohn said. “That’s what I would expect halacha to do, what I would think the Torah and our community would stand for. But they’re doing so in a way that we haven’t seen in a really long time. If you think about what the biggest decisions a rav or a rabbinical council has to make — with the exception of family law and potentially business law, the biggest rabbinical decisions that affect our community are all bein adam l’makom, between man and God, like kashrut and Pesach. When are things that are adam l’haveiro, between people, ever legislated? It’s exceedingly rare. This is a situation where it’s both.”

Looking ahead, Dr. Cohn said, “We’re not going to have a vaccine by Rosh Hashanah. It’s unlikely we’ll have one by Pesach. As a health care worker, I can’t see packing a shul with hundreds of people for Kol Nidrei. I don’t know how you justify it.”

Who: Dr. Moshe Cohn

What: “A Tour of Medical Ethics and Halakha from Inside the Pandemic”

When: 8 p.m., Sunday May 17

Where: On Zoom. Go to Congregation Rinat Yisrael’s page on Facebook for login information, or email adulted@rinat.org.