Hospice care: what and when

Fundamental to Judaism is the belief in the infinite value of human life and the obligation of each person to protect and preserve it. Life is viewed as a gift from God to be safeguarded and maintained. There is an obligation, as well, to alleviate pain and suffering. At the same time, Judaism recognizes the inevitability of death. Thus, end-of-life care is a reality with which most families eventually will have to deal .

Hospice care is an approach to end-of-life care about which many people are unaware. It is an alternative to acute hospital care, which may not always be the best choice. There are times when the care that a hospital can provide is of limited or no benefit, and may do little to alleviate a patient’s suffering while holding out no hope for improvement.

What is hospice care? Hospice care is comfort care. It is not curative. It is not designed to cure any underlying medical condition, such as heart failure or chronic obstructive pulmonary disease. The goal of the hospice program is to keep the person who is reaching the end of his or her life as comfortable and pain-free as possible, while preserving his or her dignity, as the terminal illness progresses and follows its natural course to conclusion. This is accomplished by providing all medical interventions necessary to effectively manage whatever symptoms exist, be they pain, respiratory distress, agitation, nausea and vomiting, and so on. Hospice care provides support to the family and the patients’ caregiver(s) as well. A multidisciplinary hospice team, which includes medical personnel, home health aides, social workers, and spiritual counselors, manage the care. Hospice professionals function as partners with patients, their loved ones, and caregivers.

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Hospice care can be provided at home, in a nursing or assisted living setting, or in an inpatient hospice facility. In the inpatient environment, families are welcomed and encouraged to keep their loved ones company and even adorn their rooms in a manner that will make them feel as much at home as possible. Whatever the venue, care is managed by the same interdisciplinary team.

When is hospice care appropriate under Jewish law? As in all areas of halacha, there is more than one opinion. In general, I believe it can be said that when a person’s condition is terminal and irreversible, when there is no hope for recovery and further treatment is futile, when there is severe pain and suffering, then hospice care may be an appropriate halachic alternative. While there is an obligation to prolong life, there is also the recognition that life may become unbearably difficult and painful. There are circumstances, therefore, under which the withholding of life-sustaining or aggressive medical treatment is permissible, and palliative or comfort care is appropriate. Since each person’s circumstance is unique, each situation has to be judged on its own merits. But hospice presents an alternative to continued intense suffering and an opportunity for a person to live out his or her remaining days in peace, and perhaps even to prepare spiritually for what is to come.

The decision to elect hospice care is a very difficult and painful one for both the patient and the family, and should be made in close consultation with medical experts and the patient’s rabbi or religious/spiritual guide. Life and health being as precious as they are, the decision naturally should be made with great care and with the best information and advice available.

My experience as a hospice chaplain at Villa Marie Claire, Holy Name Medical Center’s residential hospice center in Saddle River, and in the community has taught me that hospice care providers are exceptionally compassionate and caring, and hence very successful at providing incomparable end-of-life care to patients and their families. Families regularly offer thanks and praise to hospice staff for the excellent care provided their loved one. And we often hear “We wish we had known about this place sooner” at the Villa.

Rabbi Joseph Siev is a full-time hospice chaplain/spiritual counselor for Holy Name Medical Center in the community and at Villa Marie Claire in Saddle River.