MAiD -Dealing with Death -- Posted by hazzanmenes

MAiD - Dealing with Death

Dealing with the Choice of Death

4 Approaches to Spiritual Care for End of Life

MAiD comes up often in my talks with the residents. Shoshana always brings up Baruch; it continues to trouble her. Because for her, it's not about him - it's about her. He left her, and he chose to leave her, and he looked ok. Could've had a few more years left. He was intelligent, spoke Russian and Yiddish, and looked to be physically fit. But he left her. He chose to die. He said he was ready to go, that he lived his life on his terms, in control, and he wanted to be in control of his death. Everything was resolved, he was at peace. His daughters understood. He was without a purpose - but this didn't sadden him. Rather, it simply indicated that he was done. It wasn't a religious thing, but if he had a regret, it was simply that he hadn't learned enough of the service to say kaddish for those of his family who died in the Holocaust. I have some regret for that, since I could have taught him what he needed to know.

He opted for MAiD without my knowledge. Not hiding it, just didn't need to discuss. When we finally discussed it, he was resolved and at peace. He asked to see me as a courtesy, and I was thankful. My job was not about Baruch, it was about Shoshana and helping resolve her confusion and feeling of loss.

Rick was different, because we had a relationship. He started out as a fairly capable pain in the ass resident. Active in the resident's council, to the point of being disruptive. I could imagine him in his heyday, causing problems in meetings, where he was comfortable. Before I knew him, he was active on the Board, and his brother had been the chair. Then his son got sick, real sick, and died rather suddenly. I was the one who helped him and his daughter, but he wasn't the same. You see, he couldn't understand why his son would die so young. It didn't make sense. Well, he was no longer the disrupter, he lost his will to make a difference. We talked about Judaism and he came to services, but there was too much sadness. And then he had a stroke, a fall, prostate cancer, bone cancer, amputation.

By the time the cancer spread to his spine, the pain was unbearable. His legs had been amputated, so he was bedridden. He knew that life was not to be cut short, but did he have to endure the pain? And worse than the physical pain was enduring the pain of 'not making sense.' That was his real pain, that he couldn't fit the pieces together to have all this sorrow make sense. We spoke often, daily. He asked to speak to me without his daughter. His daughter wanted him to live, but he wanted to die. He wanted to sign the MAiD forms.

We discussed ending his life. We discussed the Jewish perspective - it wasn't about halacha, since he was way past halacha. It was about control. And ending the pain and confusion, but nothing was resolved. He signed the forms, he was approved for MAiD; he simply had to choose a date.

He was in control, he could leave this world, he could end his pain, but he couldn't leave without understanding the inability to order the unknown. Back and forth we went. There were some things that we, as people, could not order. Judaism was not about making everything neat and orderly - it was about letting the disorder remain in the unknown. That was our peace, that the unknown was the domain of the higher power. Can we be content with that, that there is order in putting the disorder and illogical in the box called the Unknown?

Somehow, this made sense to him. Ok, he can accept that. By accepting that, by accepting the unknown, he didn't need to exercise his control. He was able to die by surrendering to God. On God's terms. In pain, without pain. In peace. Resolved. He never chose a date for MAiD, he didn't need it.

Rivka started coming to my Thursday classes, perhaps a year ago. Out of perhaps 8-10 people, she was one who participated. By participated, I mean actually asked questions or corrected me. She knew her Judaism, but she was angry and cynical. Each Thursday she showed up with her walker. I didn't know her story. She wanted to talk to me.

I met her in her room and she told about her family, and her experience in the war, the Holocaust. The Nazis came when she was a child, her mother was shot in front of her, and she was shot and bleeding, and turned away by neighbors. Lived through the concentration camps. Made it to Israel, but, contrary to popular belief, Israel was no paradise. She stayed with relatives who could barely make a living, dirt poor in poverty. Married, then to Canada. She never got past the horror of the war. How could she.

She attempted suicide a number of times, before the physical pain ensued. Now, she was in constant pain with a crumbling spine. So now she wanted to die. So she wanted to know, how? Her doctor had the papers but hadn't submitted them. Now, she was to tell him to submit them. The problem was her family. They had strong religious opinions about her death, yet they had put her in the home because of her attempts to kill herself. She wanted me to speak to them. I did. They were loving but angry, and there was no bridging the divide. One daughter transcended her own feelings to journey with her mom.

Rivka asked me to be with her during the procedure. She had chosen a date - her daughter would come as well, but she didn't want her husband (who was still living in their house) and other daughters there. She knew she had to have it done at the hospital, not in her home. She never felt it was her home, anyway. So on the day, I met her at the hospital with her daughter. We went in with the nurse practitioner and social worker. Before the sedative was administered, I sang a psalm and recited the viddui. Then, her other daughter and husband showed up!

Rather than enable a peaceful transition to the unknown, they argued, a last attempt to convince her that what she was doing was wrong. Wrong for them. That she should, must, continue to live in this world of pain and anger. For them? For God? Tears, many tears. They left the room, and the daughter and I stayed with her and the nurse. And she calmly passed into a sleep while her daughter held her mother. And then the final injection. And then stillness.

The rest, the arrangements, the family discussion, doesn't matter.

I didn't know him at all. Boris. He just called me one day to discuss MAiD. Not about any religious or spiritual aspects, just the logistics. Who, when, the plot, the chevra kaddisha. Above all, he didn't want his wife to worry about any of the details. He spoke well, and seemed, to me, an outsider, to be healthy. He explained that he had cancer and that he had about 2 months before he would be in pain, disabled and ultimately die. He did not want his wife to see him suffer. She would need me for support.

I gave him the information I had, and didn't hear from him again for 2 months. Nothing. I didn't know if he had signed the papers or been approved. Then, on a Thursday morning, he called. Could I meet them in the lobby at 4:30 and accompany them to the hospital for the procedure? Surprised but not shocked, I met them at 4:30, and it was the first time I met his wife. She was stoic, silent, bravely accepting her husband's wishes. We got into the taxi and rode to the hospital. Boris made some joke about the weather, but otherwise we travelled in silence. I kept thinking about a train ride to Auschwitz, because we knew what would happen when we arrived. He was going to his death.

We arrived and walked across the street, into the building and down a floor in the elevator. I went with the couple into the room, and then I left and waited in the hall; Boris only wanted his wife with him. Some medical professionals went in and out. I waited about 20 minutes, in silence. Then, a wailing from his wife. A knife in the air.

When she came out, she collapsed into my arms, leaned her head on my shoulder, and then composed herself. I steadied her as we walked down the steps and into a taxi again. In the taxi, she cried, in pain for the loss, never wondering why, just missing the limb that had been torn.

Later that evening I was scheduled to sing Broadway showtunes for the residents. The first two were fine, but I broke down in the middle of 'Tomorrow' from Annie.

The next day I would lead a funeral for another resident who had chosen MAiD that same evening.

Learning objectives for the Presentation:
Participants will come away with an understanding of the diversity of situations in which the elderly consider ending their lives. As a result, presentation will identify a diverse set of approaches to spiritual care for those considering ending their lives. Each approach will be evaluated in the context of a Jewish facility, and what may be required of staff to support. Finally, participants will recognize the difference in perspective of the facility, the staff, the resident, and the family and the need to navigate the often contradictory perspectives.

Dealing with the Choice of Death - Approaches to Spiritual Care at the End of Life
Hazzan Rob Menes, Chaplain
Louis Brier Home and Hospital
Learning objectives for the Presentation:
Participants will come away with an understanding of the diversity of situations in which the elderly consider ending their lives. As a result of this diversity, the presentation will identify a spectrum of approaches to spiritual care for those considering ending their lives. Each approach will be evaluated in the context of a Jewish facility, and what may be required of staff to support the resident. Finally, participants will recognize the difference in perspectives of the facility, the staff, the resident, and the family, and the need to navigate the often contradictory perspectives.

What do you think of medical assistance in dying? What are the ethical concerns?
Profile photo for Rob Menes
Rob Menes
Chaplain in a Long Term Care facility, cantor, engineer5h
I am a chaplain in a Jewish long term care facility, in British Columbia. MAiD is a legal right of every person (given some qualifying conditions regarding type of illness, ability to consent, etc.). MAiD is anathema to the Jewish value of refraining from hastening death. MAiD involves the decision to control your death, or to abdicate the decision to the transcendent. However, Judaism recognizes that there is no value in pain or suffering and therefore there may be a situation where ending one’s life is appropriate; this is expounded in the Conservative responsum of Dorff et al. (reference available upon request)(This would be rejected by most Orthodox rabbis)

As a chaplain, I support each of my residents according to their own faith tradition. At my nursing home, as a Jewish facility, we will not allow the procedure to be performed in place. If a resident (Jewish or non-Jewish) chooses MAiD, I will support them in their journey, ensuring they understand it according to their own values and traditions and enabling them to resolve any dilemmas prior to their death. I have accompanied residents and stayed with them through their death.

For many care-givers, this represents an ethical dilemma: can they support a person in their decision to end their life, when they personally see it as an affront to morality? If the great gift from a higher power is our life, do we have the right to extinguish it? The idea parallels the concept of land ownership: do we actually ‘own’ the land, to do as we wish, or are we caretakers for another (higher) owner?

However, there are other ethical issues. Particularly in my nursing home, one resident’s choice of MAiD affects the whole community. Other residents wonder why they have chosen to leave them. This is often true when the pain and suffering one sees is not obvious to others. Our choice may be for us to make, but it will affect others. Family members will have to deal with the loss, and they would have had to deal with it at some point, but they have to understand that the person choosing to die could not find a reason to extend the time with family. What are the individual’s rights and what are the individual’s obligations?

MAiD started out as a right afforded to those with a terminal illness. However, it has been extended to certain cases of mental illness as well. This raises the problem of how we assess - as a community or nation - whether a disease is ‘unbearable’. How do we even assess whether something is ‘terminal’ since of course we will all die soon? We seem to rely on arbitrary medical judgments; are those judgments more valid than spiritual ones? Finally, at what point do we recognize that the choice to die impacts society as a whole, and originates from the values of society as a whole?