Abstract
According to Jewish law/ethics, continuous life-sustaining therapy may not be withdrawn
after its introduction, unless the patient has improved and no longer has a medical
indication for the treatment. We report the case of an 88-year-old Orthodox Jewish
patient, on invasive mechanical ventilation, with severe anoxic brain injury after
multiple cardiac arrests. Although the patient's son informed the palliative care
team that his father did not want to be in pain or to linger in a vegetative state
when terminally ill, the mechanical ventilation was keeping him alive with a poor
neurological prognosis. Additionally, the patient had previously stated his wish to
observe Orthodox Jewish principles regarding end-of-life care. After extensive discussion,
the family Rabbi clarified that it would be acceptable to withdraw mechanical ventilation
if there were a “reasonable expectation” he would breathe on his own for a “reasonable
amount of time.” Thus, if the patient's death were to occur, it would not be an immediate
consequence the normal ventilator weaning process. Following intermediation by the
hospital Rabbi, the definition of what would be a “reasonable expectation” and “reasonable
amount of time” was established by the family Rabbi as “over 50%” and “on the order
of hours,” respectively. Following pulmonary consultation, the patient underwent palliative
extubation and, 12 hours after the procedure, died comfortably surrounded by the family.
In conclusion, the collaborative and interdisciplinary work among the family Rabbi,
hospital Rabbi, and the various medical teams allowed the development of a plan that
met all of the patient's personal and religious wishes and beliefs.
Key Words
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References
- An explanation and analysis of how world religions formulate their ethical decisions on withdrawing treatment and determining death.Philos Ethics Humanit Med. 2015; 10: 6
- Approaches to patients and families with strong religious beliefs regarding end-of-life care.Curr Opin Crit Care. 2014; 20: 668-672
- Ethical challenges when caring for Orthodox Jewish patients at the end of life.J Hosp Palliat Nurs. 2018; 20: 36-44
- The critical role of religion: caring for the dying patient from an Orthodox Jewish perspective.J Palliat Med. 2010; 13: 1267-1271
- Bioethics for clinicians: 22. Jewish bioethics.CMAJ. 2001; 164: 219-222
- Jewish medical ethics and end-of-life care.J Palliat Med. 2004; 7: 558-573
- Assisted reproductive technology: perspectives in Halakha (Jewish religious law).Reprod Biomed Online. 2008; 17: 17-24
- Ethical dilemmas in the care of cancer patients near the end of life.Singapore Med J. 2012; 53: 11-16
- Clinical ethics support for healthcare personnel: an integrative literature review.HEC Forum. 2017; 29: 313-346
- A framework for ethical analysis.Plast Surg Nurs. 1991; 11: 123-125
- Risky treatments: a Jewish medical ethics perspective.Rambam Maimonides Med J. 2015; 6: e0032
- The world's major religions' points of view on end-of-life decisions in the intensive care unit.Intensive Care Med. 2008; 34: 423-430
- ‘There is a time to be born and a time to die’ (Ecclesiastes 3:2a): Jewish perspectives on euthanasia.J Relig Health. 2011; 50: 778-795
- The obligation to heal in the Judaic tradition: a comparative analysis.in: Rosner F. Bleich J.D. Jewish bioethics. Hebrew Publishing Company, New York1979: 1-44
- Health law and ethics religious advance directives: the convergence of law, religion, medicine, and public health.Am J Public Health. 1993; 83: 899-903
- “Love your neighbor like yourself”: a Jewish ethical approach to the use of pain medication with potentially dangerous side effects.J Palliat Med. 2010; 13: 67-71
- The dying patient act, 2005: Israeli innovative legislation.Isr Med Assoc J. 2007; 9: 550-552
- Timers on ventilators.BMJ. 2005; 330: 415-417
- Timer to turn off patient ventilators in hospitals being tested but not ready for use. Jerusalem Post.(Available at:)https://www.jpost.com/health-and-science/timer-to-turn-off-patient-ventilators-in-hospitals-being-tested-but-not-ready-for-use-334521Date: 2013Date accessed: August 10, 2020
- Cultural competence in end-of-life care: terms, definitions, and conceptual models.J Palliat Med. 2012; 15: 812-820
- Cultural humility: treating the patient, not the illness.Med Educ Online. 2016; 21: 1-2
- National Consensus Project clinical practice Guidelines for quality palliative care Guidelines, 4th Edition.J Palliat Med. 2018; 21: 1684-1689
- The national agenda for quality palliative care: the essential elements of spirituality in end-of-life care.Chaplain Today. 2008; 24: 15-21
- The FICA spiritual history tool #274.J Palliat Med. 2014; 17: 105-106
Article info
Publication history
Published online: August 31, 2020
Accepted:
August 25,
2020
Identification
Copyright
© 2020 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
