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Question:
I am currently preparing an in-service presentation for fellow nurses in the oncology department of the Children's Hospital of Philadelphia. As a frum nurse, I hope to address end-of-life issues that arise on a floor that regularly, r"l, has Orthodox patients and families. Specifically, I am looking for sources/halachos regarding the procedures/post-mortem care that can/cannot be done by the nurses prior to the arrival of the chevra kadisha. |
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Answer:
I'm afraid I am not aware of sources to your question. Regarding what nurses do PM:
1. All contact with the niftar must be with the utmost reverence, kavod and gentleness as one would deal with a sefer Torah. All the following should be done by Jews.
2. It is customary to wait some 20 minutes after death has been confirmed before proceeding.
3. The eyes are closed, the limbs straightened, making sure that the hands and legs are on the bed and the jaw tied shut to prevent it from opening.
4. Remove all external attachments from the body - such as IV and urinary catheters, drains, etc.
5. The body is washed clean of blood stains and excreta. If the patient died of an external hemorrhage the blood is kept aside for burial with him. Orifices are closed with cotton wool.
6. The body is then completely covered and the drapes tied to prevent them from opening, ready for transportation to the special room for metim to await the arrival of the chevra kadisha.
7. The met should be transported to the appropriate room by a Jew. If not, a non-Jew may transport him there but a Jew (attendant or a family member) should accompany him for kavod of the niftar.
On Shabbat and Yom Tov the met is muktseh. Therefore:
1. The clothes are removed by pulling them off without lifting any part of the body in order to do so.
2. Appliances may be removed in a similar fashion. The body is washed to remove blood stains and excreta but one must be most careful not to squeeze any cloth that is used for the purpose; therefore this must be done using gloves (plastic or rubber) only or with a plastic cloth.
3. The eyes may be closed. The orifices may only be closed if cotton wool plugs are available or have been have been prepared before Shabbat.
4. The jaw may only be tied (using a knot and bow and not a double knot) to prevent it opening further but may not be closed if already open. The bandage used for the purpose may not be cut to length nor may it be cut lengthwise to allow it to be knotted. If this has not been prepared before Shabbat, the whole bandage must be used and the end tucked in. If a safety pin is used it should only be put in once to attach the end of the bandage to one of the folds but not in and back in again.
5. The met should be transported to the appropriate room by a Jew, if this is possible without chillul Shabbat. If not, a non-Jew may transport him there but where possible a Jew (attendant or a family member) should accompany him for kavod of the niftar. If the non-Jew uses an elevator the Jew may accompany him taking care not to open or shut the doors or to activate the elevator.
With best wishes
Avraham S. Abraham |
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Question:
My father, sheiyichyeh, (79 years old, very obese, history of heart failure, cardiac myopothy, orthostatic hypotension and at least one previous heart attack, along with other medical issues including chronic unsourced anemia, a large inoperable abdominal hernia and widespread arthritis) is currently hospitalized with sepsis and, apparently as a result of that, another heart attack. His last echo 6 weeks ago showed an ejection fraction of 15%. The doctors want him to be a DNR/DNI, as does my (non-observant) sister who is a RN. My father is lucid, communicates well and enjoys living even though he has been bedridden in a nursing home for the last 2 years. He wants to live, but not to be tortured. He would allow any type of resuscitation as long as it had a real chance of success, and again told this to his doctors today. The doctors insist that life after resuscitation for him would be terrible, that he would never get off a ventilator (even though earlier today he successfully got off the bipap they were using to vent him after being on it about 30 hours), that he would most likely need constant sedation to handle the tube to his lungs, etc., and that he would need to move to a non-Jewish nursing facility and be separated from my mother, shetichyeh, (who is living in the same nursing home he is). He is currently getting levo and dopamine to keep his blood pressure at an acceptable level. |
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Answer:
If a person who wishes to live and when DNR/DNI is discussed with him he shows that his choice is to continue to live no one in the world has the right to convince him to accept DNR/DNI. His autonomy should be respected along with all of its implications. |
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Question:
I would appreciate guidance on the following Sheilah that was asked of me.
A Cohen is studying for an MSc in Medical Ethics in England. Some of the lectures have just been moved to a room in the main Medical School building. In the basement of the medical school is a room where cadavers that are used by the medical students for studying anatomy are stored.
Is it permitted for this student to attend classes in the Medical School building? It is extremely unlikely that any of the cadavers are of Jewish people.
It would appear from my understanding of the Nishmas Avrohom that we are not choshesh about Tumas Ohel from a goy. Is this a correct interpretation?
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Answer:
The Shulchan Aruch Yoreh Deah (Siman 372:2) says "it is right to be careful" and the Rama says "it is right to act strictly" regarding tumat nochri beOhel. With regard to what I wrote in Nishmat Avraham (I presume you are referring to P278 in the Hebrew and page 360 in the English) the permission to act leniently is because the Cohen is ill. This would therefore not be permissible merely to obtain a degree. However, if there are multiple doors between the basement where the cadavers are stored and room where the Cohen will be (also between where he enters until he reaches his room) such that there will always be at least one door closed between where he will be at any one time and the cadaver room it will be permissible for him to attend.
Avraham S Abraham
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