I would appreciate communication with you regarding what is the latest in the Halacha regarding terminal patients.
I was previously the Head of the Radiation Oncology Dept at the University of the Witwatersrand and the Johannesburg group of Hospitals. After retirement I became involved in Palliative Care and started The Palliative Medical Institute. We trained doctors,nurses and community care workers in the Ethos and skills of Palliative Care.
Our mission differed from the usual definition of Palliative Care. We realized that there is an enormous amount of unnecessary suffering in the hospital of patients who are curable, and that it does not make sense to teach Palliative Care only for those who have life threatening or terminal illness. (and in private practice, in homes, in clinics etc)
We therefore expanded the WHO definition to the following:
Palliative Medicine is the active management to relieve suffering , physical, emotional, psychsocial and spiritual of the patient and the family. ( This is the first part of the WHO definition)
It starts at the moment of first contact with the patient and continues for the duration of the illness. If and when the illness becomes incurable, palliative care plays the major or total role. ( The blue is our change from the WHO definition )
I discussed this abut 6 or 7 years ago with Prof Neil McDonald of McGill University in Montreal who was with the WHO in a senior capacity. In fact he told me that he had written their definition. He said our approach was logical and makes sense and encouraged us to continue with it. He said World Health would come to that approach in time but that they move slowly.
It is important therefore that all doctors and nurses are taught the Ethos and Skills of Palliative Care and that Palliative Care teams or specialists should be available for difficult problems.
I was asked in 2001 to put a team into the Johannesburg Academic Hospital by the Professor of Medicine who found tremendous suffering in all wards, compounded by the AIDS epidemic .
This team has been operating for 10 years, and we also teach some groups of medical students , who have found it of great value when they do their internships and in practice, because their role models during their training have indicated that with some patients "There is nothing more we can do" as they have never been taught those skills. Of course there is always something one can do!
I am writing to you at the moment because I have had, and heard of, very distressing situations with orthodox doctors, who I believe misinterpret the Halacha. I contacted Rabbi Kurstag of the Beth Din and he advised me to contact you as its not his area of expertise.
I will give you two examples of many. The first is of a patient who had an advanced carcinoma of the oesophagus. He was sent for radiation to try and palliate his symptoms of shortness of breath etc. Suddenly the terminal event occurred in the ward in that the tumor broke through into the trachea causing total obstruction of the airway. The patient was in unbearable suffering unable to breathe. I told the intern to immediately give the patient intravenous sedation so that he should not die a tortured death. He refused. He was an orthodox Jewish young man and told me that his religion did not allow it as he would be killing the patient. I was horrified as I did not believe that the Jewish religion forbade the relief of suffering in a terminal patient. I explained that it was not a lethal dose of sedation, only enough to make him unaware of the dreadful experience of not being able to breathe, and that he was actually dying ( of his cancer.) He still was not convinced. I met that young doctor again many years later,. He was now a radiologist. I asked him if he had changed his mind. he said no, and that he had had a most distressing time with his own father who was dying and unable to breathe and he could not help him.
The second patient was not mine, but I was visiting a friend who was being looked after by Hospice. While I was there the Hospice Nurse arrived and when I met her at the door she was crying. She told me that she had just come from a house where the (Jewish) patient was dying of lung cancer. He had pleural effusions. There was fluid in both lungs. Around his bed were three orthodox Jewish doctors, one a pulmonologist. They had inserted a drip, and the nurse asked them if they would discontinue it as it would increase the fluid in his lungs. Their reaction was extraordinary. They told her to leave the house and never come back. She was crying because she said the poor man was drowning in his own fluid, and she found it unbearable. I looked at the death columns and he only died two days later which must have been an unbearable death.
I have asked Rabbi Kurstag to have sessions with the orthodox Jewish doctors to explain that the Jewish religion does not teach that one must allow patients a tortured death. That is why he referred to you.
I am anxiously awaiting your reply.
A second question is regarding the Living Will so that patients can give Advanced Directives as to whether they wish to be kept artificially alive or not,
Only 60-70 years ago doctors could not cure most conditions and certainly could not prolong life. Now that they can, unfortunately the prolongation of life often means prolongation of suffering or actually causing suffering. The teaching of medicine has become disease orientated and no longer patient orientated. It is time the pendulum shifted back to the middle. We, of the Hospital Palliative Care Team are trying to achieve the integration of Palliative Medicine into Curative Medicine so that its is part of the main stream training for all doctors and nurses and that all patients will be treated humanely.