Palliative Care Conversation | The Book of Doctrines and Opinions:.
Here is my first response to this post:
In terms of the issue of Chabad and there interest in palliative care, at their shluchim convention this year, my father, the chief medical officer of the largest hospice in the US, gave a lecture on Jewish medical ethics at the end of life. From what he told me, it was well received. Chabad tends to be the most engaged in this subject due to their being widespread and encountering more diverse types of Jews as congregants. It is possible that this other lecture was similar in scope to the one at their shluchim convention. My father has also lectured this past year at the Talmudic University in Miami, better known as R’ Zweig’s Yeshiva.
Regarding the issue of Rabbis acting as doctors instead of pastoral counselors, this is one the greatest challenges I face as a chaplain. While an Orthodox rabbi, I find myself at times in the pastoral role instead of their own rabbi, who is more worried that the hospice is out to kill the person instead of caring for them in a palliative manner. In my area, I am beginning to work with the community rabbis to find a common ground to make them more hospice friendly while also being flexible with what hospice provides under the rubric of comfort care.
I remember hearing R. Tendler years ago say that all Rabbis need an extensive background in biology so as to be able to better deal with the specifics of the myriad of medical issues congregants face. The problem is that these same rabbis then believe they know the medicine enough to then make decisions with consulting with the medical authorities. Unfortunately, this often leaves the hospice in the lurch, because if the hospice suggests an intervention is harmful, there is that same sense that hospice is there to end life sooner. Much of this fear is old, but it also gets spurned on by current events and how they are misunderstood, such as Terry Schiavo’s case. With that said, what people don’t realize is how comfort care, palliative care/hospice care, can often prolong life and provide a better life as one comes to the end.
Re: Israel and palliative care – Palliative care as a means of comfort care for the dying exists in Israel. The model is different than the American one in that they do not utilize chaplaincy. Most of the palliative care groups believe that Social Worker can provide spiritual support in addition to psycho-social support. While there is some truth to that, the lack of chaplaincy is more due to the perceived dati/hiloni divide and a lack of funding than to a sense of territorialness. Additionally, the question of chaplaincy qualifications is a hot button item because most people training to be spiritual care providers in the Israel system are non-Orthodox, thus leading to a whole set of other questions.