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For sensitive religious and cultural advance care planning

Judaism

"The real focus here is life rather than death."
Jewish Leader
"The Jewish community culturally has a very strong family tie and family involvement would be expected."
Jewish Leader
"The traditional belief is that death is not a finality, there is life after death, which will obviously colour ones attitude toward death as well."
Jewish Leader
"If you know the patient is Jewish, ask, do you have a Rabbi you’re close to? Do you belong to a Synagogue? Would you like to involve your Rabbi?"
Jewish Leader

Judaism

Background and beliefs

Judaism is a monotheistic Abrahamic religion. It is based on the Torah with additional texts such as the Talmud.

Major movements of Judaism:

  • Orthodox (mainly Modern Orthodox, but also some Ultra-Orthodox including Chabad/Lubavitch and Adass Israel) – about 70% of Synagogues in Australia
  • Conservative / Masorti
  • Progressive (also referred to as Reform or Liberal)
  • Secular Jewish – not religiously observant but culturally Jewish. This might include people who describe themselves as atheistic, ignostic, agnostic, humanistic, secular, secular humanist and Bundist

The elderly Melbourne Jewish community is largely of  Yiddish, Polish or Russian speaking background. In Sydney, elderly community members are more likely to be of Hungarian origin. There may be some specific cultural notions that arise from these backgrounds.

Jewish religious tradition teaches life after death; that the soul lives on and the body will be resurrected at the end of time. The body is considered a gift from God, the holy vessel for the soul, and has to be returned intact. Preservation of life is strongly emphasised.

Jewish law (halakha) governs much of a religious person's day-to-day life.

Disclosure of medical prognosis and language

Disclosure of prognosis is generally welcome though individual's choice should be respected. How much Jewish people want to know about prognosis may vary. It is important to ask them. Some people of ageing Eastern European and Russian background may prefer to know less.

Prognosis and how the conversation is delivered may impact outcome. Within the Jewish faith, there is an emphasis on life rather than death, infusion of hope is important. A balance between full disclosure and hope may be best.

It is important to remind patients that whatever choices they make, it won't prevent Jewish customary practice to be carried out at the time of death. Exceptions to this may apply in very orthodox circles and may depend on the Rabbi.

Australian born or raised Jewish people don't have any particular inappropriate terminology or phrasing in general. Some people might prefer Yiddish ('toyt') or Hebrew ('mawet') words for 'death'.

Due to the emphasis on preservation of life, it is important to distinguish advance care planning from Euthanasia. This is a word that is not well accepted by a lot of Jewish people.

Who should be involved?

Always check with the patient, as family can influence decision-making. Younger and healthy people might just want the general practitioner present. Others would want family present, next of kin, and children. Some patients may want to consult a Rabbi, especially if it comes to certain questions on Jewish law. Some Ultra-Orthodox patients and Rabbis may not feel comfortable participating in advance care planning at all.

Questions you might ask:

Do you belong to a Synagogue/Shule?
Do you have a Rabbi you're close to?
Would you like to involve a Rabbi?

If a Rabbi is to be part of a conversation, it is best to ask the person who their Rabbi is – it would not be appropriate to bring in a non-orthodox Rabbi for an orthodox family and vice versa.

Advice on having the ACP conversation

The conversation should be approached openly, honestly and preferably in the company of a trusted family member. Ideally, at a general check-up when people are still healthy.

Please be aware that some people may mistake advance care planning for a conversation about euthanasia. Passive euthanasia (withholding or cessation of treatment) is not encouraged in Judaism. Although discussion of passive euthanasia can be difficult, end of life care without extreme life prolonging measures may be accepted even in a very traditional context.

Note that even if a patient is secular, they may still turn to a religious framework in their dying days as levels of religiosity may vary throughout one's lifespan. This may be out of a sense of tradition, familiarity or unawareness of other avenues.

Special considerations

Gender

Very orthodox Jewish people may find it more comfortable to be talking to a person of the same gender, and would find it inappropriate to have touch between people of different genders. This might also be influenced by generation.

Holocaust survivors

Large numbers of holocaust survivors have settled in Australia. The subject of death and dying might be more sensitive for these people.

Kashrut

Religious Jewish people only eat kosher foods, for which there are strict religious laws. This might be an important consideration when planning for care.

Rituals and practices

Prayers including one called the Sh'ma are recited by the dying person where possible. There is a final confession which can be recited by the person themselves or someone else e.g. a Rabbi. The dying person should not be left alone.

In their last moments a person should not be moved as it may hasten their death. After death, the body should be touched as little as possible (and not at all for the first 30 minutes), all jewellery removed and the body covered with a sheet. There should always be someone in attendance with the body. It is important to Jewish people that the body be buried whole, and so autopsy is not considered appropriate for religious Jews except where absolutely necessary.

After burial, it is customary to light a candle at home, which remains lit for a week (for Shiva).

There is also an Orthodox tradition to open a window, and pour out water from any opened bottles, glasses and jugs because the soul has departed. Some people tear a garment as they attend the soul departing the body, others may do this at the funeral.

The Jewish funeral is generally organised by a Jewish funeral home or burial society traditionally referred to as a Chevra Kadisha. Depending on location, these might exist separately for orthodox/conservative/progressive denominations. Due to its ease in difficult times, this option is often chosen by secular Jews as well. Funerals traditionally take place prior to nightfall where possible, or within 24 hours. Mourning begins immediately after the burial, with close family of the deceased participating in an intense mourning period called Shiva for one week. Other mourning procedures and rituals occur during the first 30 days after burial (the Shloshim) and others until and upon the anniversary of death.

Festivals and special dates

It is preferable to avoid major Jewish holidays. These may also be celebrated by secular patients. Jewish festivals that may impact the conversation:

  • Pesach/Passover (around March/April)
  • Shavuot (around May-April)
  • Rosh Hashanah/Jewish New Year (around Sept/Oct)
  • Yom Kippur/Day of Atonement (around Sept/Oct)
  • Sukkot/Feast of Tabernacles (around Sept/Oct)
  • Hanukkah/Chanukah (in Dec) (note – no restrictions apply during Chanukah)

Note these holidays adhere to the lunar calendar.

Weekly, the Sabbath (Saturday) is a holy day starting sunset Friday and ending sunset Saturday, when religiously observant Jewish people do not use phones, computers, cars, light switches etc. Getting in touch urgently may be challenging.

Quotes

"The real focus here is life rather than death." - Jewish Leader

"The Jewish community culturally has a very strong family tie and family involvement would be expected." - Jewish Leader

"The traditional belief is that death is not a finality, there is life after death, which will obviously colour ones attitude toward death as well." - Jewish Leader

"If you know the patient is Jewish, ask, do you have a Rabbi you’re close to? Do you belong to a Synagogue? Would you like to involve your Rabbi?" - Jewish Leader


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