Jewish Law and Custom in Healthcare Rabbi Ralph

Jewish Law and Custom in Healthcare Rabbi Ralph Kreger, BCC New York-Presbyterian Columbia Univ. MC Ministering to the Orthodox/Hassidic Jewish Population in the Hospital Setting

� Modesty : The Cornerstone of Religious Life � Touch � Sabbath Observance � Prayer � Kashrus (Kosher, Bikur Cholim Room) � Death: Don’t Touch! � Medical ethics, Limb retrieval, brain death, abortion , organ donation, autopsies � Revival Video � Boston Legal

Modesty: The Cornerstone of Religious Life • A Hassidic man wears a long black coat and big brimmed hat. • Wears a yarmulke( skullcap) • Has a beard and long side locks (known as payos) • The Jews were redeemed from Egypt because they didn’t change their dress, language or names • A woman will wear modest clothes • Dress or blouse and skirt covering the knee and elbow, high neck • Married women will wear a wig or hat or snood to cover hair • All this dress is for modesty • A man will not always give direct eye contact to a strange women

Touch: Is a very powerful thing, it is reserved for the closest of kin • Any touch by the opposite gender for medical purposes is 100% permissible Dr. to patient, Nurse giving care, Physical Therapy, Radiology Tech, Phlebotomist • When there is no danger- such as when a patient needs to be bathed If the patient is out of the woods, having an aid of the opposite gender washing you is not a medical necessity • The removing of a catheter before discharge is another example where you would want the same gender nurse administering care • Ex: a 17 year old girl’s mother would insist on a female nurse for this act • For routine physicals or for an OB/GYN a women may opt for a female physician a male for a male • For the biggest expert , becomes a non concern for the patient • Women will request an extra hair covering when going into surgery or for hospitalization • All these types of conduct can apply to all by showing respect

The Jewish Sabbath • Commences every Friday evening at Sundown and ends Saturday evening an hour after sunset. • Same rule for Jewish Holidays that fall during the weekdays • This 25 hour period is spent with family and going to synagogue and eating the traditional Sabbath festive meals. • There is a custom for Women to light 2 candles in honor of the Sabbath. In a hospital this is not possible. Electric candles made for this purpose are distributed. (battery operated electric tea lights are perfect) • Certain everyday activities are prohibited during this time period. • The direct use of electricity ex: putting on and off a light switch, writing, watching TV, riding in cars, Talking on the telephone, building and destroying, Writing and erasing ( will ask staff to sign consent forms) • Historical Background: The Book of Exodus, Tabernacle

The Jewish Sabbath • Anything for the persons medical wellbeing is obligatory and he or she is obligated to violate the Sabbath in order to save ones or another’s life. Pick up the phone and calling 911’s It’s obligatory to get an ambulance • Not using electronic automatic doors or entering room with an electronic eye Not using an electric censored toilet or sink • Declining any test or treatment (not dire) • Not being discharged on the Sabbath or Holiday ( alert Social Work) • Not using the call button or pain medication button to summon the nurse, asking the non-Jewish roommate to ring for the nurse • Electric Sabbath Candles are in place of regular ones • Bikur Cholim Apartments (lodging for family near by)

Prayer • A Jew prays 3 times a day. During that time he or she will not speak. • Communication with hospital staff will be through gestures and sign • • language If well enough, the patient will stand while worshipping They will signal to come back by showing 10 fingers means 10 minutes. The morning service is the longest and most important , it takes roughly 30 -50 minutes. During morning prayers men will wear a 1. prayer shawl (a cape like garment) called a Tallis 2. Tefillin (phylacteries are black boxes with straps wrapped around the arm and worn on the head) The area for prayer must be clean. Used clean bed pans and urinals must be removed. The patient must be appropriately covered up Knowing where the nearest orthodox synagogue is

Kosher: The Jewish dietary laws as enumerated in the Torah Basic Laws • No eating of milk and meat at the same meal • Separate utensils for both dairy and meat • All meat, canned goods, baked goods, beverages • All foods need special Rabbinic supervision during production • Kosher foods are identified by different symbols on the labeling How do we deal with this in a hospital setting? • Hospital offers and provides kosher food. • If not, ask the patient what he or she can have • Prohibited to fast on Yom Kippur and Tisha bav without a physicians Permission • Patient may choose to refrain from a medication if it’s not kosher. Usually not a problem

Death Is a very powerful time to all people regardless of ones faith When a person is actively dying the patient should not be left alone A minyan (a group of 10 men will wish to gather) to pray. The windows will be opened ( to allow the soul to ascend) After death a family member will wish to stay No one is to touch or handle the body at this point Only family members may handle the body All tubes remain in patient. Tubing may be removed from the machine side (not the patient!) Blood is associated with the soul. Tubes with patient’s blood will be buried with patient

Death • Last chance for loved ones to do kindness to their loved one. • What happens on Sabbath and holidays? • Amputated limbs get buried, chaplain coordinates with physicians office and pathology • Get the death certificate signed as soon as possible. • Deceased allowed to remain in the room till Chevra Kadisha (Jewish Burial Society) arrives • No Autopsies or organ donation allowed , only in rare instances • Virtual autopsy as an alternative • Ministering : Everything is the almighty’s will

Jewish Medical Ethics • There is no area in life where the Torah (Jewish Bible/Talmud) doesn’t have something to say. • Medical ethics and decisions are of no exception • Basic Rule of Thumb……………. . • Life is precious no matter how unproductive and how much quality of life is lacking • All cases must be discussed with the families Rabbi who is well versed in medical ethics • Will prefer to receive blood from a family member

Jewish Medical Ethics • When a patient is put on a respirator : • They may not be removed till either they are well enough or if death sets in • At times we are allowed to sign a DNR if additional treatment is futile. • Brain Death is not death according to Jewish Law (case of Wash D. C. and South Carolina) • Abortion is prohibited except in the case of the mother’s life being in danger ex: ectopic pregnancy • No autopsies – non invasive may be employed • Limb Retrieval • Assisted Suicide • Bikur Cholim Video • Boston Legal