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August 28, 2014 / 2 Elul, 5774
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Pulling The Plug

In Winnipeg, Manitoba, Canada, an Orthodox family is finding themselves in a battle with the hospital that is caring for their father. The case will be going to court to determine who has the right − the doctor or the family − to decide the course of treatment that would sustain or take the life of a patient. In this case, the children do not want their father taken off life support. The medical system is fighting to make the decision to “pull the plug,” that of a doctor, and not the family. Should the hospital win, the implications for the old, sick and disabled may be frightening.


 

Any well spouse who has had their partner hospitalized for an extended stay, or for that matter even a short one, has probably experienced the pressure to sign a DNR (do not resuscitate) from the hospital professionals. There seems to be an outlook among many medical professionals that do not equate quality of life with the old or infirm. It may be a question of money. After all, it is very expensive to keep people alive on life support. And so, as well spouses, we are often presented with the argument on how much better − more humane − it would be to not try any “heroic measures,” should problems arise and death is imminent, and just let our partners go.

 

We, as Jews, are bound by halacha (Jewish Law) when it comes to making these decisions. As a well spouse, that ruling has always given me great solace. Whenever the hospital started pressuring me, I knew I could and should consult with a posek (a rabbi that answers halachic questions) who specialized in these issues. I would be bound by his halachic decision. And, until now, so was the hospital.

 

I knew a well spouse that was coping with the hospitalization of her husband who had a frightening and potentially terminal illness. The doctors presented the various options in the course of treatment. One alternative presented was to do nothing and let “things proceed naturally.” How to proceed − or not − needed to be decided by the family, many of whose members lived in different places. Arguments arose not only between the children and the mother about what course of treatment to take, but even the children disagreed among themselves as to how to proceed in their parent’s best interest.

 

The emotional stress was tearing this once close family apart. They finally called a rav, whose specialty was in the area of medical issues. They presented the rav with everyone’s point of view. And asked him who was right. How should they proceed? To shock and relief of all family members, the rav reminded them that it was not their decision to make. The halacha would determine what to do next. He then asked the questions he needed in order to give them a halachic decision about what they were to do. The well spouse shared with me the relief that she and her family felt once they had involved the rav. The arguing stopped and the family came together in support of each other and the decision. They now spoke in one voice − the voice of halacha − and the doctors followed their instructions.

 

We, as Jews, have a halachic system that is there to guide us in every situation. In terms of illness and making − literally − life and death decisions, it is an amazing gift, to know you did the right thing and made the right choice. By following the halachic decision, families can be united instead of pulled apart, whatever the outcome.

 

We live in a time when the growing trend is that the decision of how our loved ones will be treated may no longer be family or halacha-centered, but left to those with medical and ethical degrees that work for the hospitals. The cost of the treatment along with the age and type of illness suffered may be the determining factor in deciding what course the hospital should take, if any.

 

I once heard a lecture by just such an ethicist on medical issues. This young, healthy man was a great proponent of health proxies. He talked a lot about “quality of life” and how he would not want to prolong his life if he had to live it from compromised health. Not too long after this lecture, the young man was unfortunately diagnosed with inoperable cancer. I often wonder if his view changed as his health deteriorated.

 

If, G-d forbid, the Manitoba (Canada) ruling is in favor of the medical system over the family, I suspect we may see fewer older and infirm people leaving hospitals once they are admitted. Today, families are still able to make the medical decisions concerning their loved ones. To do so with the guidance of halacha gives not only direction, but can unite your family and provide the peace of mind that comes with knowing you did the right thing − the only thing that you could and should have done.

 

Anyone wishing further information on the Manitoba case or wishing to sign an online petition or contribute to the legal fund can get information at miriam@samuelgolubchuk.com.

 

You can reach me at annnovick@hotmail.com

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When one is blind one learns to use Braille to read. When one cannot walk, a wheelchair gives mobility. Sign language allows a mute person to speak and ocular implants assist in hearing when one is deaf. These are all compensatory strategies that help a person function despite his disability. But compensatory strategies are not just for physical problems. Understanding our psychological weaknesses and setting up our lives to ensure that we are not tempted to repeat our past mistakes, is as necessary as any aid to the disabled.

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Over the past two weeks I have shared letters from a therapist and a well spouse. Both of the letters gave personal insights into the process of losing hope, how we react when that happens and some ways of coping when test scores, diagnosis and just simple repetitive behavior indicate that change for the better is impossible.

Dear Ann,

I’ve read your last few articles on psycho-neurological testing (Oct.8-22) with interest. As a therapist who has counseled couples dealing with chronic illness, I’d like to give you another perspective.

Dear Ann,

Your articles on the Neuro-Psychological Testing were right on (October 8-22). My husband underwent testing twice and your articles explained it things exactly the way they were. Besides the test, we also tried therapy.

Very often when we can’t face our big hurts or big loses we focus on the little ones. We can discuss those. We can cry over the small loses, be angry at the smaller hurts even though it may look trite and sound ridiculous to others.

Over the last two weeks we have been discussing one way in which well spouses can determine whether behavior displayed by their ill partners is caused by their illness or is a way they have chosen to act. We have focused on Psycho-Neurological testing, what it can tell us, as well as its pros and cons.

Last week I discussed a question that haunts many well spouses: not knowing if the difficult and often inappropriate behavior frequently displayed by their partners are caused by the disease and therefore not-controllable, or if the behavior is a choice the spouse makes and can therefore be changed. This doubt can be the source of much frustration and many marital disagreements. One way of alleviating this doubt is by having a psycho- neurological work up done. But that path is not so simple.

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