Re: Hospice/Palliative Care

Avrum Lapin <avrum223@xxxxxxxxxxx> wrote:

I recently read that Jews (and Blacks) avoid hospice and opt for
heroic surgery or another round of painful chemo where a good outcome
is only a few months/weeks more. Others are more inclined to select
hospice when the end is near

Is this a cultural thing (hope springs eternal that Hashem will
intervene) or is it something derived from Talmud or Torah

Ultimately, and in many cases intentionally, the latter. Too
often nowadays, the policies and philosohy determining what treatment is
given are totally opposed to the Torah, and also a reversal and
departure from former, universal accepted standards of medical care.

The new thinking in medical circles, often expressed in terms of
the need to "ration resources," essentially seeks to justify
letting patients die solely on the basis of the doctor's personal
view that a patient's "quality of life" is so diminished as to no
longer be a life worth living.

[M]any residents and younger doctors now openly advocate this
new approach ...[and] many hospitals have already adopted actual
guidelines defining quality of life that govern when to intervene
and when not to, and that medical schools are teaching this
material to doctors-to-be.... It is therefore not alarmist to
state that the lives of elderly and disabled patients are at risk
in many health care facilities today.

from http://www.jewishworldreview.com/1104/end_of_life_issues.php3
Jewish World Review Nov. 3, 2004 / 19 Mar-Cheshvan, 5765
The new ideology in health care and how to survive it
By Rabbi Mordechai Biser

Hospices, despite their favorable image in the media can be
even more hazardous:

While many in hospice assert that they will neither hasten death nor
prolong death, hospice staff around the country may misuse common end of
life interventions to hasten death. Terminal sedation, a common
intervention to relieve severe agitation at the end of life, can be
misapplied to place patients into a medically-induced coma from which
they are not allowed to recover. They die of dehydration while sleeping,
thereby allowing for a `pretty' and `peaceful,' but unnatural death,
i.e., murder.

[This] has been occurring throughout the U.S. We have families reporting
their loved one was killed off outright within hospices, through
inappropriate use of medications when there was no clinical need,
resulting in the death of an otherwise non-dying patient.

The Hospice Industry's Dark Agenda: Are Hospices Enabling Euthanasia?
http://www.hyscience.com/archives/2005/04/the_hospice_ind.php

Even more unfathomably, food and even water have been recently
characterized as "medical interventions" and hospice patients face
the risk of an untimely death by dehydration. This is a
relatively new development; Karen Ann Quinlan's father, when
asked, would not allow her feeding tube to be removed, when he
petitioned to have her taken of the respirator, which was
about 1976.

A watershed event was the reclassification of a feeding tube, which to
thousands of disabled patients is just another piece of adaptive
equipment, as a medical device, both by courts and by AMA policy. But
even patients without tubes may be receiving "artificially supplied"
nutrition by spoon. http://www.aapsonline.org/newsletters/may05.htm

It is now, I am ashamed and appalled to acknowledge, legal to cause
death by said removal in all 50 states (corrections welcome), in
contrast, maltreating one's livestock in that manner is still crime.

A person on one forum, albeit in Singapore related how the medical
staff exclaimed, regarding his mother, who had recently undergone a
gastrectomy "but with a feeding tube the patient may linger for
months" One person known to me personally lived for years.

All of the above has been chronicled numerous times. The books
by Wesley J. Smith are particularly notable (but does not
discuss the Torah injunctions pertaining to the subjects)

More and more people have reason to regret the new policies:

A decade ago, about 80% of conflicts involved loved ones pressing
hospitals and doctors to let loved ones die, according to Dr. Lachlan
Forrow, director of ethics programs at Beth Israel Deaconess Medical
Center in Boston (NY Times 2/37/05).

But today, Dr. Forrow observes, about 80% of cases involve families
pushing for continued life support.
http://www.aapsonline.org/newsletters/may05.htm

Hospices, which admit persons for whom no curative therapy is
currently available, are particularly susceptible to abuses; see
http://www.hospicepatients.org/euth-center.html

We regularly receive complaints from family members (from all over the
USA) reporting such involuntary hastened deaths.
Some hospices are not hastening the deaths of patients, but many are.
Hospice Patients Alliance supports the original hospice mission which
is to relieve suffering at the end-of-life, but never to hasten death,
allowing for death in its own natural timing.
Euthanasia and Hospice Information Center + articles - How
to Stop Involuntary Euthanasia - Hospice Patients Alliance

Halachically, that is, tht Torah view is that:

certain treatments [sic], such as oxygen, nutrition, and hydration
are obligatory for all patients, regardless of the severity of
their medical condition. This obligation is predicated upon the
assumption that there are certain bodily needs that all people
share, regardless of their prognosis, and that failing to provide
for these needs constitutes a breach in the obligation to care for
one's fellow man.

This line of reasoning considers breathing, eating, and drinking to be
normal activities of daily living, and the providing of oxygen,
nutrition, and hydration to be extensions of normal physiologic
processes rather than medical interventions. Rabbi Shlomo Zalman
Auerbach calls these treatments routine, and therefore not open to
refusal or withdrawal, unlike certain other more "extraordinary"
treatments that need not necessarily always be provided. He considers
nutrition, hydration, and oxygen to be absolutely required, similar to
antibiotics, insulin, and blood transfusions.

Daniel Eisenberg, M.D. at
http://www.aish.com/societyWork/sciencenature/The_Terri_Schiavo_Case_Related_Ethical_Dilemmas.asp

The difference between the Torah view and the recent departures
from it are illustrated in one case from New York:

A Queens Supreme Court justice, citing state and Orthodox Jewish law,
ruled last week that a feeding tube is not medicine and must be
inserted into a patient who cannot swallow unless the patient had
provided explicit instructions to the contrary.

Judge Martin Ritholtz, wrote:

"Judaism views nutrition and hydration by feeding tubes or intravenous
lines not as medical treatment but as supportive care, no different
from washing, turning or grooming a dying patient," the judge wrote.
"The first Halachic [Jewish law] principle of medical intervention is
that whenever it is possible to increase the longevity of a patient,
it should be done...."

"Those who distinguish nutrition and hydration from other forms of
medical treatment note that withdrawal of this form of support is
frequently an independent cause of death by 'gradual starvation and
hydration,' and not from the underlying disease," Ritholtz wrote.
If Terri Schiavo were an Orthodox Jewish NYer would she still be alive?
http://www.jewishworldreview.com/0405/frum_schiavo.php3

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