The timing of palliative care initiation may be more appropriately directed using a needs-based approach, instead of a prognostically driven one. Jewish Law or Halachah ("the way") upholds a strong commitment to the sanctity of life and teaches that the duty to prolong life supersedes the duty to end suffering prematurely, unless one is expected to imminently die. This intersection of palliative care and a reliance on prognostic triggers with an individual's observance of religious traditions complicates matters nearing the end-of-life. A recent pilot study by Sternberg et al. of 20 patients with advanced dementia in Israel found that home hospice care significantly reduced distressing symptoms, caregiver burden and hospitalization and teaches us important lessons about some of the essential elements to providing excellent palliative care at home, including the 24/7 availability of healthcare providers outside of the emergency department. In light of specific religious practices, palliative care should strive to incorporate a patient's specific religious observance as part of high-quality end-of-life care.
This study examines the impact of the level of religious observance on the attitudes toward end-of-life (EOL) decisions and euthanasia of Jews in Israel-where euthanasia is illegal-as compared to Jews living in the USA, in the states where euthanasia is legal. A self-reporting questionnaire on religiosity and personal beliefs and attitudes regarding EOL care and euthanasia was distributed, using a convenience sample of 271 participants from Israel and the USA. Findings show that significant differences were found in attitudes between Jews of different levels of religious observance with respect to patient autonomy, right to die with dignity, and dying in familiar and supportive surroundings. The USA and Israeli Jews have similar knowledge regarding EOL care and expressed similar attitudes and perceptions toward the issues of authority of medical staff and religious figures and patient's autonomy. Findings indicate that the level of religious observance has more potency in shaping their attitudes and perceptions of EOL decisions than the state law. We conclude by discussing the implications of our findings with regard to multicultural health systems and providing practical recommendations.
Dying is a deeply personal process. The personal values, goals, and experiences of a lifetime come to the forefront during the end of life and may be shaped to some degree by the religious and cultural identity of the patient and family. When patients are part of a faith-based, religious, or cultural minority group, it can be particularly challenging for the clinical care team to gain the understanding and insights needed to reconcile disparities between majority and minority values. This article uses a case study to illustrate and review ethical issues, which frequently occur and can be anticipated in the end-of-life care of patients who identify themselves as Orthodox Jews. Although the specifics are unique to this faith-based minority group, the process of identifying, educating, and developing a means to incorporate faith-based and cultural minority beliefs and values in the provision of care can be applied to other such minority groups that the clinical team may encounter in their work.
My brother Paul, a rabbi, died recently, just shy of 3 years after the diagnosis of widely metastatic colon cancer. The story of his diagnosis and treatment is all too familiar. An apparently healthy 64-year-old man has a sudden onset of lower abdominal pain. Imaging reveals an obstructing lesion. Surgery leads to the diagnosis of colon cancer, stage IV at diagnosis, with hepatic, peritoneal, and pulmonary spread. After a diverting colostomy and time to recover from the procedure, he begins a series of treatments. Within a year, many of the metastases have melted away, his tumor markers are down, and he feels reasonably normal. Over the next 2 years, he burns through one treatment after another, including the newest and best medical science has to offer. But after 30 months, the tumor gains the upper hand as peritoneal and hepatic disease lead to biliary stenosis and massive ascites. He is in and out of the hospital with one complication after another until he has had his fill. He returns home to hospice, and within a few days he leaves this world — 34 months after his diagnosis.
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BACKGROUND: Patients' religious and spiritual values impact their goals and perception of illness, especially at the end of life (EOL). According to the Joint Commission, identifying spiritual beliefs may improve cultural competency and patient-centered care. However, clinicians may be uncomfortable discussing spirituality and unaware of basic religious teachings.
OBJECTIVES: To assess clinician understanding and knowledge of key Christian, Jewish, and Islamic teachings around EOL care before and after a one-hour educational intervention through video podcast.
DESIGN: After literature review and consultation with religious leaders, a pre- and post-test (10 questions per religion plus demographic questions) to assess knowledge of Christian, Jewish, and Islamic teachings and an educational video podcast were developed. The pretest was administered to healthcare providers, followed by a one-hour educational intervention through a video podcast. Next, a post-test was administered.
SUBJECTS: Seventy-three healthcare providers participated in this study.
MEASUREMENTS: Differences between pretest and post-test scores were analyzed employing paired t-test tests using SPSS software.
RESULTS: The median score on the pretest was Christian: 6 [2–9], Jewish: 6 [4–10], and Islamic: 6 [2–8]. After the educational intervention, the median Christian, Jewish, and Islamic scores improved to 8 [4–10], 9 [6–10], and 10 [3–10], respectively (p < 0.0001). Additionally, the total pretest median score improved from 17 [10–24] to 27 [16–30].
CONCLUSIONS: A one-hour educational intervention through video podcast significantly improved understanding of Christian, Jewish, and Islamic teachings around EOL care. The video podcast enabled easy distribution of the educational session to multiple facilities and providers. Additional research is needed to determine the longitudinal outcomes and impact on patient outcomes of this intervention.
La mort est la consécration de l’achèvement de la mission terrestre de l’homme. Le judaïsme proclamant la pérennité de l’âme dans un monde proche de l’Éternel, le passage sur la terre offre la possibilité de s’élever spirituellement par ses choix et ses actes qui seront jugés par le Créateur au moment venu.
Lorsque le décès est pressenti, les soignants en informeront les proches afin qu’ils se chargent de l’accompagnement rituel. La présence d’un rabbin n’est pas requise (tous les hommes étant égaux), elle reste à l’appréciation de la famille.
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This study examined clergy's use of 15 suicide prevention competencies. Four hundred ninety-eight U.S. Catholic, Jewish, and Protestant clergy responded to an online survey regarding their use of these competencies. Analysis of variance, backward stepwise regression, and principal components analysis were used to determine clergy group differences, predictors of use of competencies, and a parsimonious summary of competencies. Some respondents reported infrequent opportunities to develop these competencies. Respondents reported using general pastoral competencies more than suicide-specific competencies. Protestant clergy reported that their congregants watch over each other significantly more than Jewish clergy. Catholic and Jewish clergy reported significantly more competence in conducting suicide funerals than Protestant clergy. Contacts by suicidal people and number of hours of suicide-specific training predicted the use of more competencies. Competency components included postvention following a suicide, nonjudgmental attitudes, talking with a suicidal person, and pastoral care. Findings suggest that clergy may benefit from consultation and suicide-specific training.
OBJECTIVE: The objective of this study was to examine the religious/spiritual beliefs of followers of the five major world religions about frequently encountered medical situations at the end of life (EoL).
METHOD: This was a systematic review of observational studies on the religious aspects of commonly encountered EoL situations. The databases used for retrieving studies were: Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. Observational studies, including surveys from healthcare providers or the general population, and case studies were included for review. Articles written from a purely theoretical or philosophical perspective were excluded.
RESULTS: Our search strategy generated 968 references, 40 of which were included for review, while 5 studies were added from reference lists. Whenever possible, we organized the results into five categories that would be clinically meaningful for palliative care practices at the EoL: advanced directives, euthanasia and physician-assisted suicide, physical requirements (artificial nutrition, hydration, and pain management), autopsy practices, and other EoL religious considerations. A wide degree of heterogeneity was observed within religions, depending on the country of origin, level of education, and degree of intrinsic religiosity.
SIGNIFICANCE OF RESULTS: Our review describes the religious practices pertaining to major EoL issues and explains the variations in EoL decision making by clinicians and patients based on their religious teachings and beliefs. Prospective studies with validated tools for religiosity should be performed in the future to assess the impact of religion on EoL care.
BACKGROUND: International guidance for advance care planning (ACP) supports the integration of spiritual and religious aspects of care within the planning process. Religious leaders' perspectives could improve how ACP programs respect patients' faith backgrounds. This study aimed to examine: (i) how religious leaders understand and consider ACP and its implications, including (ii) how religion affects followers' approaches to end-of-life care and ACP, and (iii) their implications for healthcare.
METHODS: Interview transcripts from a primary qualitative study conducted with religious leaders to inform an ACP website, ACPTalk, were used as data in this study. ACPTalk aims to assist health professionals conduct sensitive conversations with people from different religious backgrounds. A qualitative secondary analysis conducted on the interview transcripts focussed on religious leaders' statements related to this study's aims. Interview transcripts were thematically analysed using an inductive, comparative, and cyclical procedure informed by grounded theory.
RESULTS: Thirty-five religious leaders (26 male; mean 58.6-years-old), from eight Christian and six non-Christian (Jewish, Buddhist, Islamic, Hindu, Sikh, Bahá'í) backgrounds were included. Three themes emerged which focussed on: religious leaders' ACP understanding and experiences; explanations for religious followers' approaches towards end-of-life care; and health professionals' need to enquire about how religion matters. Most leaders had some understanding of ACP and, once fully comprehended, most held ACP in positive regard. Religious followers' preferences for end-of-life care reflected family and geographical origins, cultural traditions, personal attitudes, and religiosity and faith interpretations. Implications for healthcare included the importance of avoiding generalisations and openness to individualised and/ or standardised religious expressions of one's religion.
CONCLUSIONS: Knowledge of religious beliefs and values around death and dying could be useful in preparing health professionals for ACP with patients from different religions but equally important is avoidance of assumptions. Community-based initiatives, programs and faith settings are an avenue that could be used to increase awareness of ACP among religious followers' communities.
The aim of this study was to explore nurses’ experiences working on a chronic ventilator-dependent unit with a predominance of elderly Orthodox Jewish patients at the end of life. Little is known about how cultural complexity creates differences between nurses’ and family’s expectations for patient care at the end of life. A qualitative study of 27 nurses was conducted using focus groups. Early interviews led to the expansion of the original question to include exploring nurses’ moral distress. Content analysis revealed 3 categories of themes, one of which is highlighted in this article. The main finding was an incongruence of perspectives, described as depth-of-field dissimilarity, in which the focus and depth of perspective depend on the person doing the looking. This study suggests that depth-of-field dissimilarity can be used to develop educational strategies, clinical interventions, and research to address moral distress and cultural complexity.
En indiquant comment certains rituels juifs autour de la mort sont restés inchangés au cours des siècles, tandis que d’autres ont été modifiés ou abandonnés, cet article vise un double objectif : montrer, d’une part, que la tradition est un véritable lieu de créativité et, d’autre part, que les rites dévoilent une tension entre la vie et la mort. On constate en effet que selon certains rites le défunt doit être traité comme un vivant, tandis que l’endeuillé doit être considéré comme un mort.
Cette étude du deuil, à la fois psychanalytique et anthropologique, souligne la spécificité de l'approche analytique.
L'auteure met en évidence les processus de deuil, leur temporalité, leur spécificité, et montre leur reprise, dans l'après-coup, au cours de la cure analytique. Elle démontre combien l'inscription du deuil dans le monde social soutient le rapport symbolique de chacun à la mort.
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Ce dossier thématique regroupe les articles suivants : rituels d'autrefois, rituels d'aujourd'hui ; des funérailles... pourquoi ? ; des rites funéraires dans un contexte non religieux ; l'homme est à partir de sa mort ; les rites de deuil dans la tradition juive ; une "équipe de funérailles" dans la tradition catholique ; quand sonne l'heure des funérailles ; disparaître ; voir ou ne pas voir le corps du défunt ; "j'ai pu voir notre frère...", témoignage ; cendres. Témoignage ; cénotaphe : du vide habité de sens ; "la vie est belle...". Les attentes et la parole d'une personne en deuil ; les attentes des personnes en deuil ; le deuil, du point de vue des endeuillés ; faire mémoire en soins palliatifs ; témoignage de Véronique ; extraits de Comment j'ai vidé la maison de mes parents.
Ce numéro thématique regroupe les articles suivants : les rituels ; des rites avant et après la mort : réflexions d'un catholique ; la conception de la mort dans la religion juive ; les rites de passage chez les musulmans ; à propos de la vie et de la mort : les rites funéraires dans la tradition du bouddha ; les vivants et les morts chez les manouches ; entretien avec T. Koné ; nouveaux besoins, nouvelles pratiques ; internet : vers des rites funéraires virtuels ? ; la toilette mortuaire ; les enfants et les rites funéraires ; témoignages.
L'objectif de cette thèse était d'étudier la place du soignant dans l'accompagnement spirituel du patient en fin de vie, et si cette place peut être acceptée dans le cadre de la laïcité en France. L'auteur fait notamment un état des lieux des pratiques religieuses/spirituelles en France et aborde le cadre législatif encadrant spiritualité et soins. Puis, il présente l'enquête qualitative menée auprès de personnes bien portantes, appartenant aux groupes religieux majoritaires en France.
Après avoir défini la place et le rôle du rite dans le rapport à la maladie et à la mort, les auteurs, un à un, confrontent la fin de vie aux grandes religions : christianisme, islam, judaïsme et bouddhisme.