The following article was published in the January 19th edition of the Community Review newspaper in Harrisburg, PA, and was adapted from a D’var Torah given by by Barry Stein, Executive Director of Jewish Family Service, at Kesher Israel on December 30, 2017. This is Part 1 in a two-part series on end-of-life.
Today (December 30), is the 3rd annual Respect Life, TEAM Shabbos. TEAM stands for Traditional End-of-Life Awareness Movement and represents a national initiative that focuses on Parashat Vayechi, the last Torah portion in the book of Genesis, as a springboard for “generating awareness, educating and guiding the community on end-of-life matters.” End-of-life considerations bring to the table long-standing, strongly held belief systems, including medical ethics, halachic (pertaining to Jewish law) directives, and personal values.
My purpose with this D’var Torah is not to address death’s last act, in which end-of-life decision making takes place in a highly charged medical environment; but rather to speak about the essential, honest conversations that need to come long before one is in death’s throes. I imagine it doesn’t surprise you one bit to hear this coming from a social worker, but please understand that my motivation also comes from personal experience. Shabbat Vayechi also corresponds to my mother’s, Frances Winokur Stein, 27th yarhziet; and the progressive illness that plagued my mother during the last 14 years of her life has, without question, informed my perceptions.
The way my family dealt with my mother’s illness should not necessarily be held up as a model for others. That’s not to say that my wife and I weren’t significantly involved with my mother and father’s care. My mother was diagnosed with multiple sclerosis in her early 50’s. Ten years later, with my mom in both physical and cognitive decline, as well as seemingly suffering from social isolation, my wife and I approached my father about forming a joint household, not only to give them support but to give my father the opportunity to live more affordably in the face of significant care-giving costs.
In the end, we did succeed in achieving these goals in many respects. However, what my family didn’t do when my mother was still of clear mind or, in subsequent years, as my father became frailer, was talk about and plan for the end of life. My father was uncomfortable with discussing death, particularly in light of my mother’s chronic illness, and flatly refused to do so.
For many years, Patricia Bomba, VP/Medical Director of Geriatrics for Exellus Blue Cross/Blue Shield of Rochester, NY, published a yearly Thanksgiving article in the local Rochester paper. It was entitled “Talk Turkey with Family about End-of-Life Wishes” and encouraged people to have these difficult discussions at a time when families traditionally gather from far and wide. As Bomba explains it, “While a casual observer could find our family’s Thanksgiving tradition to be a bit morbid, we have found that it strengthens our family bond. By getting these issues literally “on the table,” we each gain peace of mind, knowing our own wishes will be honored….”
So, what does the parasha of Vayechi have to do with Bomba’s encouragement that we start a new Thanksgiving tradition? The parasha itself is called “Vayechi,” placing the emphasis on the culmination of Yaakov’s life as opposed to the finality of his death. Yet as we read this parasha and think back on who Yaakov was and how he lived his life, it also reminds us of what might well have been lacking in Yaakov’s life when it came to preparing for his death.
I have always looked upon our forefathers’ and foremothers’ behaviors, as described in the book of Genesis, as teaching us more about what we shouldn’t be doing than what we should be doing. With no disrespect in mind, I’m concerned that the relationships between Yaakov and his sons would almost preclude the kind of conversation Bomba is proposing.
To begin with, Yaakov always seemed to be running away from something, whether it was from Esau, Lavan, or even himself. Some commentators suggest that Yaakov was struggling with his own conscience when he wrestled with the angel. Even once he returned to Canaan to raise his sons, the emphasis placed on “settling” conveys that Yaakov wanted to distance himself from difficult conversations and the harsh realities of life; he seemed practically oblivious about how he contributed to the animosity that the brothers eventually felt toward Yosef.
And in the twilight of his life, as described in Parashat Vayechi, some of these same patterns of family discord and poor communication seem to rear their ugly head:
- “And it came to pass…that someone said to Yosef ‘Behold! – your father is ill’” (Genesis 48:1). The text gives us the impression that Yosef was clueless that his father was dying and yet not long before, Yaakov, sensing his death was imminent, had beckoned Yosef to his bedside and requested that Yosef bury him in Canaan rather than in Egypt. I can only wonder whether the Torah is pointing to an underlying emotional distance between father and son that pre-dated Yaakov coming down to Egypt.
- “Yosef saw that his father was placing his right hand on Ephraim’s head and it displeased him; so he supported his father’s hand to remove it from Ephraim’s head to Manasseh’s head “(Genesis 48:17). Once again, this exchange, appears to belie a tension between father and son. In other words, who is in control here, the Yosef (the father) or Yaakov (the grandfather)? Not to mention, Yaakov seems to be repeating the sins of the past.
- “Yosef’s brothers perceived that their father was dead, and they said, ‘Perhaps Yosef will nurse hatred against us and then he will surely repay us all the evil that we did him” (Genesis 50:15). The suspicions that the brothers still harbor about Yosef being duplicitous in spite of his earlier assurances, punctuates the deep-seated tensions that were at play in Yaakov’s family.
In recent years, advancements in hospice and palliative care have given new meaning to the importance of end-of-life conversations. Due to the Jewish imperative on “Choosing Life,” we, as observant Jews, sometimes jump to the conclusion that hospice and palliative care can never be reconciled with halachic (Jewish legal) mandates. And yet, it is not so black and white. Both palliative care and halacha hold a shared respect for the sanctity of a human life even when they differ, at times, about the best way to help people make the most out of their remaining time in this world. As much as possible, rabbinic authorities should view weighty issues like when the process of death begins and what constitutes hastening or prolonging that process, through the lens of how a particular patient understands her/his health condition and the trade-offs she/he is willing or not willing to make. It is also important to keep in mind that those of us who are more inclined to a halachic perspective, have family members who don’t share our observant life styles.
Suffice it to say, holding meaningful conversations about end-of-life decision making sooner rather than later can make a significant difference in enabling families to navigate the landscape of aging. To that end, Jewish Family Service has recently introduced a new counseling service with a focus on the dynamics of the aging process. If you need help in facilitating family conversations about preparing for the end-of-life, please don’t hesitate to call us at 717-233-1681.
I have little doubt, were my mother given the chance to do it all over again, she would jump at the opportunity to engage in these essential conversations. May her memory be for a blessing.
