Caring for the Jewish Patient

and for the Patient’s Family

by Rabbi E. Ben-Yehuda

 

  How is a Jewish patient different from a non-Jewish patient? Some say he/she complains more. Some say they are exactly the same, only sicker. Still others insist that the Jewish patient has better and smarter anti-bodies. A story is told of a heathen who, wishing to make fun and ‘get the goat’ of Jewish sages, would ask them to teach him Judaism "while he stands on one foot" — which is to say in very quick order, since one cannot balance himself on one foot for too long. One Rabbi after another lost his temper and sent the heathen away satisfied that "Jews can’t take it." Finally the heathen came to Rabbi Hillel, a great sage and teacher, who was known for his kindness and patience. The heathen asked his question, and Hillel smiled and replied, "certainly! Hasanu aleykha al ta’as lere’akha! — What is hateful to you, don’t do to your neighbor!" The heathen was surprised and asked, "Is this it?" Hillel replied, "Yes. All the rest is commentary. Now go and learn it."

  Jewish literature originated with the Scriptures, the Five Books of Moses (or "Torah"), the Prophets and the Writings. We do not have the New Testament, or do we call our Scriptures the "old" Testament. After the Scriptures come the commentaries, which were collected in a tome called Talmud. The Talmud, in Pirkey Avot (Ethics of the Fathers) states, "Al shlosha devarim ha’olam omed: al haTorah ve’al ha’Avodah, ve’al Gmilut Khassadim." — The world rests upon three things: God’s teaching, Godly deeds and works of lovingkindness. This, like Hillel's more brief statement, is a good short introduction to what Judaism is all about.

  The name ‘Torah’ itself is most often mistranslated to mean "Law," though its root in Hebrew is either "Yoreh," which means shoot, or "Lehorot" which means to teach. Originally it was called "Torat Moshe" — the teaching of Moses or "Torat Hashem" - the teaching of God. Torah, then, is the Five Books of Moses. However, all the teaching of God is "Torah," and therefore, we also call the whole Scriptures by that name. Everyone is familiar with the story of the Israelites at Mount Sinai, where God spoke what is most often called "The Ten Commandments." In the Hebrew Scriptures, they are called "Aseret hadibrot," the Ten Statements, or words, not commands or laws! Judaism teaches that incorporated in the words of God was "the whole Torah" — the entire teaching! Why is Torah related to the verb "to shoot?" Either because God was "shooting" His teaching from Sinai at mankind, or because God’s teaching is a target for us to aim at! We must practice our skill at getting the target each and every time.

  There is more than one meaning to the word ‘avodah’ in the Hebrew — though the chief meaning is "Work." However, the "labor of God" is not just "work" in the sense of a menial chore performed mindlessly, just to fulfill an obligation to an employer. Rather, the service of God is a privilege that is at one and the same time rewarding, ennobling, and uplifting in nature. The "Avodah" of God is fulfillment of "Mitzvot" - Godly teachings found in the Torah. There is no word in any language other than Hebrew that is an exact match of the word Mitzvot - and that may explain why the word is often mistranslated (to mean "law") and misunderstood. (The singular form is "mitzvah" as in "Bar-Mitzvah.") The expiating service of atonement that was performed by the High Priest in the Temple on Yom Kippur is one example of Avodah. The daily prayers offered by a Jewish person, done in sincerity -- and leading to a commitment to live a righteous life devoted to the service of mankind is still another. This service does not have to be performed in the synagogue -- though it is better to pray in common with others -- drawing strength from the others. Jews can and should pray by themselves. They may do so while at home or away from home, while standing, sitting or lying down.

  Helping the widow and the orphan, providing what is needed for a poor girl to have a proper wedding, visiting the sick, and preparing the remains of the dead for burial — these are also examples of Avodah, which is to say labor for the glory of God, but they fall into another category: deeds of lovingkindness and mercy.

  The Torah is replete with lessons of love — love emanating from God, filling the whole world which He created. Love that was given to man as a trust to care for those around him in a partnership with God. There is no court, no authority on earth, that can legislate the ethical and moral life-style that is required of a committed Jew.

  The guidelines for a Jew’s relation to his Creator are given in Deuteronomy 6:5, "...and you shall love the Lord your God with all your heart and with all your soul and with all your might." The message of Torah is the message of true humanity and civility — it is the most demanding and the most liberating! The Scriptures summarize the concept with the following: "My son, forget not my Torah, but let thy heart keep My mitzvot... Do not despise the chastening of the Lord... Happy is the man who finds wisdom, and the man who gets understanding... Her [Torah’s] ways are ways of pleasantness, and all her paths are peace. She is a tree of life to those who hold steadfastly onto her, and happy are those who hold her fast." [Proverbs 3:1,11,13,17,18]

 

ILLNESS, DEATH & MOURNING

 

  If you have two Jewish patients, chances are that you will find that each has different "Jewish" needs. This is because, while there is only one "Judaism" -- with no different denominations, there is more than one way to manifest one’s Judaism. In fact, in the United States, there are a number of "streams" within Judaism! The Jewish people, like any other people on earth, have a more conservative, maybe even fundamentalist, "right" — and a more liberal, less traditional, "left."

  The three main divisions ("right, center, left") are: "Orthodox Judaism," "Conservative Judaism," and "Liberal (or "Reform") Judaism." Within each of these groups one also finds the more "right" wing and the "left" wing. Thus, within Orthodoxy one finds ultra-orthodox, mainline orthodox and "modern" orthodox; the Conservatives have "Traditional conservatives" on the right, and "egalitarians" on the left, with a recent addition of the "Reconstructionist" movement, which is a liberal offshoot of Conservatism that has come into its own and claims to be a "new" branch between the Conservative and the Reform; the Liberal movement divides along issue lines: interfaith marriages, patrilineal descent (the children of a Jewish father being "Jews from birth") and the practices of the synagogue concerning the prayer shawl, the head covering, the use of Hebrew in services, intermarriage and conversion, etc..

  The Jews were spread all over the world more than two thousand years ago. After the fall of the Roman empire, and especially after the rise of Islam, the world was divided into areas that had little contact with one another. Jews were left in those different areas, and developed and changed with the indigenous culture. Consequently, Judaism was split into European (Christian-influenced) Jewry, called "Ashkenazim," and Moorish Spanish (and other Islamic lands) Jewry, called "Sepharadim."

  Ashkenazim originally spoke the language of their "land of origin" -- South-Western Germany and North-Eastern France, which was German. However, after they were expelled from that area they continued to speak that language, adding to it words in the new languages of the lands they now inhabited, plus words in Hebrew for terms they didn’t have words for in German. This "bastard" language became known as "Jewish" or Yiddish. Sepharadim spoke the language of their "land of origin:" Castillian Spanish. Again, over the years, after the expulsion, they added words in Hebrew and other languages, creating what is known as "Laddino." Ashkenazim and Sepharadim have become more like the people in the midst of whom they lived than like one another. Ashkenazim are more like European Caucasian people, while Sepharadim are more like Moorish, North African or Medditeranean people. Some have hereditary illnesses that relate to their areas of habitation over the last five hundred years or more -- such as Tay-Sacks in Ashkenazim from Russia and coagulation problems in Sepharadim from Yemen.

  Judaism is a life-cycle considering practice. We deal in a religious way with everything from birth to death. When a child is born -- if it is a male-child, we must perform the ritual of circumcision on the eighth day of life. If it is a female, she is brought to the synagogue soon after birth, and the parents have her named in a special ceremony while the scroll of the Torah is read. When a person is sick and needs hospitalization, it is a great act of lovingkindness to visit the sick. If the sick person is an ‘observant’ Jew, he or she may wish to have a special diet, where the food is supervised by Rabbinic authority and is certified to be "Kosher." The primary reason for observing kashrut is holiness. By imposing certain restrictions on food preparations and consumption we are forced to pause and contemplate the propriety of our sustenance. We distance ourselves from the animals of the field by mitigating our need for food with thought of what is proper to eat, what combinations of food are proper, and what manner of serving of the food is proper. The word "kasher" (or "Kosher"), often translated "clean" should actually be translated "proper."

  Brought down to its most basic, kashrut concerns the question of "does man eat to live — or does he live to eat?" Judaism answers the question with a resounding "Man eats to live!" Because most people use meat as their source of protein in a balanced diet, it becomes necessary to take the life of animals to provide for this staple. Still, we must have reverence for life and compassion for the slaughtered animal.

  The Torah teaches "thou shalt kill of thy herd and thy flock..." [Deu. 12:21] and the Talmud elaborated on traditions set in Scriptural times concerning sh’khita (proper slaughter): Great care must be exercised to insure that the knife is smooth and will not tear the flesh when the cut is made that severs the arteries to the head, rendering the animal unconscious. The shokhet, (one who does the slaughtering), to preserve his own humanity, must recite prayers before committing the act, thus keeping his perspective concerning life and death. Though we must kill for self preservation, we must treat the animals with kindness and forethought to the end. In another passage, the Torah states "You shall not kill it and its young in one day..." [Lev. 22:28] giving further evidence of the need to show compassion to the animals one will use for food.

  Furthermore, not only are we commanded to kill with compassion — we are also warned to eat only certain animals, which are designated "Clean" (Tahor) by the Torah, and these animals must be examined before and after the killing to insure that no blemish renders them unfit for Jewish consumption.

  The Torah prohibits most emphatically the consumption of the blood of the animals. This is why the matter of Kosher food is not merely a question of choosing beef over pork, but also of the manner of preparing the meat we consider "proper" — draining as much of the blood of the animal at the time of the slaughter, removing the blood when cutting the meat into sections, and drawing blood out of the meat just before cooking by "kashering" it with rock salt and rinsing.

  For kosher food preparation, we divide all foodstuffs into three groups: Meat, dairy, and "parve" (which may be called none-of-the-above). Not everyone knows that in the meat category Judaism places not only red meat but also fowl. Of course, only "kosher" meat purchased from a kosher butcher or meat packer may be used!

  Dairy consists not only of milk and cheese - but of all foodstuff which is prepared with dairy additives: bread and pastries, desserts and salad dressing which contain milk or milk products is considered in this category. Great care must be taken to insure that we do not mix the meat and milk.

  The third group, parve, consists of "neutral" foods: eggs, fruits, vegetables, grains and fish (Though some observant Jews consider fish in a special category that is fish only, and must not be mixed with either meat or milk). Foodstuff in the Parve category can be used in combination with food of either the first or the second categories.

 

PERMITTED AND PROHIBITED FOODSTUFF

 

  PERMITTED:

 

  All Vegetables and plants.

  All four footed animals that chew their cud and have split hoofs.

  All fish that have both scales and fins.

  All fowl that are known by tradition to be permitted.

  

  FORBIDDEN:

 

  All living things that don't meet the above criteria.

  Animals, even from the above, that died of natural causes, or were killed by men or by animals except by a shokhet, ritual slaughterer.

  Any animal found to be blemished or diseased in the inspection that takes place after the kosher slaughtering.

  A kosher kitchen has separate pots and pans, separate utensils, separate cutlery and separate dishes for dairy and for meat, and the two should not be mixed!. When parve food is prepared either in meat or dairy dishes, it becomes a part of that group (that is to say, the food that was prepared, not the whole subgroup). To preserve the integrity of the kosher kitchen, even soiled dishes should not be mixed.

  Since glassware is nonporous and does not retain the taste or oils of foods with which it comes in contact, it is considered fit for use with both categories of food, though not at the same time, of course, and provided that it will be properly purged after each use. Heatproof ceramics, such as Pyrex and Corningware, are considered in the "glass" category of dishes. However, when using glass for baking, a food residue can become encrusted or baked on the surface of the pan — and therefore such pans or dishes are allowed for use with one category only. When a patient needs a kosher meal, it is possible to obtain such meals prepackaged as in airplane foods. Should you require a special diet for a patient, please consult with a Rabbi -- he may even grant a special permission for the patient to eat ‘forbidden’ foods to save a life and help in a quick recovery.

The last life-cycle event for us to consider is death. Judaism is very life-oriented, and does not advocate dwelling on matters of death, life after death, heaven, or ancestor worship. This does not mean that Judaism does not have a position on these matters — but only that we ought not concern ourselves with them unduly. We have definite rules concerning the one who died — and those who are left behind. We do not have "last rites" in Judaism, and it is not necessary to call a Rabbi to the death-bed. However, many patients, and cenrtainly their significant-others, may be comforted by the presence of a Rabbi. It is a good idea to ask the patient and the family if they wish to have a Rabbi present. When the patient dies, observant Jews will prefer (and sometimes even forbid) any post-mortem examination -- and particularely no autopsy. If such procedures are necessary, a Rabbi may be able to convince the family to allow it to take place. The family may wish to remain with the body until the undertacers come to remove it from the hospital. They may wish to have the body placed on the ground or on a flat surface -- try to accomodate them in their hour of need.

  We are instructed that disposing of the remains of the dead is one of the most important mitzvot a person can engage in. Judaism teaches that when a person dies, the soul returns to God — and the body, which was the "temple" of the soul, must be returned to the earth, from whence it came. Death is the great emancipator, striking rich and poor alike, and the grave makes the tall and the short, the fat and the skinny, the handsome and the plain equal. Therefore, Judaism prescribes a standard procedure for burial: The body of the departed is washed in a ritual of purification; it is dressed in a shroud; it is placed in a wooden coffin, and it is entombed in the ground. The preparations are done by Jews. Those who volunteer to do the work are called "Hevra kaddisha — gmilat hessed shel emet" — a holy society to render true lovingkindness.

  The dead are mourned by their direct relatives: sons, daughters, brothers, sisters and parents. The relatives exhibit their mourning by rending their clothes, by sitting in mourning for a period of seven days ("shiv’a"), by restricting their activities to the necessities of life for thirty days ("shloshim"), and by reciting the "mourners’ Kaddish" for a year. The remains of the dead have to be buried as soon as possible — on the day of the death or on the morrow -- unless a close relative will be coming to attend the funeral and takes longer in transit.

 

CREMATION

 

  Judaism forbids disposition of the remains of our dead through cremation! There are both positive and negative reasons for this ruling. Let us begin with the positive aspects:

  The Talmud notes (in Sanhedrin 46b) that the Patriarchs were all buried in the Cave of Makhpelah, except for Rachel, who was buried on the road to Hebron, in Bethlehem. The Talmud says that while we cannot deduce from the text that it is absolutely necessary to bury the dead — it may have been a custom in Canaan that the Patriarchs accepted, we do know that Jacob, in Genesis 47:29, asks his son Joseph to perform an act of "Hesed v’emet" — Lovingkindness and Truth: bury him in the family burial place. Thus the conclusion is drawn that burial is a great Mitzvah.

  The Mishnah [Pe’ah Chapter 1] says that there are a number of mitzvot of such importance that while a man is considered worthy in life for fulfilling them, his virtue remains for all eternity - and one of these mitzvot is "Leva’yat hamet," which means attending the dead unto the grave!

  Furthermore, the Talmud (Khulin 11b), forbids the mutilation of a corpse. The Torah states "By the sweat of thy face shalt thou eat bread till thou return unto the ground; for out of it wast thou taken; for dust thou art, and unto dust shalt thou return..." [Genesis 3:19] We are told that even the corpses of convicts who have been executed must be disposed of with dignity and by burial!

  On the negative side, there are many reasons to avoid cremation. The practice of offering human sacrifices to the heathen gods was common in the ancient world, and forbidden to the Jews. There was a relation between the holocaust offering of (live) humans and the total destruction of the remains of the dead by fire — which can be seen as a physical holocaust. Thus, to prevent any misunderstanding about why a corpse was annihilated by fire — it was forbidden. We read in Leviticus "And thou shalt not let any of thy seed pass through the fire to Molech, neither shalt thou profane the name of thy God: I am the Lord. Ye shall therefore keep my statutes and my judgments, and shall not commit any of these abominations; neither any of your own nation, nor any stranger that sojourneth among you: For all these abominations have the men of the land done, which were before you, and the land is defiled; That the land spue not you out also, when ye defile it, as it spued out the nations that were before you. For whosoever shall commit any of these abominations, even the souls that commit them shall be cut off from among their people. Therefore shall ye keep mine ordinance, that ye commit not any one of these abominable customs, which were committed before you, and that ye defile not yourselves therein: I am the Lord your God." [Lev. 18:21,26-30]

  Since the burial of corpses is a Mitzvah, the destruction of a body by fire makes it impossible for a person to fulfill this most important Mitzvah - and therefore, again, cremation is forbidden. Finally, in the Talmud (Gittin 56b) there is a story told of General Titus of Rome (who had ordered the destruction of Jerusalem!), who ordered that his body should be cremated and scattered to the winds, "to avoid the judgement of God." Thus, to order one’s corpse to be cremated means a rejection of God’s judgement and His Grace through pardon. Indeed, by inference, it is a denial and desecration of God himself.

  In our own age, Jewish scholars and sages have added another reason for avoiding the practice of cremation: During the Holocaust the Nazis murdered six million of our brothers -- two thirds of European Jewry — and then added to the catastrophe by annihilating the bodies of the martyrs by fire! There are no cemeteries where the dead are forever resting, where their descendants -- if there are any -- can come to remember their names and recite the Kaddish. Thus, in our own age, cremation of the body of a Jew seems to add to the ashes of the Holocaust. Surely we cannot allow this to take place!

 

LIFE AFTER DEATH

 

  Judaism teaches that when our span of time upon this earth is over, our spirit departs our body and returns to God. This means that there is a different kind of existence, not of this physical world, an "olam haba" — a "world to come" where we are no longer bound by our earthly limitations. This ‘olam haba’ is given to those who lived by God’s teaching. Judaism does not teach of the existence of a place of punishment ("hell"). Those who are not deserving of olam haba simply die and cease to exist.

  Beyond the concept of ‘olam haba’ we also have a mystic belief in "t’hiyat hametim" -- the resurrection of the dead. No one is really sure just how it is going to work - but the theory is that in time to come, when God’s sovereignty extends over the whole earth, in the days of the Messiah, the righteous shall be revived, to assume their previous lives free of strife and fear of any human failings. However, very few Jews really concern themselves with these matters at all. Basically, Judaism is very life-oriented. Judaism teaches us that life is a gift of God from tyhe day of birth to the inevitable day of our death. Therefre, we should live our lives in such a way that if we should die -- at any time -- we would not have to fear the judgement of God.

 

OUR PURPOSE UPON EARTH

 

  "...Not the dead shall praise the Lord, nor those who go into the nether world..." [Psalm 115:17] There is a story in Aggada (Jewish folktales) about the creation of man: God took six days to create everything except man. God surveyed the world which He had made and judged it to be good, and He was ready to conclude his work and begin preparations for Shabbat. His angels came to Him in great agitation, and asked Him who would speak His praise for all that He had done. Immediately, God said, "Let us make man in our own image..." [Genesis 1:26]

  Man was put on earth to praise God, and Judaism tells us that we need not be over-occupied with what is beyond us. We are meant to seek God, to find out what His qualities are — and get closer to Him by emulating these qualities. If You believe God to be kind and graceful — become kind and graceful! Do your best — and have faith that God will do rightly by you when you come before His seat of judgement.

 

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