Spotlight on CLAL

 

• Is there a role for spirituality in a medical context?

• When illness can’t be cured, what kind of care would help make life meaningful?

• How helpful is an ethical code for making end-of-life decisions?

As Americans live longer, millions, along with their families and health professionals, face difficult questions about their medical care.  Often the concerns are not only on the complications of aging, but also on the reality of living with chronic or terminal illness.  Yet, as the options in medical technology increase, the issues become more complex: Where is the line between “quality of life” and longer life? What risks in experimental treatment are worth it?  Should a doctor intervene in the last stages of a terminal illness? 

On Sunday, March 28, 2004, CLAL–The National Jewish Center for Learning and Leadership, and the Hertzberg Palliative Care Institute at the Mount Sinai School of Medicine sponsored a conference for rabbinic and medical students in the New York tri-state area on exploring the spiritual, ethical, and emotional issues in palliative and end-of-life care.  The free event was held at UJA-Federation of New York, which funded the program.   

“Treating the whole person is an essential part of making end-of-life decisions,” said Rabbi Tsvi Blanchard, Ph.D., CLAL Director of Organizational Development and a keynote speaker.  “Conclusions need to be reached in the context of our relationships.  We function in a web of connections--with family members and loved ones--and it is through these ties that we discover different viewpoints and solutions.  It’s never just between the patient and doctor.”

 

The conference was the culmination of a four-part series on palliative care for a select group of rabbinic and medical students.   Each session focused on the different perspectives of the patient, rabbi and doctor.  Participants were asked to put themselves in the “shoes” of the other, while playing their role. 

“Medical professionals are not trained to talk to patients about spirituality,” said Cynthia X. Pan, M.D., Director of Palliative Care Education at Mount Sinai, and a series co-trainer, along with Rabbi Blanchard and David Kraemer, Ph.D., a Senior CLAL Associate.  “Yet when people become seriously ill, they often experience a spiritual or existential crisis.  For some, it is easier to speak about values, beliefs, meaning and purpose in life, rather than spirituality.  As physicians and rabbis both serve as advisors and healers to the seriously ill, they need to learn a holistic approach, addressing the physical, emotional, social, and spiritual needs of a patient.”  

The conference looked at how medical and rabbinical professionals can learn together and help patients cope with the distress of a serious illness or death.  Issues covered included: the importance of dignity, control (both of self and fate), human relationships, faithfulness to family and friends, fear, denial, compassion (for self and others), suffering, and making peace.

 

In his keynote presentation, Rabbi Blanchard looked at how values in Jewish wisdom – living lives of purpose, meaning and integrity – can help patients have more complete visions of themselves.  In addition, he explored what the tradition teaches about the need to create supportive relationships, increase mindful awareness, and gain compassion.  “Even if there is no cure, healing can take place.”

    

Diane E. Meier, M.D., Director of The Lillian and Benjamin Hertzberg Palliative Care Institute at Mount Sinai School of Medicine, was the other keynoter.  In her presentation, she discussed what moved her to go into palliative care.  Citing some case studies, she talked about the importance of palliative care training. 

When asked why he participated in the program, Ahud Sela, a rabbinic student and series participant, replied that through his own personal experience, he had witnessed people suffering not only the physical pain of illness, but also the emotional and spiritual pain.  “Learning together with doctors is so important for rabbis so that we can find a common language to work together towards addressing all the needs of the patient: physical, emotional and spiritual.” 

This point was re-iterated by Dana Sirota, a medical student, who also participated in the series.  “It is critical to understand the global needs of the patient in addition to the pathophysiology of the disease.  The training helped me to recognize how integral the patients’ role is in enhancing their own care. The doctor has a unique power in providing a sense of control and strength.  The rabbi has the ability to provide a sense of community, hope, and an outlet for communication with the unknown.”

 

A critical resource in the series and conference program was Embracing Life & Facing Death: A Jewish Guide to Palliative Care (CLAL 2003).  The book, designed for patients, family members, health professionals, religious and community leaders, and others, combines the wisdom of the Jewish tradition with contemporary ethical and spiritual concerns in a reader-friendly format.  Written by CLAL faculty, including co-author Rabbi Blanchard, and one of the leading doctors at New York-Presbyterian Weill Cornell Medical Center, it offers a spiritually rich and practically oriented perspective.   

The conference and series are part of a larger effort to get doctors and clergy to train together in palliative care.  A model program, “Embracing Life and Facing Death” offers a way for rabbis and physicians in-training to become aware of the many aspects that comprise a patient’s well-being as they develop professionally.