Jewish faith and Code status

VFlutter

VFlutter

Flight Nurse
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We have a decent percentage of Jewish patients in our hospital and I have noticed that many, if not all, of them will refuse to take their family members off full code status (sign a DNR) or will refuse palliative care consults. One of the nurses said that it may be against their religion. Can anyone shed some light on that? Is it something that is directly against their religion or just a common attitude in their culture? Just wondering if anyone else has noticed this.

My patient today was 98y A&Ox1, CHF, Met CA, and the family insisted om making the patient a full code despite RN/MD suggestions. The patient has been pretty unstable and I am not looking forward to potentially codeing her tomorrow. I think the Drs will just do a minimal code and call it quick. We do have a ethics board but we rarely use it for situations like this unless they are very prolonged.
 
It's about the sanctity and protection of life, which Jews see as orignating from God and valuable above all else. Life is a gift, to be treasured. Also, the Ten Commandments are very key, and that whole "do not kill" comes so much into play when running end-of-life decisions through the Jewish faith.

Here is a document you can read for more details:http://www.rabbis.org/pdfs/hcpi.pdf

It's really hard to respect other people's choices and faith traditions when they seem cruel or misguided. I get what you're saying.

The time to make real change in the situation was a year ago, when the patient was still able to make decisions that wouldn't come down to DNR/DNI or feeding tube issues.

Rest assured, the patient will indeed die. Hopefully you won't get an ROSC first.
 
Try this:
http://www.jlaw.com/Articles/EndofLife.html

From what I remember and understand, it could be considered desecration of the body. Death is very sacred, and care of the body prior to burial can be complex and very stringent.
 
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It is a sanctity of life thing. Anything that is not done to further life is automatically seen as taking it away, which is a no-no. Unfortunately this leads to some really nasty situations where the "treatment" ends up causing more pain/distress.
 
There was a time when the catholic church also felt this way but they have more recently lightened up on it. They also used to prohibit organ donation but they've changed their views on that as well.
 
Just out of curiosity, are these Hassidic Jews? (Black clothes, beards etc.)
 
bigbaldguy said:
There was a time when the catholic church also felt this way but they have more recently lightened up on it. They also used to prohibit organ donation but they've changed their views on that as well.
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Now if we can get rid of transubstantiation.
 
Shepard said:
Just out of curiosity, are these Hassidic Jews? (Black clothes, beards etc.)
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Nope. He also was not wearing a yamaka, so I don't know if that makes him a certain type of Jew or if he was not wearing just because he was in the hospital. I think certain sects only wear yamakas at the synagogue where as others wear them all the time? Sorry, I do not know all that much about the specifics of the religion.
 
Yarmulke just FYI.
 
ChaseZ33 said:
Nope. He also was not wearing a yamaka, so I don't know if that makes him a certain type of Jew or if he was not wearing just because he was in the hospital. I think certain sects only wear yamakas at the synagogue where as others wear them all the time? Sorry, I do not know all that much about the specifics of the religion.
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We are all supposed to wear them but many of don't follow all the rules.
 
There are the Hassidic jews (black clothes, beards,etc) and there are also reform Jews. Reform Jews still practice Judaism, but in less strict and pious manner. They generally attend synagogue on major Jewish holidays, rather than weekly, and most reform Jew don't wear yamakas regularly. They look and act like most other people, just hold on to their faith.

On the code question, as others have said, life is very sacred to Jewish people, and after they die, their past life becomes even more sacred (there are certain prayers in the Torah which are read weekly in synagogue for remembering the dead). Prolonging life is of most importance to them, even if it disagrees with social norms/expectations... or the wishes of the actual patient. Note: you also have the factor of maybe they just don't want to let their loved one go.

Hope this helps.

Source: I'm Jewish
 
For those of you who are Jewish and also work in the healthcare field do you have a conflict between your religious views and personal experience as far as your wishes go? After seeing what we do to some patients at the end of their life would you still want everything done for you? This isn't meant to be a judgmental question I totally respect your decisions just curious.
 
ChaseZ33 said:
We have a decent percentage of Jewish patients in our hospital and I have noticed that many, if not all, of them will refuse to take their family members off full code status (sign a DNR) or will refuse palliative care consults. One of the nurses said that it may be against their religion. Can anyone shed some light on that? Is it something that is directly against their religion or just a common attitude in their culture? Just wondering if anyone else has noticed this.

My patient today was 98y A&Ox1, CHF, Met CA, and the family insisted om making the patient a full code despite RN/MD suggestions. The patient has been pretty unstable and I am not looking forward to potentially codeing her tomorrow. I think the Drs will just do a minimal code and call it quick. We do have a ethics board but we rarely use it for situations like this unless they are very prolonged.
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This is a problem across all populations.

4 years ago one of the patients I was assigned to was a septic ped, he had one side of his face removed, both legs, and the right arm because of necrosis, the family (catholic) kept a 24 hour prayer vigil going for a week, with a priest telling them a miracle was possible. (like his limbs and face were going to magically grow back and life would be normal)

We put on probably the best code I have ever seen in an ICU. It was a show for the family. It served no medical purpose. Live theatre at its finest.

I guess it is about detatchment. We knew we weren't helping the kid. We knew he was going to die no matter what.But we played our game like we were going to win. It gave the family what they wanted. Cost us about 15 minutes worth of time.
 
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I would think a lot of it is more they don't want to let their family member go. Signing a DNR has a sense of defeat about it, even though as healthcare providers we realize it's much better for the patients. Jews also have great respect for the dead and dying, and if someone is terminally ill, for Hassids or a stricter sect, it may actually be illegal to invade their body attempting to ressusicate them. For reform Jews, end of life rituals and such may only begin after they've been called, or just before.

Well... that was convoluted. Sorry, been up for a while. In conclusion, while there may be some religious parts of it, I think its just very hard for the families to let go and give up.
 
firetender said:
I'm not sure it's in our protocols anymore. We used to have to call in for orders on it.
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JPINFV said:
Now if we can get rid of transubstantiation.
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You mean a piece of bread doesn't turn to flesh and wine to blood. Imagine that!!

Bit of trivia: Do you know that is where the term "hocus pocus" comes from?
 
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VirginiaEMT said:
You mean a piece of bread doesn't turn to flesh and wine to blood. Imagine that!!

Bit of trivia: Do you know that is where the term "hocus pocus" comes from?
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I know what Wikipedia said.

Also... thankfully schizotypal is culturally limited.
 
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