Death is a challenge we all face.  Unlike many, if not most, of  life’s challenges which we can temper by right thinking, right feeling and right doing, death is the one we cannot avoid.

 

We all die.  Our parents die.  Our friends and siblings die.  We die.  And our children and grandchildren die.  It is part of our lives as the Israeli poet Leah Goldberg wrote:

 

            In everything there is at least an eighth of death.

            It does not weigh much.

            With what hidden, peaceful charm

            We carry it everywhere we go.

            In our sweet awakenings,

            In our travels,

            In our love talk,

            When we are unaware,

            Forgotten in all the corners of our being --

            Always with us.

            And never heavy.

 

Death is always with us.  But that bit of knowledge is reserved for the wise, the old, the sick and the infirm because death, as the poet said, “doesn’t weigh much.”  When we are young and strong and healthy, we don’t feel its weight at all.

 

In our younger years, death’s appearance startles and frightens us.  But when we are old and can feel death’s slight presence, we no longer fear death but dread the ways in which death may appear.

 

We hope that when the time arrives for us to die, God will collect our souls or the souls of our loved ones with a kiss.  But we know that this is not always the case.  Our prayers that our very ill be gathered from us swiftly and mercifully are not always answered.  Our dying loved ones seem to linger.  Death moves slowly.  In the caesura, we find ourselves confronted by difficult choices of what to do when a new crisis develops as it inevitably will.

 

It is at this point when we feel ourselves called upon to make decisions that bring into focus our deepest beliefs about life and love.  We are confronted with a new vocabulary -- Advanced Directives, Death with Dignity,  Freedom of Choice, Patient’s Rights, Comfort Care, and DNR, DNI, and DNH; Do Not Resuscitate, Do Not Intubate, Do Not Hospitalize, respectively.

 

We reach out and take advantage of the slowing of the death process to seize death by the shoulders and shove him one way or the other. But, sooner or later, death pushes through our grasp and ends our life or the life of our loved one.

 

So we struggle together as patients, family members, chaplains, and as health-care providers to learn how we can handle, orchestrate or choreograph the physical, emotional, psychological and spiritual dimensions of dying.       

 

Sadly, there is little that we can do to guide death’s hand.  The process of dying is a life process.  But, as all other life processes, it can be and should be an opportunity for emotional growth, intellectual discovery and spiritual healing.

 

Each person’s death is as unique as his or her very being.  There is no one Jewish religious prescription that provides a universal flow chart for dying.  Each individual case is distinctive and needs to be handled by itself.

 

But the Jewish tradition places parameters on our behavior by supplying us with basic values principles that we employ in making these vital moral choices.  As a personal guide when dealing with such difficult questions concerning the issues surrounding dying and death, I employ six basic ethical principles which I have drawn from our people’s traditional wisdom.

 

(1) The Principle of Humility

 

The first principle is that of humility. Ultimately, we are not in charge of our lives.  Death and dying are for too powerful for us to command.  If we are so deluded to think otherwise, death serves as that gentle reminder to put things straight.  As a famous Yiddish proverb so aptly puts it, Mann tracht, un Gott lacht, “Man proposes and God disposes.”

 

Death, just as the rest of life, happens to us.  We can not resist the currents of life, but, with wisdom, we can learn to navigate down them.

 

Our traditions call upon us not to fight life nor flee from life but to appreciate life in all its fullness.  We are to learn for life and sanctify life.  We are to add a sense of holiness, in Hebrew, Kiddushah, to life in all its mundane aspects -- to eating and drinking, to work and to rest, to sexual desire and fulfillment, and also, to death.  They all, including death, have their unique blessing -- formula of sanctification.

 

Of all the blessings, the blessing recited on learning of a loved one’s death may be the hardest to pronounce.  How, we ask, can death which causes such pain and sorrow and grief be a blessing?  But death isn’t the blessing.  Life is the blessing.  Death is, as birth is, a part of our experience of life and has been so ever since we left Eden.

 

The first principle, the principle of humility, directs us not to struggle against death but to follow life and life’s Eternal source down the paths they lead us.

 

(2) The Principle of Stewardship

 

Well, whose life is it?  Who makes the choices?  Who makes the rules?

 

These are not such simple questions.  In American society, with our strong individualistic bent, the answer seems clear.  One owns one’s life.  For the most part, the individual is free to make his choices and to live or die by them.  But in other cultures, one’s life may belong not to the individual but to the state, or the crown, the community or the tribe, the family or the boss.

 

In the Jewish tradition, however, neither we, as individuals, nor we, as any earthly social or political entity, own our lives.  Life is seen as a gift from God.  We are, at beat, leaseholders, not owners, on the unique combination of flesh and spirit we call our lives.

 

As leaseholders, we have responsibilities to the owner.  We are called upon to take good care of our bodies and our souls at all stages of our lives.  We are encouraged to engage in physically, socially, psychologically and spiritually healing activities to maintain and enhance our lives.  The course of life that we have been allotted is a precious gift and we are directed to treat it with utmost respect.

 

(3) The Principle of Spirituality

 

In the Jewish tradition there is no higher good than life.  Life is not conditional on our ability to support other values -- justice, love, dignity, beauty, mercy, etc.  Life is, in and of itself, a non-negotiable good.  Life, the preservation of life, the maintenance of life, is so basic that, except in extraordinary circumstances, it overrides any other religious obligation we may have.  The preservation of life supersedes the Sabbath and the Day of Atonement.     

 

Life is a good in and of itself.  A life, including a life bereft of the glories, bounties, and vanities of this world, deserves the greatest respect and honor.  Life is inherently full of dignity.

 

Death, on the other hand, cannot be dignified.  Death nullifies all passing human dignities.  Whatever wealth we gained, degrees we accumulated, honors we were given, style we showed, are dissolved by death.

 

But dying as a life process can be dignified.  But this dignity, like all true human dignity, is not essentially an aesthetic judgment. It does not matter if the technology of the intensive care unit displeases us.  Dying with dignity has little to do with the sights, sounds and smells of a nursing home.  Our comfort level at the sight of a respirator or a feeding tube is not part of the equation.  Dying may not be beautiful but its dignity rests not in its appearance.

 

In the presence of death only our spiritual accomplishments retain their value and as long as we live, we can still grow and help others grow with us.  I have seen families reconciled and reunited at the dying of a loved one.  I have witnessed a demented person share love and life with a grandchild.  I have watched comatose patient provide the opportunity for a community to learn the values of love and support.  Whatever dignity there is in our deaths, is the same dignity there was in the rest of our lives.  That dignity emerges out of the way we and those close and dear to us grow as spiritual beings out of the adventures and challenges of life.

 

Life is so precious that the Psalmist claims that even God grieves at the passing of a pious person (Psalm 116:15).  The rabbinic tradition underscores this insight in the teaching of Rabbi Yaakov found in Pirke Avot, “The Teachings of the Sages”.  In that almost 2,000 year old collection of wisdom, Rabbi Yaakov taught that one moment of teshuvah, “repentance”, and good deeds; one moment of turning to God’s highest values, in this world, is more valuable than an entire life in the world to come, while a moment of the world to come, is more valuable that all the pleasures of pleasures of this world.  How can we deny an individual and his or her loved ones a blessing even more valuable that the blessings of paradise (Avot 4:22).

 

Life is indeed precious.  But if we listen to this passage correctly, we see that the Jewish tradition does not tell us to maintain physical life at all costs.  The ultimate concern is not with the duration of physical life but with enhancing the patient’s and, I would add, his or her loved ones’, opportunity for spiritual healing and growth.  We are to maintain life but we are not to exalt physical survival to such an extent that it negates spiritual discovery in its broadest sense, and becomes itself a form of idolatry.

 

The Jewish tradition calls upon us to choose life -- but not life at all costs.  My next there principle present us with options to deal with the bodily and spiritual pains of the death process.

 

As we look into death we see that the Jewish tradition talks more about what we can do than what we cannot do.  While in certain situations the “DN’s” of end life treatment -- DNR - Do Not Resuscitate; DNI - Do Not Intubate; and DNH - Do Not Hospitalize -- are appropriate, the Jewish tradition asks us not to talk about the withholding of care but rather the appropriateness of the treatment in terms of the patient’s well-being in an holistic sense.

 

We see this is our traditional prayer for healing, the MiShebeirach prayer, in which we ask for a refu’ah sheleimah: refu’at ha-nefesh, refu’at ha-guf,  “a complete healing: a healing of the spirit and a healing of the body.”

 

(4) The Principle of Healing

 

The Jewish people understand that we are called upon to heal.  Healing is a mitzvah, a basic Jewish value term with encompasses the senses of commandment, good deed, honor and privilege.  We are to address the physical pain, the social isolation, the psychological distress and the spiritual loneliness of the ill.  Our sages find the biblical mandate for healing in the law that tells us to ensure the physical recovery of those we may harm (Ex. 21:18) and in the commandment to restore that which someone may have lost (Deut. 22:2).  We, as followers of God, are to act in imitation of God who turns aside to care for the ill.  As we design a treatment plan for ourselves or our loved ones, we are directed to follow the plan that will enhance the patient’s well-being at every moment of his or her life.

 

The treatment needs to be appropriate to the patient’s condition.  Both the patient and the physician are obliged by the Jewish tradition to employ medicines, treatments and procedures of proven therapeutic value.  A patient is not required to seek out non-traditional or experimental treatments or procedures nor must a patient undergo dangerous and potentially life threatening procedures in search of a complete cure.  Life is so valuable that we are nor required to wager even a moment of life for the odd chance of recovery. 

 

Furthermore, when we approach the limits of what medical science can do to pure the patient, we need not continue to push ahead.  There are times when comfort  care is the most appropriate treatment for the patient.

 

(5) The Principle of Mercy

 

Pain has no intrinsic moral or spiritual value.  It is not good to suffer.  While some of us are able to learn and grow from our trials, the lessons are seldom, if ever, worth their price. 

 

Hardship can just as easily make us bitter and cold as it can make us accepting and warm.  Not all of us have the physical, intellectual and spiritual strength to sanctify our anguish and even the strongest of us reach a point when the pain is unbearable and ceases to be a passage to God.  In any case, while we may choose to accept our tribulation, we have no right to force that choice on others. 

 

As followers of the merciful God, we have no choice but to be merciful, to alleviate suffering, to ease pain.  We need to take physical and mental anguish seriously and treat it with all means that are avalable to us.  But we need to understand that death is not a treatment.

 

When a person declares, “I do not wish to live like this!”, the crucial words of the declaration are not “I do not want to live” but are “like this”.  We need to address the “like this”.  We need to change the person’s circumstances.  We need to treat the source of pain and discomfort.

 

The cry of anguish is a challenge to all of us as caregivers.  We need to treat the depression brought on by serious illness by appropriate psychiatric care.  We must break through the pain of social isolation by fulfilling the mitzvah of bikur cholim, “visiting the sick”.  We must overcome the patient’s sense of separation from God’s love by being loving ourselves.  And we need not be afraid of pain killing drugs.  Jewish teachings support the belief that it is appropriate to prescribe powerful narcotics and other analgesics to alleviate the suffering of terminally ill patients even at the risk of hastening the patient’s death.

 

(6) The Principle of Judgment

 

The death process, like all life processes, goes through stages.  The Jewish tradition is sensitive to the changing needs of individuals as they move through the various stages of every life process.  We see this in the traditional Jewish mourning practices during the shivah, “seven days”, sheloshim, “thirty days” and shanah, “year” periods after a loved one’s death, that move the bereaved through the steps of grief and mourning to reincorporate into the life of the community.

 

The Jewish tradition is also aware of stages in the death process.  We differentiate between a person who is seriously ill, a choleh, and a person who is terminally ill with a limited life expectancy, a tereifah, and one who is moribund, a goses.  Different treatments are appropriate for different stages in the disease and death process.  We are to use our medical knowledge to evaluate the patient and to make the judgment of what is appropriate in his or her case.

 

The sages of old understood that the uniqueness of each individual is a testimony to God’s glory.  Our lives follow their own distinctive course.  There is no one single prescription for living that is applicable to everyone.  We are not given preformulated answers to all our questions.  Rather, we are provided with underlying principles which we must compound together in varying proportions to address life’s challenges.  So to review, the principles in my spiritual pharmacopoeia are those of:

 

(1) humility -- we are not in charge

(2) stewardship -- we lease not own our bodies

(3) spirituality --  we see the issue of quality of life as a spiritual matter

(4) healing -- we are to promote the well-being of soul and body

(5) mercy -- we are to follow our merciful God

and (6) judgment -- as we use our knowledge to make the crucial choices in our lives and in the lives of our loved ones.

 

But ultimately, there is only one  principle to guide and sustain us.  It is the principle of acceptance because death is part of life.