Facing Death, Choosing Life Yom Kippur Morning 5774 – September 14, 2013 Temple Beth Torah – Fremont, California Rabbi Avi M. Schulman A year ago, I faced the possibility of not being here to lead services at Temple Beth Torah. My mother’s health was failing due to a combination of factors: diabetes, blood clots in her legs, and fractures suffered as a result of numerous falls. Over the course of the past couple of years, it seemed like my mother was on a constant roller coaster from the northern San Diego assisted living facility where she lived with my dad, to the hospital emergency room which sometimes included prolonged stays in the Intensive Care Unit. Afterwards, she would spend weeks at a skilled nursing facility. After recovering her strength, she would return to Belmont Village to be with dad. But a year ago, I did not know whether my mother was going to survive her latest medical set-back. My mind churned over the possible consequences. What if my mother died just before Rosh Hashanah? I knew all too well the Halacha, Jewish law regarding mourning for a loved one. Halacha states that if a death occurs before Yuntiff, you bury your dead, sit shiva, and then if there is a major holiday such as Rosh Hashanah, it cancels shiva altogether. You are done. Jewish law specifies that your private mourning is superseded by the obligation to be part of a communal experience of ushering in the New Year. Normative practice is to rejoin that community even if your heart is not ready. A year ago before Yuntiff, I wondered and worried how I would respond if my mother died right before Rosh Hashanah? Could I fly down to Long Beach, attend her funeral, and possibly return within a day in order to lead services here at Temple Beth Torah? If I were unable to pull myself together, who would lead services in my absence? Even if I were able to be on the bimah for Rosh Hashanah, would I be able to control my own emotions and not unduly afflict the congregation with my own grief and sadness? To do so would be unfair to the assembled worshippers who would have come to Temple to begin the New Year in a spirit of joy. Remarkably, though my mother nearly died a year ago, she recovered. This was not the first time Mom had returned from the precipice of death. Without doubt, she was aided by my brother, Marty, who is a doctor. Living only ten minutes from mom and dad, he made sure that she received excellent medical care.* But even more significantly, Mom survived because she had a tenacious will to live. If you were to have met my mom, you would have seen this nice, older Jewish lady who always had a smile and a kind word to say to everyone. But underneath that soft demeanor, my mom had a fierce inner strength. My mother did not die a year ago at this season. She lived another six months. From last September through to January of this year she was relatively free of medical trauma. I believe it was her goal to live until January in order to celebrate two major milestones. The first was that she wanted to be alive to celebrate her sister, Emma, turning one-hundred-years old. Emma is Mom’s only surviving sibling. Mom was the youngest in a family of five children. Aunt Emma’s birthday happened in mid-January and my mom was able to call Emma on her special day. Even though her big sister was not in the best of health, the two, located on opposite ends of the United States, were able to talk. Emma repeatedly referred to my mother Birdie with the same terms of endearment she used when mom was a little girl. My mother had a second goal she wanted to achieve – which was to celebrate her 85th birthday. The last weekend in January all the family – four sons, spouses, significant others, many grandchildren, nieces, nephews, and other mishpocha gathered for a luncheon party in mom’s honor. How pleased and delighted she was for all of us to be together. Even my brother Marty’s two daughters, who live in Israel, joined in the festivities via Skype so that all of Mom’s dearest loved one’s could celebrate her special day. After a wonderful weekend, we returned home. Then, just days after the party, Mom suffered a heart attack. Other complications set-in, including pneumonia. She spent a few days in the hospital and then was transferred to a skilled nursing facility. My dad was not doing well at all during that time either – not only because of the severe emotional distress over my mother’s condition, but also due to the fact that he had recently fallen and fractured his shoulder. So my mom got herself a roommate at the skilled nursing facility – my dad. It was kind of cute to think that after sixty-three years of marriage, my parents were roomies – or to use my dad’s colorful phrase, the two of them were shacking-up. Over the course of my mom’s final weeks, I was in constant touch with my three brothers. It was clear that this time mom was not going to recover. Her condition worsened by the day. I flew down to see her on Wednesday, February 13. Mom was very weak. We were able to talk for short periods of time. I helped feed her a few spoonfuls of food, but she had no appetite. I held a cup up to her lips and after she took a few tiny sips she wanted no more. I was scheduled to leave the next day on February 14. I leaned over and embraced my mom and I told her that I loved her with all my heart. I thanked her for raising me right. I assured her that I would, along with my brothers, take good care of dad. I told her she will always live inside of me. Then I kissed her good-bye. You may ask, after that farewell, was I ready for my mom to die? And here’s the truth – I was not. Despite every indication that there was no hope of a medical cure for my mother’s failing health; I was not ready to let go. I knew my mother was dying, but the critical question became: were we allowed in any fashion to hasten my mother’s death? Judaism is very clear that active euthanasia is forbidden. Acting in a way that causes a person’s death is akin to murder. But there is another side to the process of dying from the perspective of Jewish law. While it is clear that hastening death is unacceptable- what about the more subtle aspects of removing impediments to death? I was deeply familiar with centuries of legal as well as midrashic sources that seek to define those circumstances when passive euthanasia may be allowed. However, there is no clear-cut consensus in Jewish sources about when and how it is permissible to enable a person to die. There are a multitude of voices stretching back from the most ancient sources up to the most current commentaries and it was very difficult for me to discern what was the right choice to make. This dilemma would become very real for me. For it is one thing to be steeped in the wisdom of our tradition. It is quite another to apply it in real life. My brother, Marty called me the day after I returned to the Bay Area to share with me that my brothers, David and Jay and he had agreed that it was time to suspend our mother’s insulin injections. Marty wanted to know did I agree with this course of action? It was late Friday afternoon and I told Marty I required time to think about it. I needed to work through the question of whether our decision would be the equivalent of hastening her death or removing an impediment that would allow her to die peacefully? I desired time to work my way through Jewish law and commentaries and stories and legends and traditions and customs and try to determine if withholding insulin from my mother would be tantamount to killing her. We agreed that the four of us would speak on Sunday. I spent a very long day on Saturday, stretching late into the night, wrestling with questions of life and death. I struggled to come to terms with our tradition, its multiplicity of interpretations, and the subtle arguments that can be made about the boundary between taking a life and allowing someone to die. When we began our four way conversation on Sunday, I still was not convinced that withholding insulin was the right course of action. But then my brother, Marty, said with gentle firmness, “Mom has suffered enough. She is terminally ill. There is no hope for recovery. She is suffering all kinds of indignities and she is in pain. The insulin is prolonging her life, but living this way is not what she would want. Ask yourself, ‘Would Mom want to live like this?’” When Marty put it this way, shifting the focus from my own needs to what Mom would want, the answer became crystal clear. I had completely lost sight of what Mom had said to me when I was with her a few days before. In referring to all the different indignities of not being in control of her body, and having others do everything on her behalf, this woman of indomitable spirit had said to me, “I want to be finished with this.” With this realization, I was finally able to join my brothers in full support of the decision to suspend her insulin. Soon after, Mom slipped into a coma. She died peacefully two days later. My mother, Birdie Schulman, passed away on February 19. It has been almost six months since she has died – and there are things I have come to realize since her passing that I want to share with you. I have learned that when a loved one of ours is dying, it is nearly impossible to know with certainty what is the right thing to do. Regarding my mother, I was profoundly conflicted about allowing her to die. My mind struggled to come to terms with a vast corpus of Jewish law and practice that lacked absolutes about matters of life and death. There is a vast grey area about when it is right to allow someone to die and I struggled to come to terms with our tradition and to find myself standing on some bedrock of solid ground. But my mind was clouded by grief, sadness, and loss.** This, more than anything, prevented me from paying heed to what my own mother had communicated to me. Mom knew better than any of us that she had her heart’s desire fulfilled. She had lived to see her children and grandchildren thriving. She had done all she could for us – and for my father – and it was time for us to let her go. Let us find compassion in our hearts for all who have traveled down this long and painful path. For those with critical illnesses and for their loved ones, there is often a profound uncertainty about what course of action is right. There is a mystery that lies at the nexus of life and death. Human beings with critical, even terminal conditions may seek medical treatments even when the hope for survival is slim to none. Some possess a resolute will that transcends the predicted survival rate for certain diseases. Who are we to judge who shall live and who shall die based upon our scant knowledge of the immortal spirit that lies within each human being? Let us find within ourselves tender understanding for those who have lived through the nightmare of endless treatments, of seeing loved ones suffer, who have experienced the terror of not knowing if one’s life companion will live another day. The thought of letting go of someone whose life is so intimately tied with ours is nearly unbearable. But slowly, ever so slowly, an awareness grows that there comes a time when we must let go – not to be rid of the burden of caring for someone who is terminally ill – but for a far nobler reason – because we do not want our loved one to suffer any more pain. We need to let go not because we ourselves are exhausted and bone tired from giving care. We let go of the human being whose smile, warm embrace, and kiss gives meaning to our lives. We do so with the assurance that our bond with our loved one can never be broken. On Yom Kippur, we ask God to forgive us for our failings, our frailties, our frustrations, and our faults. We pray to find compassion for others, to accept the limitations that are the condition of each human being, and to find admiration for the courage our family and friends show in the face of enormous adversity. Yom Kippur reminds us of the truth that it is not just those who are ill or those whose family and friends have serious illnesses who are the ones who face heartache and struggle. This day reminds us that all of us stand at the precipice of life and death. It is a terrifying thought to consider each of us could die at any moment. We thrust this idea out of our minds as unthinkable. But we know that every day terrible things happen to good people. Our world is filled with senseless deaths: an accident, a heart attack, a car crash, a shooting that claims an innocent life and we find ourselves pushed to the extreme with our capacity to cope. On this Day of Atonement, we offer a prayer, the U’netaneh Tokef, that depicts God in heaven writing in a ledger book determining who shall live or die in the coming year. Who by fire and who by water, who by earthquake and who by hunger? And I say: I do not believe in this God. I do not believe that God acts in ways that would cut short a young person’s life or drown millions in a tsunami or bury thousands in an earthquake or takes the life of my mother because that is God’s decree. I do not rationally believe the words that are spoken – and you may not either –yet the imagery remains. Life is fragile. Death happens every day to good and innocent people. Life and death are a mystery that lies beyond human understanding. Yet, we need to come to terms with the reality of our finitude. Few of us have the courage to face our own death. We have an enormous reluctance to even acknowledge this possibility. How many of us have taken actions that express our deepest concerns about our end of life? How many of us have filled out an advanced health care directive, indicating specifically what medical treatments we would wish if we are incapacitated and unable to make decisions for ourselves? How many of us have a legally designated health care agent so that a trusted family member or friend can make critical decisions on our behalf if we cannot? How many of us have a will, stipulating how we want our property distributed when we die? How many of us have written an ethical will that clearly expresses our values that we treasure most and wish to impart to our descendents? So many of us are afraid of death, of acknowledging the fragility of our existence, of knowing that our days on earth are numbered. But to write a will and an advanced health care directive; to have a health care agent and even writing an ethical will are profound ways of sanctifying life. The psalmist proclaims, “Teach me to count my days, O God, that I may live with a heart of wisdom.” Our days on earth are numbered. Making known our deepest wishes takes courage. Lifting ourselves out of the mundane state of existence is an act of Kedushat Chayim, consecrating our lives as holy. There is value in the U’netaneh Tokef, even though it is so harsh and piercing, because it scrapes off the daily mindlessness that fill our days. The U’netaneh Tokef is powerful and haunting. Perhaps that is why this prayer is offered only twice a year, on the mornings of Rosh Hashanah and Yom Kippur, because to speak of the fragility of life more often would be more than we could bear. This prayer is Judaism’s way of teaching us the need of to face our own mortality. No one is exempt. The conclusion of the U’netaneh Tokef prayers conveys the message that we do indeed have some control over our own destiny. We draw strength in knowing that repentance, prayer, and tzedakah avert the severity of life’s uncertainties. Rabbi Amy Eilberg writes, “This confrontation with mortality can lead us to a sense of dread, despair, and overwhelming grief. At the same time, this recognition can motivate us to embrace the beauty of our lives, and to make changes so that we can live truly, righteously, and generously with the time that remains to us… The goal of the High Holidays, perhaps like the journey of life itself, is to emerge on the other end as a more righteous and godly person, more conscious of life’s fragility and beauty, and more grateful for the blessings of life.” For all of us, there is a different affirmation that we can recite everyday that spiritually fortifies us. It was composed by a poet who knew of death and disaster, of facing enemies and destruction, who did not know if he would live another day. Yet he found strength to face adversity through his faith in God. His poem, the 23rd psalm, is often offered during sad occasions such as a funeral. Yet its six verses offer each of us a compelling vision that can sustain us each and every day: A Psalm of David. The Lord is my shepherd. I shall not want. He makes me lie down in green pastures He leads me beside still waters and restores my soul. He guides me on pathways of justice for His name’s sake. Even when I walk through the valley of the shadow of death. I fear no evil, for You are with me. Your rod and Your staff – they comfort me. You prepare a table before me in the presence of my enemies; You moisten my head with oil; my cup overflows. Surely goodness and mercy shall follow me all the days of my life; And I shall dwell in the house of the Lord forever. On this holiest of days, Yom Kippur, may we have faith in God. May we dwell this day, and throughout this year, in this House of Torah, heeding the teachings of our sages, hearkening to the sound of the shofar. Let us support one another with deeds of kindness and strive to establish justice and peace throughout our world. Our heads have been anointed with goodness, our cups of thanksgiving overflow. Surely goodness and mercy shall follow us all the days of our lives. Come, with comfort and faith let us dwell in the House of the Lord forever. Amen. * I want to express my deepest gratitude to Marty and my sister-in-law, Tarra, for providing Mom and Dad with unwavering devotion and love from the moment they moved from Long Beach to northern San Diego. ** On the Saturday night before my conversation with my brothers, one of the texts I studied was a responsum by the Central Conference of American Rabbis Responsa Committee “On the Treatment of the Terminally Ill (5754.14). The responsum cited “Rabbi Immanuel Jakobovits who rules that ‘there is no obligation to prolong the life and the suffering of a clearly terminal patient.’ He permits a diabetic who develops terminal inoperable cancer to cease taking insulin. Although the insulin is a successful treatment for the diabetes, it can now only prolong suffering and delay his death. This is true ‘even though he is not yet a goses (near death); since the whole point of medicine is to restore a person’s health, (the insulin) in no longer obligatory but merely voluntary.’” I reviewed this passage numerous times, but due to my emotional state, the clarity of Rabbi Jakobovits’s position did not fully take hold within me.
Posted on: Thu, 03 Oct 2013 23:51:20 +0000
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