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Nursing with Dignity Part 1: Judaism

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VOL: 98, ISSUE: 09, PAGE NO: 35

Alisa Collins is a third-year nursing student at King’s College, University of London

There are an estimated 13 million Jewish people in the world, of whom 300,000 live in the UK - 200,000 in London.

It is important to note that there is a wide spectrum of observance among Jews. For example, some non-orthodox Jews identify themselves with the Jewish people but do not fulfil many of the religious observances. However, most Jews follow the customs of Jewish life.

Jews are divided according to their beliefs and their origins, having their roots either in central Europe (Ashkenazi Jews) or in Spain and the Middle East (Sephardi Jews).

The main divisions of belief and practice are as follows:

- Orthodoxy. This is made up of two main groups - the modern orthodox, who have largely integrated into modern society while still observing Jewish law, and the ultraorthodox, who live separately and dress in a traditional fashion;

- Non-orthodox. At the other end of the spectrum, conservative, reform and liberal Jews consider themselves non-orthodox.

This article reflects the opinions and beliefs of orthodox Jews. This does not cover all members of the Jewish faith and, as with all religions, it is best not to generalise but to discuss patients’ needs with them or their families.

It is important to note that when it comes to vital medical procedures, especially those that relate to saving life or limb, Jewish law requires that the doctors’ rulings be followed, even when this would conflict with other laws. This is based on the Biblical legal principle that saving one’s life is of cardinal importance.

Beliefs

Judaism is the belief in one eternal and omnipotent G-d (it is customary for Jews never to write the word God as this prevents His name from being erased). The Jewish people have a highly moral lifestyle and regard the Jewish Bible (the Torah) and its commandments and teachings as a way of life rather than a religion.

Worship takes place in a synagogue and the religious leader of a community is a rabbi.

In its broadest sense, the Torah refers to the whole body of Jewish law and teachings. This has two distinct elements: the written law, which consists of the five books of Moses, The Prophets and the rest of the Old Testament; and the transmitted (or oral) law, which is made up of the teachings of the rabbis from earliest history and includes the Talmud and the Code of Jewish Law.

When meeting an ultraorthodox Jewish person for the first time, bear in mind that physical contact between men and women is reserved for immediate family only. It would be inappropriate for a man to offer to shake a woman’s hand or vice versa. Ultraorthodox patients may be more comfortable with a nurse or doctor of the same gender, where possible.

Dress

In strict orthodox practice, most men and boys cover their heads with a small skullcap known as a ‘kippah’ or ‘yarmulke’. Some married orthodox women keep their heads covered by wearing a wig called a ‘shaytel’, a hat, a beret or a scarf. This is to distinguish between married and unmarried women. The wig or head covering is not a religious item but fulfils a religious requirement. If necessary, it can be removed in an emergency.

Diet

Jewish people are required to eat kosher food, that is food that is fit to be eaten in accordance with Jewish law. Many diverse laws relate to eating kosher food so it is always advisable to ask patients or their families what their custom is.

Broadly speaking the laws on food govern two areas - food types that cannot be eaten, such as pork and shellfish and derivatives thereof, and the utensils in which food must be cooked. Meat and milk may not be eaten or cooked together. For this reason orthodox households always have two sets of pots and pans, crockery and cutlery - one for meat dishes and one for dairy products. Hospital plates and cutlery cannot be used.

These laws are predominantly kept by orthodox Jews, but not by all. Cooking methods are different so offering patients a vegetarian meal is not a suitable alternative. Hospitals can order kosher meals, which may be reheated in the hospital ovens. These meals come prepared, with plates and cutlery.

Orthodox Jews wait up to six hours between consuming meat and dairy products, and some drink only kosher milk. All medication is permitted, except when there is an alternative. For example, some cough sweets/throat lozenges contain gelatine, which is not kosher.

Sabbath

Throughout history, the Sabbath has been central to Jewish life. From biblical times onward, it has been observed as a day of rest and spiritual rejuvenation. It has its origins in the Torah. Genesis relates that, after creating the world in six days, G-d rested on the seventh day. The Sabbath begins at sunset on Friday and continues until nightfall on Saturday (a 25-hour period). During the Sabbath, orthodox Jews will do nothing that might be counted as work. For example they cannot drive, cook, use electricity/telephones (including using the patient buzzer), watch television, bath or write.

Once again, where there is a threat to health, many of these restrictions can be set aside. However medical staff are allowed to carry out all necessary tasks on behalf of any patient in hospital. Certain customs are normally carried out in an orthodox home on the Sabbath, such as lighting two special candles on Friday just before sunset to mark the beginning of the Sabbath. Most hospitals will not allow this, and the blessing can be made on electric (not fluorescent) lights instead.

In a life or death situation, the laws of the Sabbath are temporarily set aside as saving life takes precedence.

Sexuality

In a Jewish marriage, the woman sets the pace of the relationship and her monthly cycle influences the most intimate areas of the couple’s life together. During her menstrual period, the couple will abstain from sexual relations and tactile affection for about 12 days. This time is referred to as ‘Niddah’, and begins with the onset of her period.

This monthly cycle of abstinence and intimacy helps to maintain a healthy sexual relationship while allowing others areas of the couple’s relationship to develop in tandem. As any discharge from the womb renders a woman ‘Niddah’, a gynaecological examination may interrupt the natural flow of a couple’s relationship. Similarly, a woman is considered to be ‘Niddah’ when her waters break during labour.

Homosexuality

Society’s perceptions of homosexuality have shifted over the years and many people see single-sex relationships as natural and valid. The Torah does not debate the validity or otherwise of a single-sex relationship but it does forbid homosexual acts, condemning them in the strongest possible terms.

Circumcision

Circumcision is the removal of the foreskin from the crown of the penis, which usually occurs when a baby boy is eight days old. A ‘mohel’, who is certified medically to perform this procedure, will carry out the circumcision, known as a ‘Brit’.

The ‘Brit’ will be postponed if the baby is too small, jaundiced or unwell for any reason. The boy is given his name at this time. If the baby’s mother is readmitted to hospital for any reason, it may be possible for the Brit to take place in an appropriate room in the hospital. As the procedure is carried out by qualified people who are often medical professionals, complications are rare. Also, the mohel’s task includes visiting the mother and child a number of times over the next three days.

Contraception

Judaism values two fundamental principles in marriage. First, the value of intimacy in a relationship and the bonding of two individuals. Second, procreation underpins this relationship with the promise of a future generation. In light of these two dynamics, contraception and the methods used need to be handled delicately, which would include the advice of a rabbi.

The advice given by a rabbi will depend largely on the family’s physical, emotional and psychological health. Although there are acceptable forms of birth control, methods of contraception vary significantly and not all recommendations would be appropriate for a religiously observant family. For example, the use of condoms is not appropriate as only female contraception is allowed.

Abortion

Abortion is allowed only if the pregnancy represents a danger to the health (mental as well as physical) of the woman. Pregnancies that result from rape or incest will normally be terminated according to most rabbinical authorities. It is preferable that abortion takes place within the first 40 days of the pregnancy.

In certain circumstances foetuses in a multiple pregnancy may be terminated to allow the others to develop normally. Foetal illnesses or abnormalities present complex challenges and require specialised rabbinical guidance.

Organ donation

Organ donation is as complex an issue as life and death itself. In many cases the harvesting of organs for donation is not permitted. There are many legal considerations in Jewish law and a rabbi must be consulted before going ahead with any procedure.

Organ donation may be permitted when the organ is needed for a specific and immediate transplant. Yet in consideration of the prohibition against desecrating the body, Jewish law forbids the donation of organs for general medical research or to an organ bank, where there is no specific and immediate recipient.

Blood transfusions

Jewish law both encourages blood donation and allows patients to receive blood and blood products.

Prolonging life/euthanasia

Withdrawing life support after a patient has been certified as brain-stem dead is a highly controversial area of Jewish law. In all instances, a rabbi should be consulted. Jewish law forbids active euthanasia as human life is considered sacred.

Autopsy

Judaism does not allow post-mortem examinations out of respect for the human body. Where a body is referred to the coroner, every effort should be made to contact a rabbi, who then liaises directly with the coroner.

Death rituals

When a Jewish patient dies, nurses should always try to contact the patient’s rabbi or the Jewish chaplain designated to the hospital. If they are not available, staff are permitted to carry out basic procedures immediately. These include closing the eyes and mouth, with strapping if necessary. Any external catheters and medical equipment attached to the body may be removed and all incisions should be dressed.

It is essential that the body is laid flat, with hands open, arms parallel and close to the body, and the legs stretched out straight. There is no need to remove identification bracelets or wash the body as the Jewish Burial Society will prepare it for burial.

The body should then be wrapped in the mortuary sheet and removed to the appropriate place, according to hospital procedure.

It is traditional for relatives or friends to keep vigil by the body and recite prayers. If possible, their wishes should be accommodated. Although the recital of prayers is encouraged, there is no concept in Judaism of last rites.

A Jewish burial should take place as soon as possible after death and arrangements for the release of the body should be made without delay. Even if the patient had not been a particularly observant Jew, he or she would want to hasten the burial. But if death occurs on the Sabbath or a festival, there is little that the Jewish community can do to prepare for a funeral.

USEFUL TELEPHONE NUMBERS

United Synagogue Burial Society: 020 8343 3456

Hospital Kosher Meals Service: 020 8795 2058

Jewish Community Information: 020 7543 5421

The Board of Deputies of British Jews: 020 7543 5400

Jewish Bereavement Counselling Service: 020 8349 0839

Drugsline Chabad (support line for drug users, former users and their families): 020 8518 6470

Miyad (Jewish crisis helpline): 08457 581 999

Chai Lifeline Cancer Care (Jewish cancer support service): 020 8202 2211

Jewish Association for the Mentally Ill: 020 8458 2223

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