Cultural Approaches to Pediatric Palliative Care in Central Massachusetts: Judaism

Beliefs

• Majority of Jews unaffiliated—Judaism can be seen as identity and not faith system
• Orthodoxy is the most fundamental of the movements—adhering to Written and Oral Laws
• Conservative sees revelation as Divinely inspired and contains a large tent between Orthodoxy and Reform
• Reform sees revelation as interpreted by the individual in a dialogue between Jewish history and contemporary wisdom
• Other smaller movements generally fall on the more liberal side

Daily practices

• Orthodox—May pray three times daily, ideally in community.  Less open to non-liturgical prayer life.
• Conservative—Daily prayers valued.  Individual approaches may vary.
• Reform—prayers are valued, can be more open to multi-faith and prayers at bedside.

Dying and death

• Belief in life after death accepted by Orthodox and Conservative; Reform acknowledges as part of tradition by allows for individuals to form their own belief system
• Persons experiencing grave suffering and/or approaching death are usually encouraged to connect with community (all denominations) and pray appropriately to denominational beliefs.
• Prayers for sick can be an important part of faith in illness for those who celebrate their Judaism in a religious fashion.  The most common prayer used in this context is called the micheberach
• Autopsy and Organ Donation acceptable to the Conservative and Reform movements and smaller segments of Orthodoxy. Always have families in touch with their rabbi.
• Body to be treated with respect.  Family may want to stay with the body until it is removed by the funeral director.
• Burial recommended as soon as possible
• Cremation either prohibited or discouraged
• Graveside and funeral home services are typical 

Facilitating practices

• Ask patient and family about preferred practices
• Provide for privacy as needed

Food

• Orthodox and many Conservative will need kosher-certified food

Health

• Blood and blood products acceptable
• May wish major amputated limb to be buried in consecrated ground
• Consult Rabbi with issues of tube feeding and life support

Holy days and festivals

• Rosh Hashanah—Jewish New Year (Solemn)
• Yom Kippur—fast (no eating or drinking); Day of Atonement
• Sukkot—weeklong festival of Tabernacles
• Shemini Atzeret/Simachat Torah—Festive days concluding the High Holidays
• Channukah—eight day festival of lights
• Purim—preceded by Fast of Esther (no eating or drinking) holiday of the Book of Esther
• Pesach/Passover—weeklong Holiday of Freedom
• Shavuot/Pentecost—Holiday of Revelation
• Asara B’tevet, Tzom Gedalia, Shiva Asa B’Tamuz, and Tisha B’Av—fast days (no eating or drinking) of mourning
• NOTE—be in touch with rabbi to facilitate religious celebration in a healing environment, especially around fasting
• Sabbath and Holy Days can be days where electricity is not used (Orthodox), consult with Rabbinic authority

Pregnancy and birth

• Orthodox- Consult Rabbinic authority about birth control, Other denominations are more liberal
• All denominations allow abortion to save the mother- consult Rabbinic and other authorities

Rituals or ceremonies

• Synagogue/Temple attendance
• Lighting candles before Sabbath and Holidays
• Be aware of cultural differences in observance and practice, especially in the large and growing number of Spanish speaking communities.

Spiritual instruments, structure, and symbols

• Electric Sabbath Candles can be meaningful