"So teach us to number our days, that we may get a heart of wisdom...." (Psalm 90:12)
Truth be told, there are no "soft issues" in medical ethics, unless by "soft" we mean the human issues, the matters of the spirit that so influence people's capacity to heal and even (as research seems to be showing more and more) their ability to be cured. "Soft" is the "how" dimension of medical ethics, a critical complement to the "what" decisions that are often its salient province or overriding focus.
Perhaps the best place to start is to ask, "What are the psychosocial needs of people going through serious medical experiences?"
Let it first be acknowledged that the needs of these people are not unlike everyone else's -- just, perhaps, more so. People who are suffering, or struggling, or facing mortality -- and those who care for them -- need what we all need, if more urgently, boldly, unavoidably.
These universal needs include: a restoration of connection, a new relatedness -- to a sense of self, the community, creation, God, the big picture; transcendence, growth, meaning, affirmation of their total identity (including but not limited to their diagnosis, condition or illness), an expanded sense of hope and possibility; re-empowerment, striking a balance of dependence and independence, taking charge and letting go; tools to integrate major losses or fundamental life-disruptions into their life-narrative.
Jews who are suffering, and those who care for them, similarly need and deserve resources of guidance, strength, insight, comfort, solace and hope -- and, for centuries, have looked to Jewish tradition and the Jewish community for these resources. In diverse host cultures and civilizations, Jews developed a very strong tradition of bikur cholim (reaching out to those who are ill and those who care for them). This mitzvah was understood as a basic and far-reaching commandment that requires and enables us to emulate God's own care and concern, indeed, to partner with God in making that care and concern manifest and tangible. Bikur cholim was highly developed through our treasured, evolving corpus of both narrative and legal texts.
"The essential feature of the mitzvah of visiting the sick is to pay attention to the needs of patients, to see to what is necessary to be done for their benefit, and to give them the pleasure of one's company. It is also to customary to pray for mercy on their behalf." (Kitzur Shulchan Aruch 193:3).
What a cogent summary of what folks need. Practical and individualized help, social and interpersonal connection and intercession/dialogue with God in echoing or amplifying the patients' needs, wishes and prayers.
The good news is that these efforts, at least in my experience, are on the rebound in our community. More and more synagogues, Jewish community centers, day schools, healing programs, family service agencies, and other Jewish organizations are developing or revitalizing bikur cholim efforts, sometimes called G'mach for gimilut hasidim (deeds of loving kindness or caring committees). More than 200 bikur cholim organizers and volunteers, from more than 75 different sites in all corners of the Jewish community, took part in the November 2002 15th annual Bikur Cholim Conference in New York City. Jewish chaplaincy, long the terribly underfunded and neglected professional field in our community, is experiencing a growth in recognition, support and status. Rabbis, cantors and Jewish educators are devoting more time in training and continuing education to expand their skills and enhance their effectiveness in reaching out to the ill and their families and professional caregivers. And materials that help Jews hope and cope are multiplying.
Yet, so much remains to be done. We live in a society that desperately seeks not only to avoid disease and pain at all costs but also to deny vulnerability, aging, disability and mortality -- and the Jewish community is not immune from these biases. Though it is somewhat more comfortable than it was in recent decades to utter the "c" word -- cancer -- Jews, like everyone else, recoil from serious illness, and we need to strategize how to restore illness and death to their natural and important place in our lives.
There are many ways to bring about the reintegration of illness and death into communal life. School curricula, youth group projects, film series, concerts, art exhibits, public programs where people tell their stories, rabbinic sermons and bulletin pieces can all work to undo the denial of suffering and death and enable Jews of all ages, backgrounds and affiliations to share the vulnerability and burdens of disease and disability. In these and other ways, we can reach for a time when Jews will feel freer to let others know of their challenges, more secure in asking for help and less constrained in offering it.
Complementing these educational and cultural innovations and communal change ought to be substantial advocacy efforts that work for a more humane and holistic approach to pain, suffering and healing. Convention resolutions are fine, but we must do more to "walk the walk." Synagogues, schools, service agencies and JCCs must join in challenging the current health-care systems that render so many suffering people alone, confused and despairing. Practical efforts directed at changing legislation, policies, and managed-care companies must go hand in hand with the one-on-one, direct support and service provision.
Our generation, as those before and after us, will be judged by how we listen and attend to those who are sick and vulnerable and to those who care for them. In the end, there is actually no "them"; there is only "us."
Reprinted from the Journal Sh'ma, a service of Jewish Family & Life!
Rabbi Simkha Y. Weintraub, a certified social worker, is rabbinic director at the National Center for Jewish Healing/Jewish Board of Family and Children's Services in New York.
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