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A matter of deathly importance:
At first I assumed that my personal experience was just that – a one-time occurrence, but I have since done some research and it has yielded some frighting results. For example, Dr. Hirshaut, a renowned oncologist, said in an interview in 2012, that “The way you kill a person is by preventing him from drinking for five days. Thats how people in hospice are killed, one after another”.
Just to be clear, I am not advocating against hospice care! It may very well be that after you look into your options you may decide that its best for your loved one to end their days surrounded by friends and family. Just be aware- if that is what you choose, please be on top of the situation constantly! Make sure the pain relief drugs aren’t being increased just to put the patient into a dangerous stupor. After all, you want them up and awake, alive and conscious, so you, as well as they, can enjoy this precious time together.
A grieving community member
Thank you for bringing this painful topic to people’s attention.
Tragically, I am all too familiar with what you described.
It is extremely important to make people aware of this.
I’m skeptical that a gadol would make such an insensitive remark to someone who was sitting shiva.
I don’t think this is murder. There is no direct shortening of life whatsoever. The water is available, the person just isn’t drinking. At absolute worst this is “Lo Sa’amod Al Dam Rei’echa”. If I were entitled to an opinion, I would be inclined to believe it’s actually Muttar.
@yehudayona +1
What you are describing is assisted suicide, which is a felony and sounds like an urban myth. Are you saying that the patient was not hooked up to IV’s and you didn’t object?
Even if you won’t get Missa in Beis Din, since it is like Bidka Demaya, there is still Misa Biyedei Shamayim.
@golfer +1
lesschumras, you sound skeptical that a person would let their relative be drugged up and not get IV. well, let me tell you, when i read this post it struck a cord in me because i know someone that this happened to.
my friends grandmother had a hospice nurse come to her home for a non life threatening infection thinking everything would be great. he didnt live nearby so he visited her on the first day and everything was fine. unfortunately the family didnt know to be watchful and keep an eye on the medication. when he next had a chance to visit her 3 weeks later he was horrified to see her a frail skeleton. he noticed there wasnt any IV keeping her hydrated. he pointed this out to his family and they realized that she actually hadnt been awake enough to eat or drink anything for a few days! they called the hospice care to demand an IV they said they would try to bring it in a couple of days. horrified by this, the family said they would call Hatzolah and then suddenly the hospice IV was able to start that night. my friend mentioned to me however, that the next morning when they had a Hatzolah member look at her, he commented that he was astonished at how low the IV drip was. she passed away later that day.
so leeschumras, yes that is the way it is done, and if the family isnt informed enough to object, well tragic stories like these are the results.
Thank you to the OP for raising this important issue. its about time that someone is speaking out about this travesty.
You mean to say that someone we would consider to be a Godol, would say something awful like that TO THE NIFTAR’S AVEIL during the nichum aveilim??????? I just cannot believe that for a minute, and I do not think you should write such a thing. There is absolutely nothing to be gained by adding agmas nefesh to the aveila. We are not even supposed to say divrei nechama when an aveil is making preparations to bury his meis. Kal v’chomer something so insensitive and accusatory during the shiva. That is just appalling.
A Godol visiting the choleh IN the hospice might rightfully enquire of the staff what is being done for the patient and have a discussion with the family if he sees something wrong is being done halachically. But to say something after the fact, which does NO good whatsoever, and in fact can cause great tzaar to the family to think they allowed their parent to be murdered… sorry, I don’t buy it. That does not sound like the actions of a true Godol, who would find a more appropriate time, if any, to impart that idea, than during the shiva itself. People deal with enough guilt when they lose a loved one. They don’t need such onaas devarim and agmas nefesh added on. That poor daughter.
My aunt died in a coma in hospice care, and she had a gastic food tube and glucose drip in addition to the morphine. Her body organs just shut down quietly one after another and she died. She was not starved to death. She just let go, in spite of the nutrition. Her son came at random times to see her, they never knew when he would show up. Everything was always done properly. I am not saying this is the case in every hospice, though I would hope so, and the rov’s point potentially could be a valid one, but certainly not to say it in the shiva house, if this ever really happened.
I WOULD suggest that hospice care should be a topic of discussion in halacha in every Shul and every Yeshivah. It is important for people to know that they should be vigilant about the care of their loved ones, to ensure that such a thing does not happen, because it WOULD be murder, even with the best of intentions.
There is hospice and then there is hospice. It is difficult to know the difference, and one must have a Rav who is qualified in this area to help support a family through a family member’s final illness. The concept of hospice or palliative care is a good one in theory, keeping the patient comfortable. In practice, however, it often means withholding food/water/medication and/or blood products (as well as giving too much pain medication which may lessen the breathing). And this can be problematic al pi halacha. We also went through this and had a great Rav, as well as a doctor who is a Yorei Shomayim, supporting us. Still, it was exceedingly difficult and we had to advocate ferociously for an IV, once our family member lost the ability to swallow and could no longer keep themselves hydrated. It is a balancing act which must be done sensitively and delicately.
yehudayona: +2
There’s a time and place.
DY: The story of R’ Yochanan and the woman who stopped walking to Shul comes to mind. See the Tzitz Eliezer’s T’shuvah about that story. This should seem to fall under that case.
Sam2 – the water is NOT available. The protocol in MANY hospice programs is just pain meds. NO food, NO water. They believe that feeding the body is the equivalent of prolonging death. This is how it works and if you are not careful, you will even sign consent forms that say that no life saving measures will take place, and THEY interpret life saving measures as food and drink. Sorry if you don’t WANT to know, but this is the reality. This is NOT just how it worked out for a select few.
Syag: There’s no tap in a room? They actually don’t make water available? That’s… strange. And should be prosecutable under American law.
Sam2 – not really used to that type of sharpness from you but you obviously haven’t had the zchus to watch 4 family members die so I’ll just answer anyway. Many people at that stage of life are not capable of drinking tap water, if they don’t have an IV inserted and saline administered, they can die.
@ yehudayona, iluvchulent, oomis,writersoul:
i agree that the story about the godol does sound a little far fetched, but we dont know the circumstances. it could be the story was taken out of context, but in any case i think you are focusing on a detail rather than the important point the OP is trying to bring to the public’s attention.
godol story aside, this is a very real and frightening issue that im glad the OP brought up, because, as you can see from the other posts, this wasnt an isolated incident. now i understand this is the common practice with hospice care, both in home and in facilities. as inamom and syag said, the whole point of hospice is to end the patients days in peace, and if you can do that quicker by withholding water and nutrients, thats what they’ll do.
i would hate to see this issue be brushed aside in peoples minds because of an anecdote that is just that- an anecdote.
perhaps there is some asken out there who will see this and is bothered by it, and will hopefully do something about it to avoid any more premature deaths in our community.
Sam, where’s the Tzitz Eliezer? (If you’re off by one or two, I should be able to find it.)
Syag, in fairness to Sam, the OP was seemingly talking about a patient who could eat and drink, having said that he is too oblivious to request food or drink.
DY – I think that if that was what Sam meant, he would have worded it differently.
yehudayona +1,000000. I was thinking the same thing!
oomis “You mean to say that someone we would consider to be a Godol, would say something awful like that TO THE NIFTAR’S AVEIL during the nichum aveilim??????? ” I know, I can’t believe it either. Sounds horrible!
I’m sure water is available, but I would also assume that a person in a hospice is neither capable of getting it him/herself or asking for it. It has to be GIVEN, which from what the op said, sounds like that’s not happening.
Sorry, but in a typical hospice setting, the urine is checked to see if a person is dehydrating and appropriate steps are taken. Don’t know which hospice you people have been using.
BTW, hospice care is a question for a Rav. Basically, instead of medical care which can lengthen a person’s life, the patient gets morphine, which slows down the heart and will shorten the patient’s life.
One must ask a Rav.
A few quick points:
1) providing “food and drink” Is not as simple as some of you believe. Artificial feedings have been shown not to prolong life and are uncomfortbale requiring a PEG tube or at the very least a NG/OG tube. Hydration att he end of life isnt simple either as many of these patients have heart and/or renal failure in which case IV fluid can literaly cause the patient to drown in their own body.
2) Nothing the OP described is murder. Lo samed al dam reiacha maybe As SAm pointed out(which is bad)but lets tone down the rhetoric as it only serves to cloud rational discussion
3) We dont believe in prolonging life at all costs. Obviously thses are serious questions to be addressed to a rav. If we did then by definition the patient shouldnt be in hospice
IsometimesAgree: I don’t know very much about hospice care. For that reason, I remarked only on that story and did not say anything that would indicate that it changed anything I thought about hospice care.
I hope that it was taken out of context.
Syag: I did not think I was sharp. I apologize if I came across that way. I assumed that non-comatose people can drink water without IVs. Maybe I just don’t know. But if they cannot drink water without IVs, shouldn’t not giving them the IVs be prosecutable?
Isometimesagree – I do not question that this is an important subject to be discussed by a Rov with family emmbers of a choleh. I do question the suggestion that a Godol would say such a hurtful thing to an aveilah during the shiva. That is counterintuitive to everything I have learned about how one should conduct oneself in a shiva house, and the purpose of the shiva visit. Therefore I do not believe that a Rov ever said such a thing at THAT paricular time. There is a time for everything, and that is not it.
Sometimes hospice care is a fancy name for euthanasia.
Sam, I was surprised to see your conversational comment labeled as sharp. Perhaps the ellipsis sounded sarcastic.
The OP described putting the patient into a state where they won’t ask for food or drink. This is not any less than Bidka Demaya, where he ties a person and places him in the path of water that will eventually drown him. This has nothing to do with allowing a person to die naturally. I don’t think you understood the OP the same way I did, because I can’t imagine that you disagree with this.
I hope noone goes by these comments.
You should ask your Rav.
I always thought it was permitted to put s/o on hospice, but when I was in the nursing home, a friend told me, who owns a hospice company, that it is almost Never permitted in NJ. (According to Halacha.)
Other states – it depends what it says in the Law!
Health, is nice to hear that you are out. How are you?
Getting better hopefully – IY’H.
As soon as the patient dies the hospice loses money. I’m skeptical that a hospice wouldn’t use an IV in a situation where a patient needed it to live.
Also I believe that hospice is only for people who don’t have any hope, to die in comfort. If a person had hope they wouldn’t be in hospice, they would be either in a hospital or nursing home.
This is what I think. I don’t know this for a fact.
I B”H am not familiar on a personal level with hospice care.
I know my husband once quoted Rabbi Shlomo Diamond (Sephardic community) on the dangers of a “morphine drip” for the reasons described above. I’m just trying to add to the point above that this is a known danger people should be vigilant about.
As soon as the patient dies the hospice loses money. I’m skeptical that a hospice wouldn’t use an IV in a situation where a patient needed it to live.
This is what I think. I don’t know this for a fact.
well, im glad you added the last line because the way it was explained to me is that a hospice care facility or company is paid for an entire 90 day period even if the patiant dies earlier. this would definitely explain why the practicies detailed above are being carried out.
admittiedly i was a bit skeptical that medicare would pay money like that so i checked it up. this is an excerpt from medicare.gov
How long you can get hospice care
Important: Hospice care is given in benefit periods. You can get
hospice care for two 90-day periods followed by an unlimited
so as you can see, the hospice company just stands to make money if it… -i dont want to say kills, so- causes an early departure of the neshamah. if the patient dies in a week or two they still get paid out for the period- the full 90 days.
just my 2 cents
🙂 Bump 🙂
Both of my parents died recently; my father at the end of 2012 and my mother in the fall last year. My father, among other things, had congestive heart failure. My mother had pancreatic cancer. Each of them had a signed DNR (Do Not Resuscitate order), which they had prepared many years before they each became ill. My father was about to enter a hospice service, but he died before my sister could get him enrolled. My mother was on a hospice service for the two weeks before she died.
My mother had food available to her until the time she became comatose, but it didn’t matter – she wasn’t eating anyway. She drank until the time she became comatose. After she was on hospice, she had no further fluid intake by mouth (she was in a coma) or by IV. Both the doctor and her hospice nurse explained to us that her body was shutting down; any attempt to give her fluids of any sort would simply end up drowning her internally.
She wasn’t dehydrating, she was dying of cancer. She went painlessly, B”H, with her children with her. Both the nursing home staff and the hospice personnel treated her with great dignity and respect during her last weeks.
iBump: the hospice only gets paid for the days that the patient is there.
My husband is involved in hospice. My husband’s brother runs a hospice and when he started off he would get a text every time a patient died, until he got too depressed. He does his utmost to keep his patients as comfortable as possible and even created non-for-profit programs for the families of the patients and also has his version of the ‘last wish’ foundation. These programs continue even after the patient has died. Just recently my father-in-law volunteered at a (free) camp that my brother-in-law created for the young family members of a past loved one.
When the mother of my husband’s friend passed away, the son told my husband that he was so impressed with the hospice that he wanted to go into hospice himself.
There are good hospices and bad hospices. It breaks my heart that something that was created so people could pass on in comfort is being abused.
Takamamesh, my deepest condolences on the loss of your parents. I lost mine within 5 months of each other, both unexpectedly, 20 years ago. It is very painful.
takahmamash – “Both of my parents died recently; my father at the end of 2012 and my mother in the fall last year. My father, among other things, had congestive heart failure. My mother had pancreatic cancer. Each of them had a signed DNR (Do Not Resuscitate order), which they had prepared many years before they each became ill. My father was about to enter a hospice service, but he died before my sister could get him enrolled. My mother was on a hospice service for the two weeks before she died.”
A DNR is usually Ok, but Not hospice. Did you ask a Shaila beforehand?
“After she was on hospice, she had no further fluid intake by mouth (she was in a coma) or by IV. Both the doctor and her hospice nurse explained to us that her body was shutting down; any attempt to give her fluids of any sort would simply end up drowning her internally.”
Sorry, No such thing! If the kidneys are working, and if even they are Not, you can give them dialysis!
interjection -“There are good hospices and bad hospices. It breaks my heart that something that was created so people could pass on in comfort is being abused.”
A person needs to ask a Shaila before using a Hospice!
oomis:
Takamamesh, my deepest condolences on the loss of your parents. I lost mine within 5 months of each other, both unexpectedly, 20 years ago. It is very painful.
Thank you, I greatly appreciate your thoughts.
Health:
Sorry, No such thing! If the kidneys are working, and if even they are Not, you can give them dialysis!
So you’re saying it’s OK to take an unconscious elderly woman, dying of pancreatic cancer, and put her on dialysis against her express wishes?
takahmamash:
based on your reasoning, if this elderly woman’s dying wish was to eat pork, you would allow it.
Halachah TRUMPS dying wishes. That why we have a Rov. If your Rov cannot or will not give you a Pska, at least he can send you to a Rov that is more knowledgeable about end of life issues.
But “express wishes” don’t count, the Torah does.
takahmamash – “So you’re saying it’s OK to take an unconscious elderly woman, dying of pancreatic cancer, and put her on dialysis against her express wishes?”
Not at all. Situations like these require a Rabbi’s guidance. If the Rov says you can leave her alone, then fine. But it is also possible he might tell the family to do whatever they can to prolong her life!
Welcome back Health, hope you are recovering!
It is absolutely true that the cancerous body can shut down and stop processing intake even with working kidneys, but it is not a given, and each patient has to be assessed. But I have been told explicitly that a DNR can only be signed after speaking to a rav, it is not always permissible to “let someone go”. That being said, I would absolutely give dialysis since the reverse means allowing poisons to accumulate. There are times when halacha will dictate that these things are permissible, but it probably won’t be based on whether or not the patient is conscious or unconscious, or whether or not it was their wishes. I’m fairly certain it is about what will be accomplished medically, and sometimes nothing will.
I would not question takamamash or take her to task, this is NOT about her choices or her parents, this is in answer to the generality and standard-case-scenario statements.
I would not question takamamash or take her to task, this is NOT about her choices or her parents, this is in answer to the generality and standard-case-scenario statements.
. . . take him to task
. . . his choices or his parents . . .
Takahmamash is a male.
sorry
Syag Lchochma – “Welcome back Health, hope you are recovering!”
Thanks!
“It is absolutely true that the cancerous body can shut down and stop processing intake even with working kidneys, but it is not a given, and each patient has to be assessed.”
True. A lot of times the body stops working & it isn’t just in cancer. But we don’t know beforehand, until we try. To not try, you have to ask a Shaila first.
“But I have been told explicitly that a DNR can only be signed after speaking to a rav, it is not always permissible to “let someone go”.”
This is true. Also, you need to ask a Shaila before you withhold
any treatment and/or medication.
“That being said, I would absolutely give dialysis since the reverse means allowing poisons to accumulate.”
Again, a Shaila needs to be asked beforehand. It is possible that a Rov would allow you to withhold dialysis and/or any other treatment!
To SL:
No problem!
🙂 Bump 🙂
this topic is currently rageing in the FJJ’s letters to the editor. i would suggest that anyone who lost a relative this way and feels strongly on the matter( and there seemed to be a bunch here) to submit a letter with thier experience .
Just a thought..
🙂 Bump 🙂
Sam, I’m still waiting for you to tell me where the Tzitz Eliezer is.
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