Mendel Janowski

WITHIN A

HEALTH CAREENVIRONMENT

A GUIDE TO

JEWISH PATIENT CARE

MENDEL JANOWSKI

COMMUNITY DEVELOPMENT COORDINATOR

YORK CENTRAL HOSPITAL

© 2008 by Menachem Mendel Janowski.All rights reserved. No part of this document may be reproduced or transmitted in any

form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission of Menachem Mendel Janowski.

Note: In consideration of the Jewish practice of not writing the name of the Creator, to avoid disrespect, this resource guide will

use the spelling of “G-d” in its stead.

“It is much more important to know what kind of person has a disease, than what kind of disease a person has.”

Sir William Osler

TABLE OF CONTENTS

Acknowledgments...............................................................................................1

Introduction..........................................................................................................2

Judaism in a Nutshell...........................................................................................4

Kosher Food.........................................................................................................6

Shabbat...................................................................................................................8

Jewish Holidays...................................................................................................11

Modesty...............................................................................................................16

Dying and After-Life Scenarios......................................................................18

Miscellaneous.................................................................................................21

Conclusion.......................................................................................................23

Recommended Guidelines for Jewish Patient Care...................................24

Glossary...............................................................................................................26

Ten Year Calendar of Jewish Holidays & Fast-Days....................................28

Contact Information........................................................................................30

Rabbis & Synagogues........................................................................................32

Accommodations & Kosher Food.................................................................33

Notes...................................................................................................................34

Index....................................................................................................................36

ACKNOWLEDGMENTS

During times of illness and crisis, our spiritual needs often increase. Patients and their families draw strength and comfort from their religion and hope from their beliefs. It is important to remember that spiritual care is an ongoing component of a patient’s overall journey, not something to be addressed at the last minute. Attention to spiritual needs can improve patient outcomes and therefore their quality of life.

There is a growing body of evidence that links a patient’s religious faith to the healing process. Several important surveys have documented the central role that religion and belief play in one’s recovery. Other polls demonstrate a rising interest among patients to have their spiritual concerns addressed by their caregivers.

Recognizing the growing importance of religion, medical schools have begun to incorporate courses on spirituality and bioethics into their teaching curriculum. A fundamental aspect of these studies is learning how to communicate with patients about their spiritual needs.

INTRODUCTION

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INTRODUCTION

WHY IS THIS BOOKLET NECESSARY? With the current rapid pace of ethnic diversification accelerating, the provision of culturally competent health care is critical. This booklet was developed in response to the growing demand among health care providers for a practical resource and information guide on understanding and meeting the needs of the Jewish patient.

It is important to note that the information in this

booklet is limited to the presentation of general

guidelines and does not replace the need to consult the

patient or family’s Rabbi, Spiritual Advisor or Jewish

Chaplain for Jewish legal/ethical (Halachic) issues,

advice and opinion. This booklet is not intended as a

quick course on Judaism. It is aimed at helping health

care providers provide culturally appropriate care for

the Jewish patient.

In the event of a Jewish legal/ethical question when treating a patient who wishes to follow Jewish law (Halacha), the rabbinic authority that has been appointed by the patient or substitute decision maker should be consulted as long as the additional delay will not endanger the patient’s life or limb or worsen the patient’s health status.

Within Judaism there are specific laws that address life-

threatening emergency medical situations which, during

such times, over-ride and replace normally applied

Jewish law. Therefore, when it comes to saving a

human life, if there is no time to consult a rabbinical

authority, Jewish emergency medical directive dictates

that immediate medical intervention must be

undertaken to save a life and under no condition should

an emergency procedure to save life or limb be delayed

in order to seek out Jewish legal opinion.

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WHAT IS JUDAISM?Judaism was the fi rst religion to recognize and believe in the existence of one G-d. It is the religion of the Jewish people, based on principles and ethics embodied in the Torah, which is commonly referred to as the Jewish Bible, or the Five Books of Moses. G-d’s law for ethical conduct (Jewish law) was then passed down from generation to

generation in a chain of unbroken tradition to this day.

JEWISH BELIEFThe laws and commandments that were revealed to the Jewish people at Mount Sinai are referred to as the Torah. In general, the Torah is divided into two segments: the written law and the oral law. The written law has three sections: 1) the Five Books of Moses, which includes: Genesis, Exodus, Leviticus, Numbers and Deuteronomy, 2) the Books of the Prophets and 3) the Scriptures. The oral law, which elaborates on the written law, includes the vast corpus of Torah texts, most famously the Mishna, Talmud and Code of Jewish Law. The Torah addresses ethical responsibilities and values and outlines ritual and religious paradigms and obligations.

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DIFFERENT LEVELS OF OBSERVANCE, CUSTOMS & AWARENESSWithin Judaism there can be different levels of religious observance, customs and awareness. Therefore, in relation to religious requirements, no one patient is necessarily the same as the next. The patient and his/her family will likely lead in this regard, as they express to staff their religious needs, if any.

Many of the laws and customs mentioned in this pamphlet are based on a traditional approach to Jewish observance. This was done in order to demonstrate observance from the Orthodox end of the spectrum and, thereby, allow the reader to extrapolate from these examples an appropriate degree of caring for those with differing levels of religious observance, customs and awareness.

JUDAISM & HEALTHAccording to Jewish belief, a person’s body belongs to G-d and, therefore, one has a religious obligation to look after his/her health by seeking out the best medical care available. And while Judaism recognizes that all forms of healing is in the hands of G-d alone and not an individual, it also acknowledges that G-d grants health care professionals the ability to act as agents in delivering curative treatment. Therefore, seeking medical treatment is regarded as standard obligatory behavior within the Jewish community.

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KOSHER FOODWHAT IS KOSHER, AND BASIC JEWISH LAWS CONCERNING FOOD

Kosher means “fi t for consumption” and refers to the Jewish dietary laws. According to Jewish law, only food that follows the Kosher stan-dards is fi t for consumption by Jews. Kosher certifi cation means that the product has been certifi ed by an authorized rabbinic authority.

Kosher foods are divided into three categories: Meat, Dairy and Pareve (neutral).

Meat includes meat, fowl and their by-products, such as bones and skin. Any food made with meat, or the above-mentioned by-products, is considered meat. All meat products require kosher certifi cation.

Dairy includes all foods that are derived from or contain milk. This includes butter, yogurt and all cheeses. Many “non-dairy” creamers, sweeteners, cereals, candy and margarine contain milk derivatives and are considered dairy. All dairy products require kosher certifi cation.

Pareve refers to foods that are neither meat nor dairy. This means that they contain no meat or dairy derivatives, and have not been cooked or mixed with any meat or dairy foods. Some examples include eggs, kosher fi sh, fruit, vegetables, pasta, soft drinks, candy and snacks. As with meat and dairy, most of these products should be used only if they bear reliable kosher certifi cation.

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KOSHER FOOD

KOSHER (KASHRUT) CONSIDERATIONS & PRACTICAL APPLICATION

Meat and dairy foods may not be cooked, served, eaten or mixed together under any circumstance. Jewish law requires separate cooking and eating utensils for meat and dairy. These utensils may not even be washed together. Pareve foods (neutral), on the other hand, can generally be mixed with meat or dairy. Therefore, Jewish patients who

keep kosher should not be served any combination

of meat and dairy.

Many food items, medications, supplements, thickened fluids, and similar that may seem neutral (that is, neither meat nor dairy), are not as innocent as they appear. Sub-ingredients that do not appear on the ingredients list often render the food dairy, meat or non-kosher. One must consult the kosher label to determine the true status of the food. If there is no kosher alternative, and the patient expresses concern, an authorized rabbinic authority should be consulted.

Furthermore, kitchens and utensils (microwaves and re-therm units included), which have been used with non-kosher items are rendered non-kosher. They will transfer that non-kosher status to kosher foods and should not be used in the preparation or warming of kosher items. However, food trays that are double wrapped and sealed with rabbinic certification may be heated in non-kosher warmers etc. provided the wrapping and seals are not broken. In order to avoid confusion and uncomfortable

situations, it is very important that kosher food trays

be served as is, without opening any of the original

wrapping or substituting additional items. As well,

any food (even one with kosher certification) that was

not included as an original item on the kosher food

tray should not be added unless it is under the direct

supervision of an authorized rabbinical authority.

For Passover dietary laws see “Jewish Holidays – Pesach” page 14.

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Shabbat, the Jewish Sabbath, is a commemoration of G-d’s creation of the universe. On the seventh day, Shabbat, G-d rested from His work of creation. According to Jewish law, the Shabbat begins approximately 18 minutes before sunset on Friday afternoon and ends with nightfall, Saturday evening. Its duration is approximately 25 hours.

Havdalah, the ceremony that formally concludes the Shabbat, is held Saturday evening after nightfall.

Note that because the Rabbis or Jewish Chaplains are likely Shabbat observant, they may not be accessible until the Shabbat is over.

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SHABBAT

A BRIEF OVERVIEW OF BASIC SHABBAT OBSERVANCES

Shabbat is a day eagerly awaited throughout the week, a time to set aside the week’s concerns and devote oneself to higher pursuits. Some of the Shabbat observances include services in synagogue or prayers at home (or even in one’s room - if unable to attend synagogue), the lighting of the Shabbat candles before sundown (many facilities provide electric candles), recitation of the Kiddush (a blessing recited over a cup of wine or grape juice acknowledging the sanctity of the day), the blessing over the Challah (traditional, braided bread served during the Shabbat meals) and the festive Shabbat meals.

As mentioned above, Shabbat commemorates G-d’s resting from the works of creation. We emulate this with the cessation of certain creative activities that are related to effecting physical changes in nature (e.g. tearing toilet-paper - many facilities provide pre-cut tissues, cooking, writing, handling money, sewing, kindling a fire, changing the state of an electrical current, turning lights on or off, adjusting beds, using a telephone, automatic doors or elevators, driving etc.). However, Shabbat and its laws are much more than a list of “do’s” and “don’ts.” They help create a unique, restful and spiritual atmosphere. Shabbat is a total immersion experience that shapes the people who observe it.

SHABBAT AND HEALTHIn the event of a Jewish legal/ethical question when treating a patient who wishes to follow Jewish law (Halacha), the rabbinic authority that has been appointed by the patient or substitute decision maker should be consulted as long as the additional delay will not endanger the patient’s life or limb or worsen the patient’s health status.

SHA

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Within Judaism there are specific laws that address life-

threatening emergency medical situations which, during

such times, over-ride and replace normally applied

Jewish law. Therefore, when it comes to saving a human

life, if there is no time to consult a rabbinical authority,

Jewish emergency medical directive dictates that

immediate medical intervention must be undertaken

to save a life and under no condition should an emergency

procedure to save life or limb be delayed in order to

seek out Jewish legal opinion.

SHABBAT CONSIDERATIONS & PRACTICAL APPLICATION

As Shabbat observance includes the cessation of certain activities, allowances should be taken into consideration when dealing with a Shabbat observing patient or family member. For example, allow verbal consent rather than written, defer payment, understand that one may not ride an elevator, use the telephone, turn lights on or off, push call buttons or ride in a car if it is not medically

necessary. Therefore, it could happen that in the event of a discharge they may not be able to leave the facility until the conclusion of Shabbat.

Another consideration addresses the scheduling of shifts for Shabbat observing employees. It is greatly appreciated when institutions implement a timetable that accommodates the religious beliefs of their personnel, whenever possible.

In view of the above, it is highly commendable when organizations recognize and respect the Shabbat needs of patients, visitors and staff, allowing them to observe the Shabbat to the best of their ability and in accordance with Jewish tradition.

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JEWISH HOLIDAYS

JEWISH HOLIDAYS

AN INTRODUCTION

The Jewish calendar is used to determine the dates of all Jewish Holidays. The common Gregorian calendar is based on the solar cycle, while the Jewish calendar uses both the lunar and solar cycles. Therefore, while Jewish Holidays occur on the same date of the Jewish calendar every year, they will not occur on the same date in the Gregorian calendar (please refer to the Ten year calendar on pages 28 and 29 for this year’s dates). Just like Shabbat, Jewish Holidays begin approximately 18 minutes before sunset and end with nightfall.

Additional similarities between Shabbat and Jewish Holidays, with the exception of Chanukah, Purim and the intermediate days of Sukkot and Passover (which are from the third day of the Holiday until the sixth day, inclusive), are the lighting of candles (many facilities provide electric candles), the recitation of Kiddush (benediction), the blessing on the Challah or Matzah, the festive Holiday meals on the eve of the Holiday and during the day and refraining from some of the creative activities that are prohibited on the Shabbat. The observance of Yom Kippur is similar to Shabbat, the main exception is that eating and drinking is prohibited. Medical questions related to fasting should be directed to an authorized rabbinic authority.

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HOLIDAY CONSIDERATIONS & PRACTICAL APPLICATIONS

Many, but not all, activities that are prohibited on the Shabbat are also prohibited during the Holidays. Chanukah, Purim and the intermediate days of Sukkot and Passover are the exception and on those days such activities are permitted.

It should be noted that some patients and family members may observe religious restrictions during Jewish Holidays, which include handling money, adjusting beds, using elevators, electric doors or telephones, turning lights on or off, pressing call buttons and even returning home in the event of a discharge before the Holiday is over. For a better understanding of these laws, to accommodate the patient or in the event of a question, please consult an authorized rabbinic authority. Note, that because the Rabbis or Jewish Chaplains are likely to be observing the Holiday, they may not be accessible until it is over.

THE HOLIDAYSROSH HASHANAH, commonly referred to as the Day of Judgment or Jewish New Year, is a two-day Holiday generally celebrated during the months of September or October. It marks the creation of the world and humankind and is a time for reflection on the past year. The central observance of Rosh Hashanah is the sounding of the Shofar, a ram’s horn.

YOM KIPPUR, the Day of Atonement, begins eight days after Rosh Hashanah, commencing before sunset and concluding after nightfall the following day. During this twenty-six hour period, Jews refrain from all eating and drinking (even water). Medical questions related to fasting should be directed to an authorized rabbinic authority. Bathing (for non-medical purposes) and the application of non-medical ointments are also forbidden on this day. Yom Kippur is considered the holiest and most solemn day of the year. Its central theme is atonement and reconciliation.

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SUKKOT, the Festival of Tabernacles, also referred to as the Season of Rejoicing, is celebrated four days after Yom Kippur, beginning before sunset and extending till nightfall seven days later. The Sukkah, a central point of the Holiday, is a temporary outdoor structure covered by foliage. These structures are traditionally used as symbolic dwelling places for the duration of the Holiday. Jews typically eat their meals in the Sukkah and try to spend as much time there as possible. It is an extremely important religious and cultural symbol. Another significant Sukkot observance is the taking of the Four Species on each day of the Holiday except for Shabbat. One takes an Etrog (citron), a Lulav (palm branch), three Hadassim (myrtle branches) and two Aravot (willow branches), grasps them together, recites a blessing and waves them in all directions.

SHEMINI ATZERET and SIMCHAT TORAH is a joyous two-day festival that follows immediately after Sukkot and celebrates the completion and subsequent commencement of the Torah

reading cycle.

CHANUKAH, the Festival of Lights, is an eight-day Holiday that is generally celebrated during the month of December. It commemorates the victory of the Maccabees over the ancient Greeks and the re-dedication of the Jewish Temple in Jerusalem after its desecration under the rule of Antiochus IV. During the re-dedication, a single container of consecrated olive oil was found, enough to kindle the Temple Menorah (candelabra) for only one day. Miraculously, that oil burned for eight days – the amount of time it took to press, prepare and deliver new oil to the Jewish Temple. To commemorate and publicize these miracles the Menorah is lit nightly. One light is kindled on the first night, two on the second, and so on until the eighth night, when all eight lights are kindled.

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PURIM, a most joyous and fun Holiday generally occurs during the month of March. It commemorates a time when Jews living in Persia were saved from extermination. The four main observances associated with Purim are:1) listening to the public reading of the Megillah (Book of Esther) in the evening and again the following morning2) sending gifts of food to friends3) distributing charity to at least two needy individuals4) eating a festive Holiday meal

PESACH, or Passover, which begins one month after Purim and extends for eight days, usually occurs in April. It commemorates the Exodus and freedom of the Jews from enslavement to Pharaoh in ancient Egypt. One of the primary Pesach symbols is the Matzah, a flat, unleavened (cracker-like) bread that recalls the hurriedly baked bread that the Jews ate during their hasty departure from Egypt. Jewish law prohibits eating or owning Chametz (food product made from wheat, barley, rye, oats, spelt or their derivatives that has leavened or fermented) for the entire Holiday. Chametz includes items such as bread, cake, beer, whiskey, pasta and anything made from raw dough that had been left to rise for 18 minutes or more, as it then begins to ferment. The first two nights of Pesach feature the Pesach

Seder – the evening meal in which the Exodus and subsequent freedom are remembered.

SHAVUOT is a two-day Holiday that begins fifty days after the second day of Passover, usually during the month of May. The word Shavuot means “weeks” and marks the completion of the seven weeks (forty-nine days) between Passover and Shavuot, signaling the start of the wheat harvest. In addition, on this day over 3,300 years ago, the Torah (the Five Books of Moses and its teachings, including the Ten Commandments) was given to the Jewish people on Mount Sinai. JE

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FAST DAYS: There are five minor and two major fasts in the Jewish calendar. The minor fasts include the Fast of Gedaliah, the Fast of Tevet, the Fast of Esther, the Fast of the

Firstborn and the Fast of Tammuz. The minor fasts last from dawn until nightfall. Should they occur on Shabbat, they are postponed until Sunday. While these fasts are more lenient for people with medical conditions and those who have difficulty fasting, one should consult with an authorized rabbinic authority in cases of doubt. However, the two major fasts, Tisha B’av and Yom Kippur, are considerably longer and more stringent than the others. Questions related to fasting on these days

should be directed to an authorized rabbinic authority.

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MODESTYPhysical modesty is a key component of traditional Jewish life for men and women alike. The term “modesty” is used to describe and defi ne character traits pertaining to conduct, especially between the sexes, affecting dress, attitude and behavior. It is important to realize that modesty is the subject of differing interpretations among various segments of Judaism. This is simply a brief overview of general practices in order to dispel common misunderstandings.

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MODESTY

PRACTICAL APPLICATIONMany observant men and women unrelated to each other refrain from any physical contact with the opposite gender unless medically necessary. A number of rabbinic authorities prohibit shaking hands with the opposite sex while others are more lenient and allow it in certain settings.

Many married women wear hair coverings (e.g. wigs, hats, scarves) while men cover their heads with a Kippah (skullcap) or cap. It

is quite common for these head coverings to fall off and

patients appreciate assistance in restoring them.

While there are varying standards concerning modest dress, many women will attempt to cover their arms till the elbows and legs till the knees and everything in between. As such, the standard hospital gowns are rarely considered modest apparel. Therefore,

many patients may request two long-sleeved gowns,

enabling them to adequately cover themselves.

NIDDAH, LABOUR AND DELIVERYNiddah, also known as family purity, refers to a state of separation between husband and wife. It occurs when a woman notices uterine blood caused by her menstrual cycle, or other occasions, such as childbirth. According to Jewish law, during the time of bleeding and for seven subsequent days husband and wife abstain from physical contact. The laws of Niddah do apply during labour. As such, in a situation where a couple is following these laws of family purity, the labouring

wife may require the assistance of a nurse, birthing-coach

or midwife even though her husband is by her side. Simple activities such as helping one climb in and out of bed or passing items to one another are avoided by many. As these laws touch on intimate facets of a couple’s relationship, many couples may be uncomfortable and unable to adequately explain their needs and will greatly appreciate your patience, understanding and interest in assisting them during this time.

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DYING & AFTERLIFESCENARIOS

SANCTITY OF LIFEIn the Jewish tradition, life is sacred, given and taken by G-d alone. A living body is animated and vivified by a spark of Divinity, with which it is endowed by G-d. So long as G-d sustains the spark of life it is sacrilegious on our part to extinguish it. Every breath is endowed with Divine purpose even when such purpose cannot be perceived (e.g. patient in comatose state). Jewish patients and their families often have strong feelings on this matter and appreciate when medical staff consult a rabbi of the patient or family’s choosing if questions arise. Furthermore, just as there is a Jewish way in life, so to there is a Jewish way in death. Judaism believes that part of the soul remains with the body, at least until burial. Accordingly, bodies are treated after death with the same dignity that is accorded to them in life. This is a complex subject and standards vary even within the Jewish community. It is therefore recommended that one consult with the rabbinic authority that is authorized by the patient or family.

HEROIC MEASURES, DNR AND ORGAN DONATIONThe precise definition of a heroic measure depends directly on the circumstances involved. Therefore, in a case where death is inevitable, one must consult with the authorized rabbinic authority of the patient or substitute decision maker’s choosing in order to determine how to proceed with both new and ongoing procedures.

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Regarding the traditional Jewish view of DNR and organ donation, they are neither banned completely, nor given indiscriminate permission. The parameters determining the permissibility of DNR and organ donation within Jewish law are subtle and complex. Therefore, when faced with any of these situations, one must consult with the rabbinic authority that is authorized by the patient or substitute decision maker.

ON THE THRESHOLD OF DEATHA person in his/her last few hours of life, i.e., in the final process of dying, is termed a “Gosess,” moribund. This is jointly determined by authorized medical and rabbinical authorities. The Gosess is perceived by Jewish law as a living person in all matters and hastening the death of a Gosess is strictly forbidden. When a patient is clearly approaching the end, Jewish law forbids all forms of physical contact that may hasten death. This includes washing the patient, closing eyes, removing the pillow, touching or handling, providing nonessential medical interventions such as unnecessary blood-pressure readings etc. A Gosess is compared to a flickering candle that can be easily extinguished if touched.

If a patient or family has requested the presence of a Rabbi or Chaplain, it is important to summon them as soon as possible so they may be with them during this difficult time.

VIDDUYIt is an important custom to recite the Vidduy, a

confessional prayer, as one nears the end of life. It can be recited by the dying person or someone else if the dying person is unable. It is very important to contact a Rabbi or Jewish Chaplain for this prayer.

CARE OF THE DECEASEDJewish law requires the funeral and burial to take place as soon as possible following death. The body should not be left unattended from the time of death until the burial. Unnecessary delays are viewed as disrespectful to the deceased.

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Therefore, once death has been ascertained, prompt notification to the local Jewish funeral home by or on behalf of the next of kin and assistance in coordinating the necessary paperwork to release the body as quickly as possible is of great importance.

It is important to collect the sheets the body is lying on, as well as anything else that is stained with or contains the patient’s body tissue or blood and give it to the Jewish funeral home representative. Assistance in these areas is greatly appreciated.

Being that Jewish funeral home representatives are likely

to be Shabbat and Holiday observant, if death occurs during

those days, they may not respond until the conclusion of

the Shabbat or Holiday. In such a situation, leave a message

for the funeral home representative and try to refrain from

moving or touching the deceased, as much as possible.

Upon death, it is customary to open a window in the room, turn on a light and for the family, Rabbi or Chaplain to recite certain prayers. One may disconnect IV lines and catheters, however, care should be taken not to remove the actual needles or tubes from the body. It

is preferable for the body to be covered with a sheet and

left untouched, awaiting the arrival of the Jewish funeral

home representative. However, if necessary, one may close the eyes, straighten the arms and legs, elevate the head and close the mouth (by placing a rolled up towel under the chin) of the deceased. As well, if the space where the body is laying is needed, one may respectfully move the body.

An aborted fetus, or for that matter, a stillbirth or newborn death should be buried in accordance with Jewish law once it has discernible limbs (approximately 6 weeks).

AUTOPSIES, EMBALMING AND CREMATIONAccording to Jewish law, physically altering the body of the deceased is disrespectful and forbidden. Autopsies, embalming and cremation are generally not permitted. However, if any are required by civil law, an authorized rabbinic authority must be consulted.

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MISCELLANEOUS

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SABORTIONIn the traditional Jewish view, abortion is neither banned completely, nor given indiscriminate permission. An aborted fetus, or for that matter, a stillborn or newborn death should be buried in accordance with Jewish law once it has discernible limbs (approximately 6 weeks). The parameters determining the permissibility of abortion within Jewish law are subtle and complex. When faced with such situations, an authorized rabbinic authority must be consulted.

PRAYERPrayer is a fundamental component of Jewish belief and tradition. During a typical weekday, prayers are offered three times daily: morning, afternoon and evening. On the Shabbat and Holidays, there are as many as four or even fi ve sets of prayers. During the weekday morning prayer, men may don either a Tallit or Tefi llin or both. A Tallit is a large prayer shawl and Tefi llin are Phylacteries – two black leather boxes with straps, worn on the head and arm. One who is praying may try to refrain from talking during portions of the prayers and, if possible, it is greatly appreciated if staff are able wait until the conclusion of the prayers before approaching.

PSALMS (TEHILLIM)Psalms are often recited during times of crisis and need. While, there are special chapters that are said for different occasions, Psalm 20 and the Psalm corresponding to the year subsequent to the individual’s age (e.g. if one is 40 recite Psalm 41) are most frequently read.

RITUAL HAND WASHING (NETILAT YADAYIM) Ritual hand washing is generally performed upon awakening from sleep, after relieving oneself, before reciting prayers and before eating bread. It requires a cup and basin, allowing the individual to pour water from the cup over his/her hands into the basin.

VISITING THE SICK (BIKUR CHOLIM)Judaism considers visiting the sick to be of great importance. These visits are encouraged only if the patient welcomes them and they are benefi cial to the patient.

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CONCLUSION

If this booklet has left you with more questions than answers, then it has fulfi lled its objective. As noted in the introduction, this booklet is limited to the presentation of general guidelines and is not intended to be a quick course on Judaism. Neither is it intended to replace the need to encourage consultation between you, the health care professional, and the patient or family’s Rabbi or Jewish Chaplain for Jewish legal/ethical (Halachic) issues, advice and opinion. It is geared towards helping you appreciate and consider the Jewish patient’s religious and cultural needs. Most importantly, it is meant to give you an understanding of when a question or issue requires consultation with a Rabbi or Jewish Chaplain. Thank you for reading this guide. We hope it assists you in providing the highest level of understanding and compassion for all who enter your sphere of care.

CONCLUSION

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RECOMMENDEDGUIDELINES FOR JEWISH PATIENTCARE

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In order to assist health care professionals with providing culturally compassionate care, these guidelines are suggested as a useful resource.

Health care organizations should consider the spiritual and psychological value associated with these guidelines. Supporting patients who wish to engage in the observance of Jewish laws and customs when safe to do so and not medically contraindicated can prove beneficial to both the patient and care provider throughout the treatment and healing process.

It is important to realize that within Judaism there can be different levels of religious observance, customs and awareness. Therefore, in relation to religious requirements, no one patient is necessarily the same as the next. The patient and his/her family will likely lead in this regard, as they express to staff their religious needs, if any. Although the list below is not mandatory it is, however, highly recommended.

Please understand that the following guidelines may also apply to visitors and caregivers whose presence is deemed supportive of the patient’s health and well-being.

Support patients in making oral statements of consent, suitably witnessed, rather than compelling them to sign any form in violation of religious principles upon the Shabbat or Holiday.

Provide medical attention and defer payment until the conclusion of the Shabbat or Holiday.

RECOMMENDEDGUIDELINES FOR JEWISH PATIENTCARE

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In the event of discharge, patients may be unable to leave the facility until the conclusion of the Shabbat or Holiday. It is helpful if discharge can be delayed or suitable, alternative arrangements made.

Patients may be unable to accept appointments that are scheduled for the Shabbat and Holidays, the eve of such days or fast days. Please accommodate patients by rescheduling a suitable, alternative appointment.

Provide patients with kosher food of proper quality, quantity and variety to assure meeting the nutritional and religious needs.

Include the name of the patient’s spiritual advisor (rabbi or chaplain) on the consenting patient’s health record so that the appropriate individual can be called upon to serve as consultant when religious/ethical concerns or questions arise.

Facilitate consultation, when requested, between the health care provider, patient and spiritual advisor (rabbi or chaplain), who should be welcomed and considered an integral part of the healing team. This is especially important when considering procedures such as abortion, artificial insemination, autopsy, circumcision, contraception, euthanasia, organ-donation, prostate surgery, sterilization, withdrawal of life-supporting therapy or hazardous procedures.

Facilitate psychiatric and other counseling by professionals attuned to patterns of behavior amongst observant Jews, when available.

Bikur Cholim Visiting the sick

Brit Milah Circumcision for boys, usually at 8 days of age

Chevra Kadisha Jewish funeral home/burial society

Daven To pray

Fleishig Meat food items or utensils

Halacha - Halachic Jewish law - Jewish legal issues

Kippah/ Yarmulkah

A head covering commonly worn by men as a symbol of their religious commitment

Kosher Any food item that is permissible for a Jew to consume

Mashgiach Someone that supervises the manufacture and processing of food in order to certify it as Kosher

Mazal Tov An expression of congratulations

Megillah A scroll of parchment that contains the story of the Holiday of Purim (which is read aloud twice during this Holiday)

Menorah A candelabrum that is lit during the Chanukah holiday

Mezuzah A parchment of holy writings that is attached to the door frame of Jewish dwellings

Milchig Dairy food items or utensils

Terms Description and usage

GLOSSARY

GLO

SSA

RY

26

GLOSSARY

Pareve Neutral food items or utensils that are neither meat nor dairy

Rabbi A Jewish, religious and spiritual leader and teacher

Shabbat/ Shabbos

The Jewish Sabbath. Begins Friday afternoon before sundown and ends Saturday evening after nightfall

Shul Synagogue – the Jewish place of worship

Siddur Prayer book

Tallit/ Tallis A large, four cornered prayer shawl commonly worn by men during the morning prayers

Talmud A record of rabbinic discussions pertaining to Jewish law, ethics, customs and history (also known as the Oral Law)

Tefillin Phylacteries. Two black boxes commonly worn on the arm and head of male worshipers during weekday morning prayers

Torah The Torah refers to either the Jewish Bible/Five Books of Moses or the entire spectrum of Jewish teachings

Tzitzit/Tzitzis A four cornered garment with fringes commonly worn by men underneath their clothing

Vidduy The confession – it can be recited by the dying person or someone else if the dying person is unable

Yahrzeit Anniversary of one’s death (calculated according to the Jewish calendar)

Yizkor A memorial prayer recited four times a year by those who have lost either one or both of their parents

Yom Tov Jewish holiday

Terms Description and usage

GLO

SSARY

27

Holiday/ Fast Day

TEN YEAR CALENDAR OF JEWISH HOLIDAYS & FASTS DAYS

Rosh

Hashanah Se

pt

30

- O

ct 1

Se

pt

19 -

20

Se

pt

9-1

0

Se

pt

29-3

0

Se

pt

17-1

8

Se

pt

5-6

Se

pt

25-2

6

Se

pt

14-1

5

Oct

3-4

Se

pt

21-2

2

Fast of

Gedaliah Oct

2

Se

pt

21

Se

pt

12

Oct

2

Se

pt

19

Se

pt

8

Se

pt

28

Se

pt

16

Oct

5

Se

pt

24

Yom

Kippur Oct

9

Se

pt

28

Se

pt

18

Oct

8

Se

pt

26

Se

pt

14

Oct

4

Se

pt

23

Oct

12

Se

pt

30

Sukkot

Oct

14-2

0

Oct

3-9

Se

pt

23-2

9

Oct

13-1

9

Oct

1-7

Se

pt

19-2

5

Oct

9-1

5

Se

pt

28

- O

ct 4

Oct

17-2

3

Oct

5-1

1

Shemini

Atzeret &

Simchat

Torah Oct

21-2

2

Oct

10-1

1

Se

pt

30

- O

ct 1

Oct

20-2

1

Oct

8-9

Se

pt

26-2

7

Oct

16-1

7

Oct

5-6

Oct

24-2

5

Oct

12-1

3

Chanukah

De

c 22 -

29

De

c 12-1

9

De

c 2-9

De

c 21-2

8

De

c 9-1

6

No

v 28

- D

ec

5

De

c 17-2

4

De

c 7-1

4

De

c 25

- Ja

n1

De

c 13-2

0

Fast of

Tevet

Jan

6 &

D

ec

27

De

c 17

Jan

5 &

D

ec

23

De

c 13

Jan

1 &

D

ec

22

Jan

8 &

D

ec

28

2009

2013

2011

2015

2017

2010

2014

2012

2016

2008

TEN

YEA

R C

ALE

ND

AR

28

TEN YEAR CALENDAR OF JEWISH HOLIDAYS & FASTS DAYS

Fast of Esther

Mar

ch 2

0

Mar

ch 9

Fe

b 2

5

Mar

ch 1

7

Mar

ch 7

Fe

b 2

1

Mar

ch 1

3

Mar

ch 4

Mar

ch 2

3

Mar

ch 9

Purim

Mar

ch 2

1

Mar

ch 1

0

Fe

b 2

8

Mar

ch 2

0

Mar

ch 8

Fe

b 2

4

Mar

ch 1

6

Mar

ch 5

Mar

ch 2

4

Mar

ch 1

2

Fast of the

Firstborn Ap

ril

17

Ap

ril

8

Mar

ch 2

9

Ap

ril

18

Ap

ril

6

Mar

ch 2

5

Ap

ril

14

Ap

ril

3

Ap

ril

22

Ap

ril

10

Passover

Ap

ril

20

-27

Ap

ril

9-1

6

Mar

ch 3

0-

Ap

ril

6

Ap

ril

19

-26

Ap

ril

7-1

4

Mar

ch 2

6-A

pri

l2

Ap

ril

15

-22

Ap

ril

4-1

1

Ap

ril

23

-30

Ap

ril

11

-18

Shavuot

Jun

e 9

-10

May

29

-30

May

19

-20

Jun

e 8

-9

May

27

-28

May

15

-16

Jun

e 4

-5

May

24

-25

Jun

e 1

2-1

3

May

31

- Ju

ne

1

Fast of Tammuz Ju

ly 2

0

July

9

Jun

e 2

9

July

19

July

8

Jun

e 2

5

July

15

July

5

July

24

July

11

Fast of Av

Au

g 1

0

July

30

July

20

Au

g 9

July

29

July

16

Au

g 5

July

26

Au

g 1

4

Au

g 1

2009

2013

2011

2015

2017

2010

2014

2012

2016

2008

Holiday/ Fast Day

TEN YEA

R CA

LEND

AR

29

Referral Agencies, are one of the first places patients and families turn to in times of illness. These agencies develop relationships with physicians and health care organizations with the express purpose of directing the patient to an appropriate physician and facility

Jewish Family and Child Services, provides a wide range of social services. Typical services include social work, counselling, hospice, financial aid and educational sessions.

Hatzoloh, a volunteer EMS organization is the largest all-volunteer ambulance service in North America. Its volunteers are trained EMTs, paramedics and physicians.

Chevra Kadisha, is the Burial Society/Funeral Home for the Jewish community. Upon death, the Chevra Kadisha helps take care of funeral arrangements. For more information please see Dying & Afterlife Scenarios - Care Of The Deceased pages 18-20.

Chai Lifeline, assists children with serious illness. It provides patients, families, schools and the community with a host of supportive programs. Programs include Camp Simcha, Homebound Educational Learning Program, Disney Trip, counselling centers and telephone support groups.

Health related resources commonly found within Jewish communities:

Bikur Cholim, provides assistance to the patient and family. Typical services include community volunteers visiting the patient, arranging Kosher food for the patient and meals for family members, transportation to appointments and postpartum and respite stays.

CONTACT INFORMATIONC

ON

TAC

T IN

FORM

ATI

ON

30

TEN YEA

R CA

LEND

AR

CO

NTA

CT IN

FORM

ATIO

N

31

RABBIS & SYNAGOGUES

RABB

IS &

SYN

AG

OG

UES

32

ACCOMMODATIONS & KOSHER FOOD A

CC

OM

MO

DA

TION

S & KO

SHER FO

OD

33

NOTESN

OTE

S

34

NO

TES

35

Abortion...................................................................................................................20, 22

Afterlife Scenarios............................................................................................18-20, 22

Autopsies........................................................................................................................20

Bikur Cholim............................................................................................................22,29

Birthing............................................................................................................................17

Burial Society.....................................................................................................19, 20, 29

Calendar of Jewish Holidays & Fast-Days..........................................................26-27

Care of the Deceased............................................................................................19-20

Chai Lifeline.................................................................................................................29

Chevra Kadisha................................................................................................19, 20, 29

Contact Information..............................................................................................29-30

Cremation......................................................................................................................20

Death and Dying...............................................................................................18-20, 22

DNR (Do Not Resuscitate).......................................................................................18

Embalming......................................................................................................................20

Emergency Medical Situations............................................................................3, 9-10

Fast Days..................................................................................................................12, 15

Fast of Esther.................................................................................................15 Fast of Gedaliah............................................................................................15 Fast of Tammuz.............................................................................................15 Fast of Tevet...................................................................................................15 Fast of the Firstborn....................................................................................15 Tisha B’av.......................................................................................................15 Yom Kippur..............................................................................................12, 15

Funeral Home...................................................................................................19, 20, 29

Glossary..........................................................................................................................26

INDEXIN

DEX

36

IND

EX

Hand Washing.............................................................................................................22

Heroic Measures.......................................................................................................18

Hatzoloh......................................................................................................................29

Holidays.................................................................................................................11-14

Chanukah....................................................................................................13 Pesach..........................................................................................................14 Purim...........................................................................................................14 Rosh Hashanah..........................................................................................12 Shavuot........................................................................................................14 Shemini Atzeret........................................................................ .................13 Simchat Torah.............................................................................................13 Sukkot..........................................................................................................13

Jewish Family & Child Services...............................................................................29

Judaism.......................................................................................................................4-5

Kosher.........................................................................................................................6-7

Labour and Delivery.................................................................................................17

Life and Death Situations............................................................................18-20, 22

Modesty.................................................................................................................16-17

Organ Donation........................................................................................................18

Prayer...........................................................................................................................22

Psalms (Tehillim)........................................................................................................22

Recommended Guidelines ...............................................................................24-25

Referral Agencies.......................................................................................................29

Sabbath.....................................................................................................................8-10

Shabbat.....................................................................................................................8-10

Ten Year Calendar................................................................................................26-27

Visiting the Sick (Bikur Cholim).............................................................................22

37

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