Friday, April 04, 2008

Question & Answer With Rabbi Zvi Leshem - Terminal Illness & Emuna


A Simple Jew asks:

The Biala Rebbe taught that the fact that a certain terminal illness has no known cure is an absolute clear indication that its only true cure is through supernatural means such as prayer. In his Ma'amar Techias HaMeisim he wrote,

"We must never discourage a sick person from his hope to recover, neither through our words, nor even through our thoughts. When friends and relatives lose hope of a patient's recovery, this itself can cause death, G-d forbid, though no fault of his own."

Later in this discourse, he provided these explicit instructions if a doctor suggests that the patient's condition is indeed terminal,

"We must not even repeat such words in the doctor's name. This creates an atmosphere of despair and discourages others from praying wholeheartedly..."

Given the Rebbe's opinion expressed above, how would you suggest that a person communicate the doctor's prognosis to concerned family members?

Rabbi Zvi Leshem answers:

Needless to say this is question of the deepest significance, of hatzalat nefashot mamash. I will share some insights from my experience as a community Rav, from my learning and from a discussion that I had with one of my Rebaim on this topic. As a Rav I have had both congregants who were very ill and congregants who had family members who were very ill, so I have dealt with this from both sides.

Very shortly before my teacher Rav Shagar z”l was niftar last Sivan from pancreatic cancer; he was asked if he had resigned himself to death. His response was that the possibility of a miracle was still a very realistic possibility. We must note however, that he, like the Biala Rebbe, was indicating his clear awareness that al pi teva, there really was no hope. Thus it would seem that after engaging in the hishtadlut of chemotherapy etc, the Rav was focused upon two tracks; still davening for a miracle, but at the same time, preparing with equanimity for death. I also recall my dear friend Rav David Zeller z"l, who died two weeks earlier just two days after Shavuot from a rare blood disease. He as well, while on the one hand ordered new experimental drugs on Motzei Shavuot, seemed clearly to have made his peace with either possibility. Thus in the weeks before his death, and on Shavuot itself, he seemed to be especially at peace with himself and with those around him. From the longer version of the Piaseczner Rebbe’s Death Meditation (HaChsharat HaAvreichim, chapter 8), one can receive deep insights into the self awareness that the dying person receives.

In discussing these issues with one of my Rebbaim, specifically regarding the questioning of counseling family members of terminally ill patients, he made the following distinction. The patient himself has an inner self awareness that he may die and that he needs to prepare himself accordingly. This involves a deep cheshbon hanefesh, and squaring away (at least mentally) of accounts with others that may have accrued over the years. As the awareness comes that one is preparing to meet HaShem, the anger and resentment that plague most of us throughout our lives no longer have significance. I would like to quote from a letter that I received today from a friend who is gravely ill with cancer (may HaShem grant him a miracle):

I think more about what my day of judgment will be. How can I answer for my life? I am proud of the life that I have led, the father that I am, the husband that I have tried to be, the values and goals that I represent – even my failings, mistakes and all have always been the result of the best of intentions.

Everyday that I am here is a bracha (blessing) for those who care about me but I have no expectations of tomorrows…The good news is that I have few regrets and I feel ready to stand at the gates of heaven and hear my decree…I feel ready for the big day.

However, the Rav explained, this is not the case for family members. They cannot fully share the deep spiritual experience that the dying patient is going through. Their only desire and fervent prayer is to prolong life and maintain hope. For them the discussion of the possibility of death is not constructive, it is devastating in a way that leads to paralysis. They need to maintain hope even in a situation where the patient himself has made peace with his imminent death.

According to this understanding there is a slight variation on the Biala Rebbe’s words. His concern seems to be solely for the recovery of the patient, who may be effected negatively by the atmosphere of despair, or the lack of prayer, should his true situation be understood by his family. We are pointing out that in addition, that there may be times when the patient understands and accepts that it is time to move on, and in fact needs this clarity and equanimity in order to do teshuva properly and transfer to the next world peacefully. Nonetheless, his family may need endless encouragement and hope in order to cope with their fears and grief. Thus the Rav or counselor needs to walk a thin line in helping both the patient and his family, whose needs may be entirely different, through this trying situation.

May HaShem heal all of the sick and wounded and comfort all mourners. May we merit Techiat HaMatim in our time.

2 Comments:

At April 4, 2008 at 12:00:00 PM EDT, Anonymous shoshana (bershad) said...

I've been pondering your statement that, for family members, "the discussion of the possibility of death is not constructive, it is devastating in a way that leads to paralysis. They need to maintain hope ..." and I wish to respectfully disagree, at least with regard to certain situations. Speaking from a psychological perspective--and as someone who has been in this situation twice (one of them just this week)--the cold, harsh reality comes as a terrible shock to family members, but that doesn't stop them from praying; it just changes the nature of the prayers. One prays that the patient doesn't suffer pain and will know how much she or he is loved, that the transition will be peaceful, that the family will be comforted and have the strength to deal with the loss.

In the two experiences I'm referring to, the patient was unconscious/unaware, so teshuvah and resignation were not an issue. The doctors did all they could, but finally they had to acknowledge that the prognosis was dismal; they didn't want to raise false hopes. The family members could still pray for a miracle, but they also needed to begin to accept and confront the new reality. Hearing the truth is a painful slap in the face or punch in the gut; it takes your breath away. But it need not paralyze you; it just refocuses you.

 
At April 6, 2008 at 2:29:00 PM EDT, Anonymous Jewish Lights said...

R. Zvi states that

"[Family members] cannot fully share the deep spiritual experience that the dying patient is going through. Their only desire and fervent prayer is to prolong life and maintain hope. For them the discussion of the possibility of death is not constructive, it is devastating in a way that leads to paralysis. They need to maintain hope even in a situation where the patient himself has made peace with his imminent death."

That isn't always true, of course. Sometimes family members too must make peace with a sick person's imminent death.

Each case is individual.

 

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