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Advance Care Planning For the Jewish Patient

Advance Care Planning For the Jewish Patient. Mrs Nava Kestenbaum The Interlink Foundation 0161 740 1877 nava@interlinknw.org.uk. Aims and Objectives. AIMS:

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Advance Care Planning For the Jewish Patient

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  1. Advance Care Planning For the Jewish Patient Mrs Nava Kestenbaum The Interlink Foundation 0161 740 1877 nava@interlinknw.org.uk

  2. Aims and Objectives AIMS: Part 1:To inform health and care professionals about ways to manage ACP with Jewish patients, taking into account their principles of faith, attitudes and social structures. Part 2: To educate Jewish organisations and individuals about ACP within existing health and care frameworks such as the Gold Standard Framework GSF or Preferred Priorities for Care (PPC). OBJECTIVES: • Define Jewish attitudes to palliative care • Identify key Advance Care Planning (ACP) documents • Completing a Preferred Priorities for Care document or a Thinking Ahead (GSF) document. • Understand the decision making process and relevant contact personnel for further guidance or support.

  3. Gold Standards Framework (GSF) END OF LIFE CARE TOOLS • Advance Care Planning • Preferred Priorities for Care (PPC) • GSF Thinking Ahead • Advance Decisions- Living Will • Lasting Power of Attorney (LPA) Rapid Discharge Pathway (RDP) Liverpool Care Pathway for the Dying (LCP) Death END OF LIFE CARE TOOLS

  4. Jewish Attitudes to Palliative Care • Jews do not own their body but are invested with guardianship over life and soul including making significant efforts to preserve life despite prognosis. • Nothing may be done to hasten death – including withdrawal of water, nutrition, oxygen or medication. • Information should be presented to sustain hope and avoid despair leading to the patient giving up. • Each family is encouraged to consult a competent Rabbi who can assess every risk benefit decision carefully for Halachic implications. • A Rabbi will always take account of a patients pain or suffering in decisions to provide palliation or ‘heroic’ treatments.

  5. Jewish preferences in care • Except at risk to life, Jewish patients will want to practice rituals and have kosher food as far as possible. • Generally, elderly Jewish people prefer to be addressed by their title and surname or familiar first name – which may be a Jewish name. • Families will frequently keep a vigil by the bedside of a seriously ill relative. • Patients and families will often be concerned about signing a DNAR .

  6. The Jewish patient – social structureSpheres of influence Wider community organisations - Strong influence on decision making Clinicians, care team Social services

  7. LEGAL FRAMEWORK FOR ADVANCE DECISIONS

  8. Key Documents Least to most legally binding

  9. I do not wish to have any post mortem procedures performed including an autopsy or organ removal. I do not wish to have a DNAR offered to me Yes, held by spouse / GP / care home I wish my care to adhere to my Jewish values and customs. I do not want ANH or medication withdrawn without consultation. Please see my Advance Decision document for who I wish to be consulted in deciding my treatment or changes to care

  10. In use by health and care personnel

  11. I do not want any nutrition , hydration or other life sustaining treatment to be withdrawn without prior consultation with representatives including my Halachicconsultee. Information should be presented in such a way that I do not despair and give up hope. I request all my food to be strictly kosher unless permitted by Halacha. Pain relief which can shorten life should be given only with clinical, family and Halachic consultation. I wish to be enabled and supported to pray or perform other Jewish practices where possible.

  12. I do not wish to have any post mortem procedure performed including an autopsy or organ removal.

  13. Enter patient representative and Halachicconsultee

  14. PART 2:Guidance for Organisations and families

  15. Decision Making for the Patient yes no yes no

  16. Key Contacts:

  17. Guidance for patients and families • Relevant for individuals 18+ • A Lasting Power of Attorney supersedes an Advance Decision directive and may invalidate it.

  18. Best Interest Meetings • For the following 3 types of decisions: • Serious Medical treatment • Change of Residence • Safeguarding Adults • Multidisciplinary input. Must take account of views of relatives or anyone interested in patients welfare. • Age, appearance or behaviour are not to be basis for decision • Beliefs, views and preferences of patients must be considered • May involve a patient advocate • Balanced scorecard involving Medical , Emotional and Welfare assessment of advantages and disadvantages. • Can appeal decision through second opinion, complaint procedure. • Decision to withdraw or withhold ANH from patients in vegetative or comatose state requires Court ruling

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