ISSUE #13
 
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END-OF-LIFE 
"PLEASURE FEEDING" -
IS IT OK?

FAMILY SHOCKED BY CHANGE IN PATIENT'S EATING STATUS DUE TO TRANSFER FROM HOSPICE

In a true CMC experience, a patient was placed in hospice care after her condition deteriorated and it was anticipated that she would not have much longer to live. While in hospice care, the hospice placed no restrictions on the patient's diet, allowing the family to prepare any type of food for the patient to enjoy.

Subsequently however, the patient began to show signs of recovering her health. Therefore, with the help of guidance from Rabbi Wolf, the family removed the patient from hospice care and placed her back into regular medical care. 

(Parenthetically, following this transfer, the patient continued to live for close to another year.)

However, as a direct consequence of the transfer out of hospice care, the medical team immediately restricted the patient's diet, insisting that the patient must now pass a swallowing test to ascertain what texture/thickness of foods would be safe for her to ingest orally.

The patient's family members were (rightfully) shocked by this turn of events. They wondered, since there was evidently a medical need to establish the patient's ability to swallow in order to eliminate possible concerns about choking, aspirating, or other significant potential dangers, why then had these tests not been administered previously, while the patient was under hospice care?

"MIGHT AS WELL ENJOY... EVEN IF THERE MAY BE SOME RISK INVOLVED..."

Because of this question, the family came to understand (to their disappointment) that when a patient is not expected to live much longer, some practitioners or caregivers (whether operating within a hospice structure or otherwise) may take the approach (whether explicit or subtle) that more or less says, "The patient is not going to live much longer anyway, so they might as well just enjoy whatever food/drink they want. Even if there may be some risk involved, it is still worth it in order to maximize their quality of life during their final days."

END-OF-LIFE "PLEASURE FEEDING" - FRAUGHT WITH SIGNIFICANT ISSUES IN JEWISH LAW

Patients and family members should be aware that the above-mentioned approach toward end-of-life "pleasure feeding" despite potential medical risks is fraught with very significant issues in halacha (Jewish law). 

It can never be assumed that doctors or hospice staff are aware of these halachic issues, nor that they are operating on the basis of the exact same values and/or religious priorities that their patients hold dear.

Nevertheless, it should also be noted that many patients may derive significant psychological benefit from being able to eat foods that they enjoy. This psychological benefit may also affect the patient's physical strength and may potentially even help prolong his/her life as well. Furthermore, certain risk factors (such as dysphagia - difficulty swallowing) may be mitigated in some cases by using restricted diets and implementing specific precautions and feeding techniques.

Thus, every individual case of end-of-life "pleasure feeding" may be different, both in terms of the potential risk (and potential benefit) involved, as well as in terms of the application of Jewish law to the particular circumstances.

ASK THE DOCTOR FOR INFORMATION; 
ASK THE RABBI FOR GUIDANCE

Consequently, for every individual case in which practitioners may allow for a patient to enjoy end-of-life "pleasure feeding" (and in all similar situations), it is incumbent upon family members to do two things: 
  • Ask the doctor to explain (and/or to administer tests to ascertain) exactly what medical risks may be involved by giving the patient "pleasure feeding." Discuss potential psychological benefits of such an approach, and obtain information and training about how certain risks may be mitigated for the patient's condition. 
  • Obtain experienced and authoritative Rabbinical guidance, in order to weigh all the relevant issues and proceed according to the directives of Jewish law.
 
 
For over two decades, CMC has been counseling patients and family members throughout the Chicago area concerning end-of-life issues such as those mentioned above. CMC connects patients and families with local Rabbonim who are expert in the end-of-life field, so that they may be reassured of having authoritative halachic answers that are tailored to their specific individual circumstances.

To request CMC guidance and/or support regarding an end-of-life issue or for any patient and/or family member struggling with illness, please call CMC or click this link to visit CMC's website.
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Rabbi Aron Wolf
Chicago Mitzvah Campaign
2939 W Touhy Ave
Chicago, IL 60645
1-866-MY RABBI (1-866-697-2224)