Mendel Janowski

CARE
ENVIRONMENT

HEALTH

WITHIN A

A GUIDE TO

JEWISH
PATIENT CARE
MENDEL JANOWSKI
COMMUNITY DEVELOPMENT COORDINATOR YORK CENTRAL HOSPITAL

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.

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.

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

INTRODUCTION
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 patients 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 patients religious faith to the healing process. Several important surveys have documented the central role that religion and belief play in ones 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.

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 familys 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 patients life or limb or worsen the patients health status.
Within Judaism there are specific laws that address lifethreatening 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.

INTRODUCTION
3

JUDAISM
WHAT IS JUDAISM? Judaism was the first 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-ds law for ethical conduct (Jewish law) was then passed down from generation to generation in a chain of unbroken tradition to this day. JEWISH BELIEF The 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.

IN A NUTSHELL

DIFFERENT LEVELS OF OBSERVANCE, CUSTOMS & AWARENESS 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. 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 & HEALTH According to Jewish belief, a persons 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.

JUDAISM IN A NUTSHELL
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KOSHER FOOD
WHAT IS KOSHER, AND BASIC JEWISH LAWS CONCERNING FOOD Kosher means fit for consumption and refers to the Jewish dietary laws. According to Jewish law, only food that follows the Kosher standards is fit for consumption by Jews. Kosher certification means that the product has been certified 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 certification. 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 certification. 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 fish, 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 certification.

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 retherm units included), which have been used with non-kosher items are rendered non-kosher. They will transfer that nonkosher 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.

KOSHER FOOD
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SHABBAT
Shabbat, the Jewish Sabbath, is a commemoration of G-ds 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.

A BRIEF OVERVIEW OF BASIC SHABBAT OBSERVANCES Shabbat is a day eagerly awaited throughout the week, a time to set aside the weeks concerns and devote oneself to higher pursuits. Some of the Shabbat observances include services in synagogue or prayers at home (or even in ones 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-ds 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 toiletpaper - 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 dos and donts. They help create a unique, restful and spiritual atmosphere. Shabbat is a total immersion experience that shapes the people who observe it. SHABBAT AND HEALTH 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 patients life or limb or worsen the patients health status.

SHABBAT
9

Within Judaism there are specific laws that address lifethreatening 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.

SHABBAT
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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 years 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.

JEWISH

11

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.

JEWISH HOLIDAYS
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THE HOLIDAYS
ROSH 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 rams 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.

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 twoday 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.

JEWISH HOLIDAYS
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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 morning 2) sending gifts of food to friends 3) distributing charity to at least two needy individuals 4) 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.

JEWISH HOLIDAYS
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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 Bav 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.

JEWISH HOLIDAYS
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MODESTY
Physical modesty is a key component of traditional Jewish life for men and women alike. The term modesty is used to describe and define 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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PRACTICAL APPLICATION Many 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 DELIVERY Niddah, 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

MODESTY
17

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 couples 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.

DYING & AFTERLIFE

SCENARIOS
SANCTITY OF LIFE In the Jewish tradition, life issacred, 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-dsustains 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 havestrong feelings on this matter and appreciate when medical staff consult a rabbi of the patient or familys 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 DONATION The 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 makers 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 DEATH A 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. VIDDUY
It is an important custom to recite the Vidduy, a confessional prayer, as one nears the end of life. It can be

DYING & AFTERLIFE SCENARIOS

19

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 DECEASED Jewish 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.

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 patients 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.

DYING & AFTERLIFE SCENARIOS

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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 CREMATION According 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.

MISCELLANEOUS

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ABORTION In 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. PRAYER Prayer 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 five sets of prayers. During the weekday morning prayer, men may don either a Tallit or Tefillin or both. A Tallit is a large prayer shawl and Tefillin 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 individuals 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 beneficial to the patient.

MISCELLANEOUS

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CONCLUSION

If this booklet has left you with more questions than answers, then it has fulfilled 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 familys Rabbi or Jewish Chaplain for Jewish legal/ethical (Halachic) issues, advice and opinion. It is geared towards helping you appreciate and consider the Jewish patients 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.

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RECOMMENDED GUIDELINES FOR JEWISH PATIENTCARE

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 patients health and well-being. 1. 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. 2. Provide medical attention and defer payment until the conclusion of the Shabbat or Holiday.

RECOMMENDED GUIDELINES
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3. 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. 4. 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. 5. Provide patients with kosher food of proper quality, quantity and variety to assure meeting the nutritional and religious needs. 6. Include the name of the patients spiritual advisor (rabbi or chaplain) on the consenting patients health record so that the appropriate individual can be called upon to serve as consultant when religious/ ethical concerns or questions arise. 7. 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. 8. Facilitate psychiatric and other counseling by professionals attuned to patterns of behavior amongst observant Jews, when available.

RECOMMENDED GUIDELINES
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GLOSSARY
Terms
Bikur Cholim Brit Milah Chevra Kadisha Daven Fleishig Halacha Halachic Kippah/ Yarmulkah Kosher Mashgiach Mazal Tov Megillah Menorah Mezuzah Milchig

Description and usage

Visiting the sick Circumcision for boys, usually at 8 days of age Jewish funeral home/burial society To pray Meat food items or utensils Jewish law - Jewish legal issues A head covering commonly worn by men as a symbol of their religious commitment Any food item that is permissible for a Jew to consume Someone that supervises the manufacture and processing of food in order to certify it as Kosher An expression of congratulations A scroll of parchment that contains the story of the Holiday of Purim (which is read aloud twice during this Holiday) A candelabrum that is lit during the Chanukah holiday A parchment of holy writings that is attached to the door frame of Jewish dwellings Dairy food items or utensils

GLOSSARY
26

Terms
Pareve Rabbi Shabbat/ Shabbos Shul Siddur Tallit/ Tallis Talmud Tefillin Torah Tzitzit/Tzitzis Vidduy Yahrzeit Yizkor Yom Tov

Description and usage

Neutral food items or utensils that are neither meat nor dairy A Jewish, religious and spiritual leader and teacher The Jewish Sabbath. Begins Friday afternoon before sundown and ends Saturday evening after nightfall Synagogue the Jewish place of worship Prayer book A large, four cornered prayer shawl commonly worn by men during the morning prayers A record of rabbinic discussions pertaining to Jewish law, ethics, customs and history (also known as the Oral Law) Phylacteries.Two black boxes commonly worn on the arm and head of male worshipers during weekday morning prayers The Torah refers to either the Jewish Bible/Five Books of Moses or the entire spectrum of Jewish teachings A four cornered garment with fringes commonly worn by men underneath their clothing The confession it can be recited by the dying person or someone else if the dying person is unable Anniversary of ones death (calculated according to the Jewish calendar) A memorial prayer recited four times a year by those who have lost either one or both of their parents Jewish holiday

GLOSSARY

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TEN YEAR CALENDAR

Rosh Yom Fast of Kippur Sukkot Shemini Hashanah Gedaliah Atzeret &

28
Holiday/ Fast Day
Oct 14-20 Oct 9 Oct 2 Sept 30 - Oct 1

Torah

Simchat

Dec 22 -29

Jan 6 & Dec 27 Oct 3-9 Sept 19 -20 Sept 9-10 Sept 29-30 Sept 17-18 Sept 5-6 Sept 28 Sept 16 Oct 12 Sept 30 Oct 5 Sept 24 Sept 25-26 Sept 14-15 Oct 3-4 Sept 21-22 Sept 23-29 Oct 13-19 Oct 1-7 Sept 19-25 Oct 9-15 Sept 28 - Oct 4 Oct 17-23 Oct 5-11 Oct 4 Sept 23 Sept 14 Sept 26 Sept 19 Sept 8 Oct 8 Oct 2 Sept 18 Sept 12 Sept 28 Sept 21

Dec 12-19

Chanukah

Dec 17

Jan 5 & Dec 23

Dec 13

Jan 1 & Dec 22

TEN YEAR CALENDAR OF JEWISH HOLIDAYS & FASTS DAYS

Jan 8 & Dec 28

Fast of

Tevet

Oct 21-22

20 08 09 20 10 20 20 11 12 20 20 13 14 20 20 20 15 16 17 20

Oct 10-11

Dec 2-9

Sept 30 - Oct 1

Dec 21-28

Oct 20-21

Dec 9-16

Oct 8-9

Nov 28 - Dec 5

Sept 26-27

Dec 17-24

Oct 16-17

Dec 7-14

Oct 5-6

Dec 25 - Jan1

Oct 24-25

Dec 13-20

Oct 12-13

Purim

Shavuot

Fast of the Firstborn

Passover

Fast of Tammuz

Holiday/ Fast Day

Aug 10

July 30 March 30 - April 6 March 29 April 18 April 6 March 25 April 14 April 3 April 22 April 10 March 8 Feb 24 March 16 March 5 March 24 March 12 March 20 Feb 28 April 19-26 April 7-14 March 26 -April2 April 15-22 April 4-11 April 23-30 April 11-18 Feb 25 March 17 March 7 Feb 21 March 13 March 4 March 23 March 9

July 20

Aug 9

July 29

July 16

Aug 5

July 26

Aug 14

Aug 1

Fast of Av
April 20-27 April 17 March 21 March 20

Fast of Esther

July 20

June 9-10

20 08 09 20 10 20 20 11 12 20 20 13 14 20 20 15 16 20 17 20

July 9

May 29-30

April 9-16

April 8

March 10

March 9

June 29

May 19-20

July 19

June 8-9

July 8

May 27-28

June 25

May 15-16

July 15

June 4-5

July 5

May 24-25

July 24

June 12-13

July 11

May 31 - June 1

TEN YEAR CALENDAR

29

CONTACT INFORMATION
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.

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.

CONTACT INFORMATION

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.

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

Jewish Family and Child Services,

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

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

30

CONTACT TEN INFORMATION YEAR CALENDAR

31

RABBIS & SYNAGOGUES

RABBIS & SYNAGOGUES

32

ACCOMMODATIONS & KOSHER FOOD

ACCOMMODATIONS & KOSHER FOOD

33

NOTES

NOTES
34

NOTES

35

INDEX
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 Bav.......................................................................................................15 Yom Kippur..............................................................................................12, 15

INDEX

Funeral Home...................................................................................................19, 20, 29 Glossary..........................................................................................................................26

36

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

INDEX
37

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