Mrs Nava KestenbaumThe Interlink Foundation

0161 740 1877nava@interlinknw.org.uk

Aims and ObjectivesAIMS: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:1. Define Jewish attitudes to palliative care 2. Identify key Advance Care Planning (ACP) documents3. Completing a Preferred Priorities for Care document or a Thinking

Ahead (GSF) document.4. Understand the decision making process and relevant contact

personnel for further guidance or support.

Gold Standards Framework (GSF)Gold Standards Framework (GSF)

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)

END

OF LIFE CARE TO

OLS

END OF LIFE CARE TOOLS

Death

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.

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 .

The Jewish patient – social structureSpheres of influence

Wider community organisations -

Social services

Strong influence on decision making

LEGAL FRAMEWORK FOR ADVANCE DECISIONS

Key Documents

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

Yes, held by spouse / GP / care home

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

In use by health and care personnel

I do not want any nutrition , hydration or other life sustaining treatment to be withdrawn without prior consultation with representatives including my Halachic consultee.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.

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

Enter patient representative and Halachic consultee

PART 2:Guidance for Organisations and

families

Decision Making for the Patient

no yes

no yes

Key Contacts:Position Role Name Contact

details

Adult Safeguarding Officer(Hospital, PCT or Local Authority based)

Helpful when there are concerns about standard of care eg. Feeding, personal care

MCA/DOLS Officer (Mental Capacity Act /Deprivation of Liberty)

Decision making about requirements and implementation of Best Interest meetings

Director of Nursing Questions about treatment options or care pathways

Palliative Care Lead Officer.

IMCA – Independent Mental Capacity Advocate

Represents patient at Best Interest meetings where no family available

Rabbi Ecclesiastical Authority

Halachic, ethical decisions.

Guidance for patients and families

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

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