Do what you love for those you love.

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By: Machla Abramovitz

It was early afternoon on eruv Yom Kippur last year when Rabbi Raymond Beyda of Congregation Shaarei Zion received an emergency call from Denise, a community member who was living in San Antonio, Texas. Their familyhad a life and death decision to make concerning their 89-year-old mother, and urgently needed Rabbi Beyda’s help. Denise’s mother, who was suffering from a terminal heart condition and was being treated in a local hospital, desperately wanted to go home.She had been in the ICU for over a month, and couldn’t take it anymore. The hospital was willing to comply with her wishes, but doing so would effectively kill her.

Rabbi Beyda immediately contacted the ICU doctor, who admitted that in order to send Denise’s mother home they would have to cap her supply of oxygen that was presently being generated by a machine. “He told me that she might not make it to the ambulance, or else would pass on in the ambulance. I needed additional information about her condition before a halachic decision could be made,” Rabbi Beyda says.

A comprehensive discussion with her attending physician determined that other than this heart condition, the woman was alert, and otherwise in decent health. A quick call to medical posekRabbi Zvi Ausch in Boro Park confirmed that in her particular case (each case must be evaluated individually) everything must be done to keep her alive, regardless of how agitated she was.

But how were they to calm her down, since morphine, the sedative used by the hospital, could arrest her breathing? Rabbi Beyda called his colleague, nephrologist Dr. Albert Matalon from NYU Langone Medical Center, who informed him that there were antidepressants used for psychiatric patients that would do the job without endangering her life.

“Once the hospital understood that we were not going to pull the plug on my mother, they sedated her safely, switched her from the ICU into a standard, more comfortable room, and even found a way to get her home with the oxygen she needed. By doing this, we extended her life by a few months and she died comfortably, surrounded by loving family and friends. Rabbi Beyda and Dr. Matalon made us aware of the halachot as well as the medical options that were available to us. We can now look back at my mother’s last months with no regrets, knowing that as a family, we did everything we could for her,” Denise says.

Denise and her family are not alone in confronting today’s medical system, which appears to undercut the terminally ill patient’s right to a prolonged life, often without the family’s knowledge of this fact. Many are similarly unaware that Jewish law has much to say about what they are required to do under these trying circumstances, and that what is required may often be at odds with accepted societal perceptions as to what qualifies as “quality of life.”

Hayim Aruchim – Help Especially
for the Sephardic Community

How, in fact, did Rabbi Raymond Beyda, a popular speaker, pulpit rabbi, guidance counselor, and author, and Dr. Albert Matalon, whose specialization is kidneys and not cardiology, come to play such a crucial role in helping direct the medical treatment of this elderly woman living many states away? They are among four Sephardic responders (three rabbis and one doctor) who mana 24-hour hotline for Hayim Aruchim, the Sephardic branch of Agudath Israel of America’s The Center for Culturally Sensitive Health Advocacy and Counselingthat helps families make health care decisions according to halacha. Now two years into its mandate, Hayim Aruchim serves the greater Sephardic community that extends beyond its Brooklyn base to include Manhattan and New Jersey, as well as California, Texas, Florida, and Canada.

Why, though, is there a need for a Sephardic branch?

“When it comes to life and death situations, I don’t know of any differences in interpretation and practice between Ashkenazi and Sephardi. Still, the average Sephardi may not understand that and may not feel comfortable seeking help from an Ashkenazi organization under these dire circumstances. Rabbi Ausch, Hayim Aruchim’s chief posekis Ashkenazi, but he works together with families’ personal rabbanimwhenever necessary, and carefully explains to them the halachot. Community posekHacham Eliezer Harari also advises on halachic decisions. As well, our communities are more comfortable discussing personal issues with someone they personally know and respect,” Rabbi Beyda says.

It’s an excellent partnership between Agudath Israel and Hayim Aruchim. “Agudath Israel has people working on site in Maimonides, Mt. Sinai, Columbia, and several other hospitals throughout New York. There are officially four of us manning the hotline, but there are eight people actually at work at all times,” Rabbi Beyda says. “When someone in need dials the hotline – 347 578 8200 – the four Sephardic responders simultaneously get the call to their cell phones. If no one picks up, the caller can leave a voice mail. When the caller hangs up an email with the voice mail attached goes out priority to the four Sephardic responders and backup to the Ashkenazi responders as well.“

This team of dedicated professionals was handpicked for their extensive knowledge of medical halacha. Their training is rigorous. They meet with oncologists, critical care doctors, pulmonary experts, and others in order to gain enough of a background in medical conditions and terms to be able to converse intelligently with doctors to enable them to ascertain the available halachic options in what are often life and death circumstances. Inaddition to the ongoing training the Hayim Aruchim responders receive, every two months or so they all meet with Rabbi Ausch to hash over difficult problems that arose during that time.


Hayim Aruchim’s Role

Rabbi Beyda is quick to point out that Hayim Aruchim does not do medical referrals. “We are trained to communicate with the presiding doctors, analyze the family’s options, determine which ones are halachically permissible, explain all options to the family, and push for the halachically permissible ones.”

Hayim Aruchim provides a service that meets a fundamental need. Unfortunately, in today’s medical culture, not all options are being communicated to the families. “Between the BUSINESS of hospitals, the BUSINESS of insurance companies, and the pervading ideology that maintains that without ‘quality of life’ life is not worth living (whereas we believe life itself is a gift) the medical community paints a picture for the family that they are doing the best thing for the patient by unplugging the respirator or by not doing what is necessary to extend the patient’s life. ‘I wouldn’t do that to my mother,’ is a common refrain. One shouldn’t assume that doctors are always on the patient’s side. There are financial incentives. The sooner a patient is released from the hospital, dead or alive, the more money is generated to the hospital, and the amount is substantial,” Rabbi Beyda states.

This resistance to prolonging a terminally ill patient’s life can take many forms. Even the simple matter of inserting a feeding tube can become an issue, according to Rabbi Beyda. “One doctor argued with me that he wouldn’t insert a tube because tubes get infected and infections are dangerous. I challenged him on this. How many get infected, I asked? 15%. How many of that 15% don't respond to antibiotics? 1% might die from infection, he answered. And how many patients will die if they don’t eat, I asked?”

“Some doctors are extremely helpful and accommodating while others get defensive once they realize that someone with a medical background is questioning the information they gave to the family. We try to be as non-confrontational as possible. That’s the only way to get the cooperation of the medical staff, whose help we need to obtain the information about where the patient stands medically. Only once we have that information can we confront the halachic issues involved in their case,” Dr. Matalon says.

By law, hospitals are obligated to treat a patient in every way that is medically necessary. Still, what’s medically necessary is sometimes debatable, and the law is not clear in the case of debilitated patients who will only gain a number of weeks of life by extending their treatment. “But even in situations where it is clear that the doctor is obligated to continue treating, some doctors refuse to do so, maintaining that the decision should be up to the family. Doctors, though, have a way of presenting the case that convinces the family not to prolong their loved ones’ lives. There is a way of phrasing the options that influence how the family will respond. Part of our job is to sift through the terminology to find out what their true options are,” Dr. Matalonsays. When, in the past, hospitals refused to supply available life-saving treatment, Hayim Aruchim was able to transfer patients to more accommodating facilities. It has also taken hospitals to court for non-compliance.


One Woman’s Escape from Death

Lorraine Safdieh’s case proves the doctor’s general point: Her daughter, Shelly Safdieh-Rothstein from West Long Branch, NJ, still shudders when recalling her mother’s escape from certain death two months before. Their family’s ordeal began innocently enough.They were celebrating their mother’s 83rd birthday when Lorraine began to choke. Hatzalah quickly rushed her to the hospital, where the obstruction was removed. But rather than send her home, the hospital recommended that she be placed under hospice care within their facility.
Because Lorraine was in the late stages of Parkinson’s disease, her throat muscles were weak, which caused her to choke on her food. The hospital tried using feeding tubes to no avail, as she continued aspirating whatever food she swallowed. Once under hospice care, the nurses assured them, morphine would be administered to keep Lorraine comfortable until her heart gave out on its own. The family, though, wouldn’t hear of this. “We are not in the habit of doing Gd’s work,” Shelly repeatedly told the medical professionals.

When Dr. Matalon got involved, Lorraine had practically wasted away to skin and bones, not having eaten for over a week. He proved a lifesaver in more ways than one. He not only provided a solution to her aspiration problem, but gave the family his cell number, making himself available for emotional support. Rather than slowly killing her off, he suggested, the hospital could simply extend the feeding tube directly into her intestines, which would stop their mother from aspirating her food.

“The family was under the impression – correctly so – that halacha would not allow them to withhold nourishment from a patient. The hospital didn’t offer the family this option (of the extended feeding tube) because they probably felt that she was an elderly debilitated patient, and they didn’t want to go to
the trouble of sedating her – albeit mildly – to enable her to eat. Even though the attending doctor was not in favor of my recommendation, her gastroenterologist felt it was something they could and should do,” Dr. Matalon says.

To the family’s further frustration,they were told it would take almost two weeks before the extended tube was inserted, and Lorraine began receiving the proper nourishment. She’s now in rehab and doing even better than she did before that fateful birthday, since she’s now receiving the nutrition she needs through this extended tube. The family also hired a physiotherapist to help their mother strengthen her throat muscles to enable her to eventually swallow on her own. “If we had had nobody to turn to, maybe we would have placed her in hospice. If not for Dr. Matalon I would never have known about the feeding tube extension. Not one gastroenterologist told me about this," Shelly says.

Helping Families to Do
What is Right Halachically, for Young and Old

Hayim Aruchim doesn’t only concern itself with the elderly; there are occasionally issues with infants that come their way. Babies born with deformities, for instance, often do not receive life sustaining help, largely because the hospital deems their lives negligible. Whether a baby should be put on a feeding tube or on a respirator is a
heart-wrenching decision for families to make. But for each case a halachic advisor must be consulted. This also applies to terminal cancer patients, regardless of the patient’s age. “Hospitals are becoming more and more reluctant to provide care to those patients that they feel are not going to benefit to their standards,” Dr. Matalon says.

Needless to say, the huge responsibilities associated with these efforts are emotionally taxing. There is a lot of emotional burnout
and these four halachic experts are eagerly waiting for three other recruits to finish their training and take on some of the responsibility. There are huge advantages to having Sephardi rabbis and doctors serving their own communities, but there are disadvantages as well. “We know these patients and their families, if not personally, we know their cousins or uncles. We appreciate what they are going through, and we don’t want them to go through it,” Rabbi Beyda says.

In this regard, as well, their partnership with Agudath Israel works to their advantage. “When in doubt we can refer the question to someone who doesn’t know the people involved. That way we get a clear psak uncolored by the emotional strain associated with the case.”

Because Rabbi Beyda is so well known, people often call him directly on his cell. One such occasion precipitated an extremely gratifying and unexpected result. Siblings questioned whether they were obligated to put their elderly father through a procedure that would extend his failing life. From the frustration in the daughter’s voice, Rabbi Beyda sensed that they had gone through a lot as a family and were ready to just let nature take its course. The halacha, though, was clear; it obligated them to do whatever possible to keep their father alive. Despite their misgivings, the rabbi convinced the family to move forward with the procedure. About a month later, Rabbi Beyda received a text message from the elderly man’s son; attached was a photo of the great mekubalRabbi Yaakov Hillel sitting, head bent, beside the patient, with the man’s hands extended on Rabbi Hillel’s head. Rabbi Hillel had asked the man for a beracha.“I’m
so happy I contacted you,” the son texted Rabbi Beyda. “It’s hard to believe that it’s been only a month since we were considering taking the doctor’s anti-life opinion.
Look how he’s doing now.”

There are times, though, when families must let go, albeit in a halachically acceptable way. On those occasions, Hayim Aruchim helps facilitate patients' transfer to the appropriate end-of-life facilities. Besides nursing homes and hospices, one of the least known of these options, Rabbi Beyda says, are the LTACs, or Long Term Acute Care facilities, that accommodate patients with all kinds of medical issues that include those on dialysis and even patients who have been declared brain dead. Hayim Aruchim has experts who are very familiar with the facilities that exist within 100 miles of New York, they make sure to match up each person with a facility approved by their insurance.

The greatest comfort Hayim Aruchim offers families is the knowledge that they are doing what is right for their loved ones in accordance with halacha. "Families tell us that this is a terrifying situation for them to be in, when they are fighting with hospitals to keep their terminal loved ones alive, and they don't know what halacha has to say about their options,” Dr. Matalon says. That knowledge goes a long way towards helping families better cope with the inevitable pain of loss.

If a friend or member of your family is seriously ill and you need guidance or support, compassionate help is available from Hayim Aruchim’s 24-Hour hotlineat 347 578 8200. For more information please visit their website at