Lech L’cha | a Dvar Torah about End-of-Life Decision Making
By Amy Shutkin
In modern conversational Hebrew, the name of this week’s Torah portion, Lech L’cha, translates roughly into “Get out of here!” There are many potential connotations to this ubiquitous phrase. So here’s a “trigger warning:” this dvar Torah lives where Lech L’cha meets end-of-life decision-making.
Lech L’cha, both the Torah portion and the explorations within, describes several arcs from origin story to end-of-life decisions, including Abraham and Sarah’s uprooting themselves late in life to follow a spiritual call, and the promise that they will become parents for the first time when Abraham is 100 and Sarah is 90.
This year, Lech L’cha can serve as a reflection of how we relate and retell our own life stories and how this in turn facilitates making peace with ourselves.
In this Hebrew year of 5778 Kehilla is exploring a new Jewish community engagement campaign (we’re part of a cohort from all across the country and Canada), led by an expert team from The Conversation Project (TCP), to design and implement advance care planning outreach efforts in our congregation.
In this Torah portion, Avram was renamed Avraham and Sarai became Sarah. We’re calling this Jewish TCP engagement effort by a new name, too – Kavod Conversations. Together with faith communities all across North America, this week’s dvar Torah is part of a consciousness raising effort called Conversation Sabbath (#ConvoSabbath | October 27th – November 5th). Our goal is simple and transformative: to ensure that everyone’s wishes for end-of-life care are expressed and respected.
We know that discussing end-of-life issues, even with and/or especially with our loved ones can be uncomfortable. It is uncomfortable. It’s uncomfortable because we’re talking about end-of-life issues that really matter to us. Our kavanah, our loving and compassionate intention, is for the Kavod Conversations program to provide Kehilla members with guidance in preparation for each of our individual journeys.
A personal note about the value of these conversations: My mother has been dealing with these issues for over 50 years. Following a traumatic brain injury sustained in a near-fatal car crash, my father has slowly metamorphosed from the progressive young labor lawyer my mother married into a profound state of dementia. Now in his 92nd year and in declining health, he lives a mostly quiet life inside his own head. In better times he and my mother had held numerous conversations to clarify their end-of-life priorities. She knows what he values (Milwaukee’s legendary Kopp’s chocolate frozen custard), and we can honor his wishes when the time comes.
This summer the international annual conference for Chevra Kadishas (holy burial societies) was again well attended by Kehilla members. We are regarded respectfully within this group for publication of our groundbreaking Shmira Readings and Psalms, among our other contributions. Additionally, Kehilla continues to pioneer gender-neutral and gender fluid Hebrew and English liturgy for tahara, the ritual washing of our deceased.
As a long-time member of Kehilla’s Chevra Kadisha, I was unexpectedly moved to tears when, in the course of the weekend, we were introduced to the Kavod Conversations project. During the keynote address we were challenged to embrace our own mortality and think about finishing the sentence, “What matters to me at the end of life is…”
My thoughts raced to Hero, my daughter who was raised and bat mitzvahed in the Kehilla community. She is now a young adult living in rural Akron, Ohio. What mattered, I recognized, is that she be with me. I struggled to keep from crying. The tears came. Startled, my phone tazered me silently. It was Hero calling me just at that moment. Later that day I called her back and we talked about the synchronicity. At home following the conference, my husband and I sat together and completed a guided conversation about what matters to each of us at end-of-life. We used a free tool called a Conversation Starter Kit, which can be downloaded from TCP’s website. We didn’t see eye to eye on everything. Even after so many years together, some of our responses actually surprised us.
As a community, Kehilla acknowledges our ongoing wrestling and struggles with the complexities of our Divine relationships. These are shared values that ground our conversations. Pursuing our inner truths, what really matters to us, and sharing these with our loved ones is precisely what makes an end-of-life conversation so challenging. According to TCP, “The ultimate goal… is… to change the cultural norm from not having these conversations to having them.”
Kehilla’s Kavod Conversations project team agrees with TCP that “to change that norm, we need to impress people with the importance of the conversation, provide them with tools to make it easier to have the conversation, and encourage these critical talks to take place at the kitchen table before there is a crisis.”1
As a society we have grown increasingly at ease with discussions surrounding responsible sexuality. Similarly we can also acclimate into a more comfortable mindset when talking about our end-of-life choices. Take, for example, Dr. Jessica Nutik Zitter. Dr. Nutik Zitter is double-board certified in both pulmonary/critical care medicine and palliative care medicine. She practices at Oakland’s Highland Hospital and is a member of Oakland’s Congregation Beth Jacob. Dr. Nutik Zitter is also the author of Extreme Measures: Finding a Better Path to the End of Life, a frequent contributor to the New York Times, and is featured in the Oscar-nominated Netflix documentary, Extremis. This video is now included within Oakland Unified School District’s high school health curriculum. In a New York Times’ Sunday Review op-ed this past February, Dr. Nutik Zitter wrote:
… a student visiting a dying grandparent might draw from the curriculum to ask a question that could shift the entire conversation. She might ask about a palliative care consultation, for example, or share important information about the patient’s preferences that she elicited during her course. High school, when students are getting their drivers’ licenses and considering organ donation, is the perfect time for this. Where else do we have the attention of our entire society?2
Too many people die in a manner they would not choose and too many of their loved ones are left feeling bereaved, guilty, and uncertain. Serious disagreements can tear families apart. The extraordinary level of high-tech medical care with which we are blessed to have available to us may be a mixed blessing. Such are first-world problems.
Kavod Conversations is not intended to be managed by Kehilla’s Chevra Kadisha. However, as members of our holy burial society we are a group that is more comfortable than most in dealing with death. The intention is for us to begin planting seeds by introducing this program further and further upstream into our community. Locally, TCP is already embedded within Kaiser’s integrated advance care planning initiatives. Both Alameda and Contra Costa have county-sponsored TCP programs and conduct trainings as well. As a result and over time, we trust that increasingly wider circle of community members will hold their own conversations.
Our Kehilla pilot team includes Allison Rodman, who works in this field professionally and was trained by TCP years ago. Allison will lead the Kavod Conversations presentations and trainings. Julie Patrusky is taking on the role of Conversation Guide. As a professional project manager, my role is to facilitate transparency while leading organizational and programmatic support.
Ultimately it will be up to Kehilla’s spiritual leadership and clergy to integrate elements of this practice into our own life-cycle rituals. Through early spring, the combined Kavod Conversations cohort is engaged with adding Jewish elements to the existing TCP framework. In the coming year Kehilla’s Kavod Conversations project team will offer guidance and conduct workshops to provide Kehilla leadership and community with the resources needed to process our final desires and begin talking with our loved ones, in comfortable settings, about our wishes and preferences. If you are curious to learn more now, you can download a Conversation Starter Kit for free from theconversationproject.org website.
Have you had the conversation? Get out of here!