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Advance Care Planning For the Jewish Patient

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Presentation on theme: "Advance Care Planning For the Jewish Patient"— Presentation transcript:

1 Advance Care Planning For the Jewish Patient
Mrs Nava Kestenbaum The Interlink Foundation

2 Aims and Objectives AIMS:
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: Define Jewish attitudes to palliative care Identify key Advance Care Planning (ACP) documents Completing a Preferred Priorities for Care document or a Thinking Ahead (GSF) document. Understand the decision making process and relevant contact personnel for further guidance or support.

3 Gold Standards Framework (GSF) END OF LIFE CARE TOOLS
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) (Eg. Diagnosis of life threatening disease, Alzheimers or admission to Residential Care) Advancing Disease Increasing Decline Last Days of Life First Days after Death Death END OF LIFE CARE TOOLS

4 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.

5 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 .

6 The Jewish patient – social structure Spheres of influence
Rabbi, Family , friends Community support (Bikur Cholim, family support), GP,, care home, Chai cancer care Wider community organisations - Strong influence on decision making Clinicians, care team Social services


8 Least to most legally binding
Key Documents Jewish Advance care Planning Statement of Wishes and Preferences Preferred Priorities for Care (GSF Care Homes) GSF Thinking Ahead Advance Decision Making Interlink’s Halachic Living Will DNAR instruction Advance Decision to Refuse Treatment Lasting Power of Attorney (LPA) Least to most legally binding



11 I do not wish to have a DNAR offered to me
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 Yes, held by spouse / GP / care home 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

12 In use by health and care personnel

13 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.

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

15 Enter patient representative and Halachic consultee




19 PART 2: Guidance for Organisations and families

20 Decision Making for the Patient
Does Patient have Mental Capacity? Test if unsure Has patient completed any ACP documents Safeguarding Adults Change of Residence Serious Medical treatment Best Interest meetings based on MCA principles for Any Lasting Power of Attorney appointed? Does Halachic Living Will , PPC or GSF document identify consultee Patient should be consulted directly. Preferred Priorities for Care should be referenced Family/ representative should support patient in decision process yes no yes no

21 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.

22 Guidance for patients and families
Patient diagnosed with dementia, terminal illness or entering care home Begin Advance Care Planning Does patient have mental capacity? Use planning documents: Preferred Priorities for care Thinking Ahead (GSF – care homes) Halachic Living Will Lasting Power of Attorney File documents with GP, hospital case notes, patients representative Review every year or sooner if change in circumstances Relevant for individuals 18+ A Lasting Power of Attorney supersedes an Advance Decision directive and may invalidate it.

23 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

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