health mind and body

Europe’s Jewish hospice offers dignity to survivors


AMSTERDAM — Henny Goudeketting, a 95-year-old Holocaust survivor, who was sterilized in Nazi medical experiments at Auschwitz, has neither children nor other relatives to care for her. Now, after multiple infections and recurrent falls, she’s readying to say goodbye.

“It’s kind of strange,” Goudeketting told JTA. “I know I have no future and I’m ready to die, but I’m still afraid of actually dying.”

“My biggest sorrow is not being able to have children,” said Goudeketting, an Amsterdam native who returned to that city at 23 after surviving Auschwitz. She worked for decades as a seamstress.

Last month she was admitted to Immanuel, a small but upscale eight-room facility for the terminally ill. It is Europe’s only Jewish hospice, according to Tel Aviv University’s Kantor Center for the Study of Contemporary European Jewry.

While such facilities are common in the U.S. — the National Institute for Jewish Hospice, which was established in 1985 in New York, lists no fewer than 225 accredited Jewish hospice programs — they remain rare on the continent. Funded through private donations, as well as patient fees and some subsidies, the hospice was built by the Dutch Jewish community for survivors like Goudeketting to receive top end-of-life care.

“I’m not sure whether this is real, the luxurious treatment I’m getting here,” she said. “I’ve never experienced anything like this in my whole life.”

The Netherlands, which last year was No. 1 on Europe’s index of public health systems, has 146 hospices nationwide with an average guest satisfaction rating of 9.1 out of 10. Immanuel is the only hospice in Europe for guests like Goudeketting who keep kosher, although there are other hospitals with palliative programs that offer kosher food.

It’s also the only hospice where the staff and volunteers “already know the special issues connected to caring for the generation of Holocaust survivors,” said Sasja Martel, the institution’s founding director. That’s crucial, she said, “because at the last stage of life, it’s often too late to start explaining” what those special issues are.

A case in point: At Immanuel, the staff encourages guests to resist the urge “to finish their plates,” Martel said, and only eat when they are hungry.

“Traumatized by the Holocaust, survivors and their children tend to associate eating with staying alive,” she explained. “And that’s true, but at the terminal stage eating can hasten death.”

Rabbinical or other spiritual counseling is available to guests, as is counseling on accepting death, mostly by volunteers. That’s an issue for many survivors who are conditioned to “fight death at all costs,” Martel said.

The hospice, which has an annual budget of approximately $500,000, is subtly adorned with Jewish symbols ranging from mezuzahs, menorahs and, atop one piece of furniture in the main hall, a small pile of stones of the kind that Jews place on cemetery headstones. But even though they are understated, the symbols can have a profound effect on some guests.

 “The significance of little things is amplified near the end,” Martel said. “Many guests feel a need to touch their identity, reconnect with it, even if only through the symbols. Or the typical Ashkenazi Jewish chicken soup we serve, that they remember from their grandmother, or the white tablecloth on Shabbat and the candle lighting. Or just a Jewish joke.”

Staff are trained to accommodate the special needs of survivors like Goudeketting, who have no family, added Martel.

“We need to be conscious that for many of our guests we are all that they have, which is not necessarily the case in other hospices,” she said.

There are other sensitivity issues. For example, the hospice decided not to hire a nurse who had a German accent, Martel said last week at a symposium on hospice care in Judaism in honor of Immanuel’s 10th anniversary.

One former patient, Bram Koopmans, said in a filmed interview before his death in 2010 that the hospice was his first contact with a Jewish community institution since staying at an orphanage for child Holocaust survivors in the 1940s.

On his deathbed, Koopmans said that after decades of avoiding his Jewish identity, staying at Immanuel made him remember the Jewish blessing over bread, which he was taught at the orphanage. Holding back tears, Koopmans recited the blessing during the interview while holding one hand over his head.

“It’s been waiting in me for years and years,” he said. “It’s as though I never left.”

Koopmans asked volunteers at Immanuel to go to his home and fetch a kippah and menorah that he had hidden away, Martel recalled. He also asked a rabbi to give him a bar mitzvah at the hospice. Koopmans had a Jewish burial, which he didn’t plan to do when he first arrived at Immanuel.

One thing not offered at Immanuel is assisted suicide, which is readily available in the Netherlands for the terminally ill. The country’s parliament is now debating a controversial draft bill that would allow even healthy people to receive assisted suicide. But ending one’s life is “diametrically opposed to the Jewish values that sanctify life,” said Martel.