Two Rabbi/Doctors outline care for aging parents

The care of aging parents, though difficult, is a necessary fact of life and should be approached with a proper attitude and with an understanding of ethics and Jewish law.

In a talk that combined Talmudic and other Jewish legal sources with medical expertise, Rabbi Dr. Aaron Glatt and Rabbi Dr. Richard Weiss discussed “The Circle of Life: Considering the Ethical and Halakhic Parameters of Caring for Aging Parents” this past Sunday at the Young Israel of Woodmere. The program was presented by Yeshiva University’s Student Medical Ethics Society.

“I certainly don’t have all the answers,” began Dr. Glatt, Executive Vice President and Chief Administrative Officer at Mercy Medical Center and Assistant Rabbi at the Young Israel of Woodmere. He said that this is a “difficult talk” and a problem that everyone there “has, is, or will face…maintaining a loved ones dignity going through the aging process. We’ll all be in those shoes one day, im yirtzeh Hashem (if G-d wills it) because the alternative is no good.” He warned about being careful, that we “get exactly what we reap” that how we treat our parents will be how we will be treated by our children. “Forget the ideal of lishma (for the sake of the deed)” but for selfish reasons—setting the stage for “our own aging process.”

Glatt cited Nadav and Avihu’s deaths in this week’s Parsha as caused by their lack of respect for their father Aharon, uncle Moshe and for G-d, and by not having married. He stressed that children are “doing G-d’s work” when taking care of their parents’ and that it “makes it easier to bear” knowing that. “We have to subordinate our own psychology to Hashem’s way.”

Rabbi Glatt recounted the Talmudic story of Dama ben Nesina, a non-Jew who lived during the time of the Temple and who was cited as exemplary in his respect for his parents. He did not wake his father and did not object when his mother assaulted him in public. Rabbi Glatt also told of Rabbi Tarfon’s respect and care of his mother.

Glatt delineated six requirements in the care and honoring of parents: feeding and giving them to drink, bringing them to and from places, clothing them and ensuring they are comfortably dressed. “Basic physical needs are your responsibility; they can pay for them. If you can afford it and your parents can’t and you don’t pay, a “curse is on you” for not doing it. It is your obligation to take care of your parent; if you have no time, you have to pay someone to do it for you and it comes from your pocket. You also have to visit them.

Rabbi Glatt stressed the importance of providing parents with a quality of life—if a parent is very old, 95 or 103, or a parent is terminal and they want an extra cookie or more chulent—they shouldn’t have to watch their sugar and cholesterol so vigilantly. “Let them enjoy,” he said. Prepare the food they like, he continued, don’t make them eat their vegetables if they want the dessert. Don’t embarrass them--cut up their food in the kitchen and don’t make them wear a bib if they don’t want to. Make them feel needed; if they want to help, give them something to do--“there is nothing worse than having no purpose in life—make them feel useful---it’s an unbelievable kibud (honor).”

If a parent is in very bad shape, he said, you can pay for someone to take care of them if it may be more embarrassing for the parent to have a family member take care of them in that state, such as with toileting. Make sure they dress comfortably, clothing that is comfortable and easy to wear and remove for the bathroom so they won’t soil themselves. Make sure the area is safe--have a grab bar installed in the shower.

Ask a halakhic question regarding providing medical care yourself if you are a health professional, since a child is not allowed according to Jewish law to draw blood from a parent. He pointed out the need to take away the car from a parent at some point and arranging for transportation instead, paying for car service, helping the parent navigate insurance, and medications, but he cautioned, “try not to take away their independence.”

He stressed the importance of the children, grandchildren and great grandchildren visiting the parent, bringing the parents to smachot, and don’t say it’s “too much tircha—the tircha is for you not her.”

Rabbi Richard Weiss, MD, currently the Rabbi of the Young Israel of Hillcrest in Queens and an adjunct assistant professor of Biology at Stern College for Women of Yeshiva University, emphasized the importance of “demeanor, approach and attitude” in how one speaks to a parent. He said that providing the proper dignity to a parent is “fundamental.” He cited various articles and books on elder care and issues including Dr. Michael Salamon’s “Home or Nursing Home,” about when it is appropriate to transition a parent to a skilled nursing facility or have assistance in the home. He noted the need to determine what the parent wants, what is realistic and what we can provide for the parent. He explained the different halakhic questions arising in the care of parents, including the obligation to not listen if their demand is “to their detriment.”

One is never permitted to retaliate to a parent but that doesn’t “mean that you have to subject yourself to disgrace, bizayon,” he said. He cited “as G-d commanded you” as in the desert, when the parents didn’t provide for the children, but all physical needs, the clothing was maintained, food and water provided by G-d, and yet the children were still obligated “independently in the direct care of the parent.” “If a parent makes unreasonable demands the child is still obligated to secure care--the question is personally or through a facility.” Said Weiss, just as you are obligated to spend money on a mitzvah such as lulav and etrog, if you have to take a day off from work, it’s a mitzvah, but you are not obligated to lose your job and disorder your life. Just as when a parent forbids a child from marrying a person, the child can listen to the advice but make their own decision--“life is not run by the parent,” added Weiss. Also, the determination if the parent can live in the child’s home—“it can be productive and optimal” or would it cause “friction.”

Glatt noted that the financial obligation of maintenance is on the parent but a child is obligated to provide the parent’s care—that the parent is “theoretically obligated to pay but the actual obligation is on the child.”

Weiss discussed consulting with an elder care attorney, and the importance of balancing time between the family and the parent and maybe integrating the two. Glatt praised modern technology, having conversations between grandparents and grandchildren on “Face time” and Skype. He stressed the importance of making phone calls to parents, and Weiss noted that, in a minority opinion, a parent can listen to havdalah over the phone.

In response to a question, Weiss said that it is a halakhic, medical and ethical requirement to report elder abuse and to bring it to the attention of the rabbi, doctor and social worker to address it. Weiss also noted that if a feeding tube is needed, the parent, child and doctor should be consulted together and noted that it’s not as bad as a ventilator. Glatt stated that a “feeding tube is not always medically the answer” but that it is sometimes for “convenience” but he questioned “whose convenience” noting there is pain and sedation—is it because no one wants to take the time to feed the parent? He stressed the importance in consulting a rabbi who knows the family, the person’s local rav. Weiss emphasized the need to have the parent make a decision about care when the parent has the ability to make the decision and set up a health care proxy, noting that the documents are available from Agudah and the RCA.

Glatt stressed the importance of conveying the medical information correctly and accurately to the rabbi to be consulted. “The default position,” he said, “ is to do everything until you know for certain.” The decisions on care should be held “when everybody is healthy and well—go l’chumrah and not l’kulah. It’s not a decision to be made at 2 AM when the patient is not breathing well,” he added. Weiss pointed out the difficulties with a ventilator halakhically.

“You are doing what G-d wants you to do,” said Rabbi Glatt quoting the Chasam Sofer, and in a sense, summing up the task and mitzvah all children are obligated with. “How could it be difficult—it’s not not difficult but becomes not difficult when doing exactly what Hashem wants you to do.”