End-of-Life Care in the Bible

The following article was originally published by 70 Faces Media and appeared as part of a series supported by MJHS Health System, 70/Faces Media and UJA-Federation of New York to raise awareness and facilitate conversations about end of life care in a Jewish context.

What we can learn from Jacob, Sarah and Moses’ final moments.

BY RABBANIT ALISSA THOMAS-NEWBORN

The Torah is called Etz Chayim, a tree of life, because it provides values, ethics and laws by which Jews are commanded to live. But how we die is also part of how we live. And so when we face death, our biblical ancestors can serve as models for how we approach the end of life. Below are some key examples from the Torah and what they teach us about dying.

Jacob

Is there such a thing as a good death? Today much of the research around this question says yes, and it looks like this:

• Death at home or in one’s place of choice
• Death surrounded by loved ones or whomever one desires
• Death with closure in all relationships

Hospice organizations, palliative care teams and family members of those who are dying are finding that these components can ease anxiety and pain and create peace at the end of life.

In the Torah, Jacob has a famously good death. Not only does he know that his death is imminent, he has the mental clarity to call each of his children to his bedside to bless them and give them advice for life after he is gone. (Genesis 47:28) He rebukes those who need it and tells his own life story. Jacob even tells his children exactly where to bury him — alongside his ancestors. In contemporary terms, he models a life review and legacy work, and provides an ethical will — all things that healthcare professionals, therapists and clergy so often encourage. Jacob does not get the life he wanted — as he says to Pharaoh: “Few and evil have been the days of the years of my life.” (Genesis 47:9) But he does get the death he wanted. He ties up his loose ends and makes sure everyone he needs to speak with hears him. He does this all in the comfort of his home.

Of course, the type of death Jacob has is not always possible. Some deaths are unexpected and unplanned. Some deaths happen in the hospital because that is the only place a person is able to get the care they need. Sometimes a person who is dying is no longer conscious or cognitively capable of imparting their wishes. And because we don’t know what our own death will be like, it is important to prepare for it as early as possible, even before we are ill. Telling a loved one whom we want at our beside or what medical measures we want to be taken or how we want to be remembered can be done at any age. These conversations are uncomfortable, but they are also the ultimate expression of love.

There is wisdom for us all in Jacob’s death. There is even a famous teaching (Rashi on Genesis 49:33) that says Jacob did not really die. The lesson being: When we leave behind instructions, a legacy, and blessings, we never truly die.

Sarah

Can a person die of a broken heart? In the Torah, Sarah does.

After struggling to bear children, Sarah finally gives birth to her beloved son, Isaac. One day God commands Sarah’s husband, Abraham, to sacrifice this cherished child as a test of faith. When Sarah finds out that her son was being prepared for slaughter, “her soul went out from her and she died” (Rashi on Genesis 23:2) although Isaac would not, ultimately, be harmed or killed. The Torah portion in which Sarah dies is called, “Chayei Sara,” or “The Life of Sarah,” underscoring that how she died reveals much about how she lived and how she is to be remembered.

What can we learn from Sarah’s death? Rabbi Kalonymus Kalmish Shapira, a 20th-century Polish rabbi known as the Aish Kodesh in the Warsaw Ghetto, tells us that Sarah’s death is a prayer to God — and a plea that a person should not be expected to suffer unlimited pain and anguish. If Sarah, one of the most virtuous, giving and faithful people in our tradition, could not withstand such pain, no one can or should have to. The story of her death is a prayer to God to step in and hold us, comfort us and save us when we cannot continue on.

When we are faced with unbearable sorrow in our own lives, perhaps as we face our own illness and death or that of a loved one, we can think of Sarah. We can imagine her sitting with us in our pain, holding our hand — and maybe even crying along with us. When we have nothing to say to God, Sarah is our voice, demanding that God make our lives and deaths better than hers. Let us learn from her story and say in our prayers, “God, this is enough! Please give me the strength to get through this. Please let Sarah’s death not be for nothing. Please heal my broken heart.”

Moses

“It is not up to you to finish the work, but you are not free to desist from it.” (Pirkei Avot 2:16)

We often think that we have to do everything ourselves, that if we don’t, it won’t get done. At the end of his life, Moses — a leader used to doing it all — learns that this way of thinking is counterproductive.

To this day, we say that no one will ever be like Moses in his character or in his relationship with God. But even Moses was human and died. If Judaism had ended with Moses, if the work stopped with him, we would not be here today. If the Torah only existed in the life of one person, it would not be eternal. And so, in the final moments of his life, Moses is told by God to focus on passing his leadership on to Joshua. (Deuteronomy 31:14) He has to accept that he will not, in his lifetime, get to enter the land of Israel; in this acceptance, Moses learns that passing on the tradition is the greatest way of keeping it.

Our job is not to finish the work, but to be a link in the chain. This is a lesson we often accept only when we face death — and thus the loss of time, opportunities and dreams. And yet this same tough realization is a source of hope. There is more than just now; we are part of a greater story. We do not have to worry about finishing everything because we will have help from future generations. This truth is humbling and freeing. It allows us to let go.

At the end of life, sometimes a person feels tethered to this world, worried about children or a spouse, unable to let go of the things he or she wants to finish or take care of. Or perhaps a loved one will not leave the bedside or practice self-care for fear that no one else will look out for the patient. In such situations, it is a wise and compassionate gift to ourselves and to our loved ones to give permission to let go and accept help.

In your own life right now, reflect on letting go and accepting that your unfinished work will be carried on by others. What would it feel like to say (to yourself at the end of life or to a loved one at the end of life): “You did not desist from the work. You did it every moment of your life. You took care of everyone and are loved. But you don’t need to finish it, you don’t need to do it all yourself. Your legacy will continue; your story will go on. I give you permission to let go.”

Though in death we lose life in this world, we also gain the gift of legacy, of a story that is greater than ourselves. By passing on his leadership, Moses made sure we could do the same.

At MJHS, we value both personal and professional caregivers and recognize the critical work you do. That is why we have created these online caregiving resources to help you through this crucial time in your life.

If you need additional help and support caring for your loved one, please feel free to contact MJHS. We can recommend other care options available to you through one of our programs.