Orthodox Jewish Medical Beliefs and Practices
Submitted by Rachel Gouge
Tags: culture diversity ethical values nursing education
Moses Ben Maimon, also known as Maimonides (n.d.), a Jewish philosopher, rabbi, and physician from the 12th century, held the belief that doctors should not focus on the disease, but on the patient suffering from it. This belief shows the heart of the Jews towards both the physician and the patient. Physicians and health care workers are considered essential in Jewish healthcare, and the patients and their health are highly valued.
Religious Jewish people may stand out from other cultures in their general beliefs, practices, clothing, and food choices. Though there is a wide variety in the degree of observance, a typical practicing Jewish man can be noted by his beard, long side curls, large, brimmed hat, long black coat, and a yarmulke; in contrast, a Jewish woman may be distinguished by her long hair, covered head, and below-the-knee skirt or dress. By appearance, religious Jewish people can often be immediately identifiable; their customs and practices stand out just as clearly.
The richness of Jewish culture, traditions, laws, beliefs, and customs is a large part of the reason I chose to study this group of people. Almost equal to this, though, is the kind of fascination I have always had in learning about the Jewish people, considering the strength they showed through the horrific events of the Holocaust; incredible stories come from this period. All combined, the Jews have a noteworthy history that deserves to be studied to endeavor to understand how best to care for them in the healthcare setting.
Though there is a significant population of Jews in the United States, currently around 6.4 million, a sizable portion do not identify with the Jewish religion. There are three different branches of Jews: Conservative, Reform, and Orthodox. The Orthodox Jews, also known as Haredi or Ultra-Orthodox, are by far the most conservative in their beliefs, with religion dominating their lives and choices. As stated by RN Elizabeth Johnston Taylor, they “view contemporary culture as a threat and insulate themselves from secular society” (Taylor, 2019, p.143). There are currently around 500,000 Orthodox Jews in the United States today; a substantial portion lives in or near New York City, where about 340,000 of them reside (Taylor, 2019). Though this is an insignificant number in relation to the total population, it is still vital for those in the healthcare setting to understand how Orthodox beliefs might affect both the patient and the nurse during a hospital stay.
The Orthodox Jews have extremely strict laws to follow and observe, which are based on their understanding of the Torah, or Law, the first five books of the Bible. These laws, along with the oral tradition, or rabbinic teachings, are known as Halacha. Halacha is used as a guide for Orthodox Jews to help them make choices in their lives. Such laws and traditions, which are deeply engrained, can significantly impact the Jews’ healthcare choices, and may change the way nursing care is given to this devout group of people.
An important tradition to be aware of is the devotional practices of the Orthodox Jews. Jews adhere strictly to a day of rest each week, the Shabbat, or Sabbath, observed from sundown Friday until one hour after sundown on Saturday. During this time, according to their beliefs, no work may be done. This includes use of electricity, use of the telephone, bathing, writing, and many other factors that are considered work. Throughout this time, a nurse should not expect her patient to receive any visitors from family and should anticipate planning with the patient for any specific food or clothing needed for Shabbat. The nurse should not anticipate discharging a patient on the Sabbath; it would be against the Jewish law for the patient to make a trip home until after the observance of this day is over (Taylor, 2019). Due to the importance of this event to Orthodox Jews, prior arrangements should be made if it is necessary for the patient to have a stay during Shabbat. Having a discussion with the patient prior to their observance of the Sabbath in terms of their care would be highly appropriate and may stave off unwelcome complications.
Prayer is also a large part of the life of an Orthodox Jew. Men pray 20-40 minutes in the morning, and 5-10 minutes every afternoon and evening, for a total of three times a day. The custom is to wear a prayer shawl and strap a black box to their foreheads, facing east towards Jerusalem while praying. Though individual prayer may be utilized, group prayer is desired, often at least 10 men performing prayer together. If possible, accommodation can be made at the health care facility for a large space to allow for a group. As well, it could be helpful to attempt to schedule or reserve time slots in the patient’s schedule to allow for the three prayer services.
Since most Orthodox Jews do not believe in contraceptives and consider it a woman’s duty to bear children, a Jewish family tends to be large, with an average of seven children in the family. Often, the family and extended family want to be near the patient, and many visitors for the patient would be customary practice. This all needs to be considered, though, of course, the health of the patient is the most important. Sometimes limiting visitors may be the best, or only, option. Sexuality is considered to be sacred, with specific views on when sex is allowable. Husbands are not allowed to touch their wives while their wives give birth; neither can they view the birthing, though they may be in the room. Modesty is considered especially important for women; one of the strict customs of modesty is that women should keep their heads covered. Due to this belief, the nurse should be careful when entering a patient’s room, to allow a woman to be properly covered. If the patient is of the opposite sex, consideration should be given to the beliefs in touch or exposure, possibly needing to provide a healthcare worker of the same sex. These are all discussions that will need to take place with the patient.
The rabbi, or teacher, is highly regarded in the Jewish community. The Rabbi’s judgment and counsel carry substantial weight. Rabbis are considered to be “conduits of God to humans” (Taylor, 2019, p.145), and for this reason, all major decisions should be made through consultation with them. If there is a question about the interpretation of the law or uncertainty about almost any decision in life, an Orthodox Jew will consult with his local rabbi and heed his counsel. This applies to questions about sexuality, contraception, food, dress, worship practices, and extends into healthcare decisions. Some of the healthcare decisions a patient may want to consult their Rabbi about are about treatment options, surgery, and end-of-life decisions. The Rabbi’s counsel will be highly regarded and likely chosen over the advice and direction of the physician himself. This does not mean Jews have a disregard or distrust of physicians, only that the Rabbi will have the final say.
End-of-life beliefs for the Orthodox Jews are based on the view that life is sacred, comes from God, and should be preserved, a belief called Pikauch Nefesh (Bressler & Popp, 2018). Though Jews believe in an afterlife, and believe that suffering can have value, this does not mean that they attach weight to unnecessary suffering. As stated by Elliott Dorff (2002), “Because the body belongs to God, each person is duty-bound to seek both preventive and curative medical care and to follow the expert’s advice in preserving one’s health” (p.3). Due to this, opioids and pain management are recognized as appropriate treatment, and advanced directives are acceptable; however, euthanasia is not.
One of the Jewish people’s strong beliefs is the fervent desire for home care, surrounded by their families. If this is unable to be accommodated, quite often the family will endeavor to make the room in the facility as homelike as possible. Relatives may bring in pictures and personal items for the patient. The patient may have the desire to have the entire extended family at the bedside.
The viewpoints that Jews have about health and their care do not necessarily stand out as being vastly different from other cultures of faith. However, the religious outlook of the Orthodox Jews should be taken seriously as the patient makes healthcare decisions. The frame of reference for a nurse caring for a Jewish Orthodox patient is that at the heart of all these decisions is their faith in the law, the Rabbi, God, and an afterlife. These beliefs must be respected and valued, as well as accommodated whenever possible.
References
- Bressler, T. & Popp, B. (2018). Ethical challenges when caring for Orthodox Jewish patients at the end of life. Journal of Hospice & Palliative Nursing, 20 (1), 36-44. https://oce-ovid-com.hartness.idm.oclc.org/article/00129191-201802000-00007/HTML
- Dorff, E. (2002). The Jewish tradition. Religious beliefs and healthcare decisions https://www.advocatehealth.com/assets/documents/faith/jewish4.pdf
- Taylor, Elizabeth J. (2019). Judaism: Orthodox. Fast facts about religion for nurses: Implications for patient care. Springer Publishing Company
- 10 Thought-provoking quotes by Maimonides that will help you deal with perplexity https://quotes.thefamouspeople.com/maimonides-227.php