Jewish World Review August 12, 1998 / 20 Menachem-Av, 5758

Rabbi Bunny Freedman

Creating a world of kindness

By Yocheved Golani

SIX-YEAR-OLD SEBASTIAN MAINSTER DITTMAN of Southfield, Michigan greeted the visitor at his door by pulling at his tie.

"I was expecting you," he told Rabbi Elchonon Bunim (Bunny) Freedman as he yanked the rabbi onto a couch. Climbing on top of him, he then said in a clear, pure voice: "I’m Sebastian. I’m the boss around here."

It was a Sholom Aleichem (greeting) in capital letters.

Sebastian was dying from an inoperable brain tumor. And Rabbi Freedman spent quality time with the youngster's family and schoolmates as well as with Sebastian himself, who was well aware of his impending death. The intervention helped people to come to grips with the development of the inevitable overtones of the child’s dying process.

The little boy was happy to talk with orthodox Rabbi Bunny, as he is known in his chaplaincy role with the Hospice of Michigan. It is a role that Rabbi Freedman fills with dignity and the chesed (compassion) of a Torah-oriented Jew. Since 1992, he has headed the Jewish Hospice Services division of Hospice of Michigan and Jewish Family Services, providing a Jewish context of care for people with terminal illnesses.

Whether Rabbi Bunny is coursing down the freeways of Michigan to visit a bedridden person or looking deeply into the eyes of dying Jews who are grateful for the compassion he bestows in unqualified measure, his every concern is to help fill the remaining days and hours of people who know they are dying with quality of life.

"Sebastian was very aware of dying. He talked about being with G-d, and still being with mommy (and his brother), just in a different way..." Rabbi Freedman recalls. "He thought he was going to another place. He didn’t understand, Boruch HaShem (Thank G-d), how profound that separation would be." When the time came to die, the child exhibited no discernible symptoms of rapid decline but asked to be taken to the hospital. "It was eerie," says the rabbi.

Part of Sebastian’s emotional mastery of his situation was a result of hospice work. The Hospice of Michigan, like all hospice care, is dedicated to alleviating the fear and guilt of everyone involved in the dying process, as well as helping them to cope with the overwhelming sadness of imminent loss. Home care and institutional services are arranged with the goals of respite for the emotional exhaustion of the friends and family members whose loved one is dying, sometimes over a significant period of time. For Jewish Hospice clients, appropriate resources such as Yiddish or Russian-speaking staff, relevant textual materials, kosher food and social services are procured.

The greatest concern of hospice care is devoted to the person who is dying. Rabbi Freedman explains, "The unit of care is holistic for the entire family, with the patient as the center of concern. Physical, emotional, and spiritual concerns are addressed. Dying Holocaust survivors have a peculiar set of needs that hospice meets with appropriate sensitivity. Dying parents have other concerns, and so on. But before anyone chooses to be a hospice client, there are universal concerns to address, also. The underlying fear about hospice care is that there is an abandonment of treatment alternatives. This is not the case. A typical hospice patient is one for whom there is no known medical cure and death is inevitable. Once a hospice patient’s symptoms of restlessness and constant pain. are under control there is often a greater desire to live. "Hospice is not about giving up, it is about restoring quality to a life at its terminal stages," says Rabbi Friedman.

Referrals to the Hospice of Michigan can come from anyone and unlike other institutionalized medical facilities, access is not restricted to doctor referrals. The hospice raises funds for uninsured and low-income patients. Hospice is a type of care rather than a place, so it doesn’t usually entail out-of-pocket costs because it is reimbursed by Medicare and Medicaid, and private insurance. Hospice care includes medical and nursing care, and social work services in which tears do not impede communication, they enhance it. Medications, medical equipment and related supplies are also provided. Some patients receive help with household chores and errands. Spiritual support and counseling are also available, and that is where Rabbi Bunny fits into the scheme of death with dignity.

He joined Hospice of Michigan in 1992, transmitting the dictum of Rav Moshe Feinstein z"l (as excerpted from Rabbi Moshe Tendler’s text, Care of the Critically Ill) that "best interest" decisions must be made by the dying person, their family, their rabbinic guide, and their doctor. Rabbi Freedman is careful to impart to potential clients and supporters of Jewish Hospice care that "For those of us who are Halachically (Torah-observant Orthodox) observant, it is enormously important that a rabbi be brought into the decision-making process when we are caring for a terminally ill person. A Jewish Hospice not only allows for this, it encourages the input of such an authority figure". The Jewish Hospice involvement of Rabbis Yosef Stern and Meyer Scheinberg of Brooklyn, New York prompts their observation that in the advent of a death that is treated with authentic Jewish compassion, "it is not uncommon to see families bond and draw strength from each other". It is a time when unparalleled fortitude and elevation of character can present themselves.

Rabbi Stern tells of an incident in which a highly respected woman from a prominent Orthodox family died on the first day of Passover. "The bereaved family nevertheless understood that the joy of the holiday is sacred. So the entire family stood around the bedside of the deceased and sang Visomachto Bechogecho (a song of intense joy at cleaving to G-d and His appointed times of holidays) with all their heart and soul. It is an image I will never forget." Such is the height of character that can be reached when Halacha is paramount in a person’s values and therefore is a guide for human conduct."

Rabbi Freedman insists, "The layman is all too familiar with the frequent scenario of painful treatments applied in a pointless and depressing fashion in medical institutions. People die, but they don’t have to die amidst false hope and unrelenting pain. There is a way to die with dignity." It is the philosophy of Hospice care that anyone, Jews included, has a right to decline futile care when a cure is not possible. It is standard procedure in Jewish Hospice care that the family’s rabbi serves as their advocate and advisor to hospice officials. This is a great relief to Orthodox clientele who follow strict guidelines in their approach to the issues of mortality and medical intervention. It is also a relief for non-Orthodox subscribers to Jewish hospice care.

An example of the devotion invested by the rabbi and the hospice movement in the care of hospice patients is exemplified in the following story: Rabbi Freedman was called to the bedside of a 45 year old woman at the endstage of a cancer that was inexorably killing her. She had been on hospice care for the past four days, having been discharged that long ago from a hospital that could do no more good for her. It was the mother of the dying woman who had contacted Rabbi Freedman.

At the time of the call, Rabbi Freedman was about to leave town in a raging snowstorm. He needed to reach the airport but changed his plans after hearing out the woman, whose concern was twofold. On one hand, the mother wanted her daughter’s spiritual life tended to as her physical life ended. On the other hand, the dying child had married a gentile and had not lived Jewishly during her entire adulthood. Rabbi Freedman realized that if he missed the opportunity to care for the spiritual needs of either woman, he would leave the surviving mother embittered toward Judaism for the rest of her life. His absence would also preclude any vestige of Jewish conduct for the spiritual welfare of the dying woman. He opted to go to the bedside of the dying daughter, where he recited the confession of sins that all Jews must say on the High Holidays and upon an impending death, the Viduy, and also said Shema (the prayer acknowledging G-d's sovereignty) for the patient who had already lapsed into a coma. He provided reading materials and personal guidance for the mother so that she could observe her child’s death in a Jewish manner. The comatose patient died the next day. Rabbi Freedman summarizes the experience by saying, "People believe that it must be depressing for me to do my work. Far from it. It’s the ones where I don’t make it that haunt me. The happiness and relief that people feel because I become involved in their lives is immeasurable. But if I can’t help, it weighs on my heart. That’s when my work hurts me." The loss of the airplane trip is one that the rabbi dismisses as a worthwhile tradeoff.

Bunny Freedman’s full-time work includes close alliances with area rabbis from every branch of Judaism. Jews who find themselves facing the end of their lives or the lives of someone they love often want to deal with spiritual issues that they neglected in earlier times. Jewish Hospice Services helps them to become familiarized with and to appreciate the Jewish customs and traditions of death and mourning. This includes emotional support after a person’s death. There are outreach programs to immigrants, children, the developmentally handicapped, AIDS patients, Holocaust survivors, the indigent, and residents in various residential or medical facilities.

The families of Jewish AIDS patients are additionally hurt by the shandeh (shame) factor, Rabbi Freedman explains. "Sexually transmitted diseases are anathema in a culture which prides itself on sexual morality. Hospice has to ease the fears of public exposure as well as the sense of guilt and anger when dealing with a family whose loved one is dying of AIDS."

Husband and father to a family which is proud of his work, Rabbi Freedman feels that the knowledge of an option such as hospice care can be a godsend for many individuals. And Jewish Hospice care, which follows Halacha, can be a profound comfort not only to Orthodox Jews in need, but also to any Jew in need.

In Hospice of Michigan, all the caregivers are educated in and oriented toward caring for the special needs of Jewish patients. Michigan Hospice medical director Doctor John Finn is a Christian of Irish ancestry who is astonishingly sensitive to the halachic (Jewish, Toraitic laws of conduct) needs of Orthodox Jewish patients. He has read diligently on the subject of the Jewish approach to death and dying. He goes out of his way to deal appropriately with Jewish patients. He has traveled to Israel to consult with medical experts and ethicists, and wants to set up a Jewish hospice there. Doctor Finn works hand in hand with Rabbi Freedman and they have consulted with Doctor Fred Rosner, Director of Medicine at Queens Hospital of New York. Doctor Rosner is a medical ethicist and helped to create the community educational program in Michigan.

Rabbi Freedman has served as a consultant for other communities exploring the possibilities for setting up Jewish hospice services in locations such as Baltimore, Maryland and Manhattan, New York. Metropolitan Jewish Geriatric Center in Brooklyn, New York and Van Dyke Hospital in Lakewood, New Jersey have already set up Jewish hospices based on the Michigan model, with Rabbi Freedman’s assistance.

According to Keren Traub of the Gevuras Yarden Organization in Baltimore, the initial proposal for this service has been made because the Baltimore Jewish community is one with persons who could benefit from Jewish Hospice Services. Mrs. Chana Weinberg (wife of the dean to world-famous Ner Israel Yeshiva in Baltimore) of Baltimore’s Bikur Cholim (Aid to the Sick) Organization observes, "It is imperative that a dying person be treated with utmost respect and accorded great dignity. A home setting is familiar and bound to be the least disturbing to a patient, a person, who is dying. Hospice care is provided in that familiar setting, and it is necessary." With the many fine medical institutions in the state of Maryland, there is still a dearth of options for people who want a more compassionate approach than the routinized, mechanized care for the dying that is to be found in the average medical institution.

According to Larry Ziffer of Baltimore’s Associated Jewish Charities, Rabbi Freedman is a consummate professional in the planning and execution of Jewish Hospice Care. A 1996 meeting between them has resulted in initial and strategic movements up to and including February 1998, regarding the setting up of a local Jewish Hospice program. "The atmosphere now is electric," Mr. Ziffer says. "We have specific goals and overwhelming community and official response to the idea of hospice in this community. We are at the penultimate stage of setting up Jewish Hospice Services in the image of Rabbi Freedman’s model. We now need another Rabbi Freedman to handle a similar load of his 200 cases annually, and to accomplish the good results that he achieves."

A major consideration for Jewish patients and the people who love them is the issue of euthanasia. Sometimes referred to as "mercy killing", it is an undeniable affront to the spirit, law, and practice of Judaism. Other medical practices such as DNR (Do Not Resuscitate) orders, the denial of nutrients, experimental therapies, transplants, and such, lead to confusion for laymen and to overwhelming questions that thus arise for them. In the face of these alternatives, caregivers and loved ones who are already emotionally drained by the patients’ suffering are in danger of losing their perspective. In conjunction with the problems of Living Wills, a death during Shabbos or Yom Tov and the halachic imperative for proper supervision of the body and its burial, there is a pressing need for authentic Jewish guidance*. The issues can be dealt with individually, with specific guidelines that are culled from Jewish Law. Rabbi Meyer Scheinberg of Brooklyn, New York indicates that these "shailos (ethical/legal questions of Jewish Law) can and must be dealt with according to Halacha." Just because a Jew makes the decision, it isn’t necessarily a halachically compatible decision. "This is why authoritative guidance is necessary," Rabbi Freedman observes.

Rabbi Freedman and the Hospice of Michigan can be reached by phone at (248) 443-7648, or by fax at (248) 559-4649. Their shared address is Suite 212 , 16250 Northland Drive, Southfield, Michigan 48075.

The Mishnah in Tractate Semachot 1:1 states: "One who is in a dying condition is regarded as a living person in all respects." It further enumerates prohibited acts upon the dead body, such as attempts to prevent putrefaction. Rashi, Judaism's foremost commentator, observes that nothing may be done to hasten death. "...Whoever closes the eyes of the dying...is shedding blood," he writes. "One should wait awhile; perhaps he is only in a swoon." Tractate Shabbes 151b of the Babylonian Talmud forthrightly specifies "He who closes the eyes of a dying person while the soul is departing is a murderer." These and other teachings have implications in all aspects of the care afforded to the dying individual.