Judaism is both a monotheistic religion and a culture. A religion is a “belief in a divine or superhuman power or powers to be obeyed and worshipped as the creator(s) and ruler(s) of the universe,”1 whereas a culture refers to “nonphysical traits, such as values, beliefs, attitudes, and customs that are shared by a group of people and passed from one generation to the next.”2 The Jewish people are primarily the descendants of the biblical forefather Abraham and foremother Sara. Converts have, however, joined the fold throughout the centuries.
After enduring the 400 year crucible of Egyptian slavery (1400–1200 BCE), the Jewish people were forged into a nation and a religion by entering into a covenant with God and accepting the divinely ordained code on Mount Sinai. The latter, referred to as the Torah, includes the Ten Commandments as well as a written and oral code. The written code, originally composed of the five books of Moses, was canonically expanded to encompass the books of the Prophets and Writings to collectively form the written scriptures referred to as the Tanach.
The oral code comprised a basic oral teaching along with a compendium of exegetic techniques whose critical purpose was to enable the ongoing interpretation of the Tanach. Although initially handed down from one generation to the next by word of mouth, the code was eventually committed to writing. Over the centuries, as new situations evolved, the sages utilized these techniques to expand the code. The latter came to include a large intricate corpus of law, the Halacha, which is essentially an all-encompassing manual for daily behavior. In addition, the oral code included works of philosophy, ethics, parables, and folklore. These enrich the understanding of the Halacha and also provide general guidelines for leading a moral and fulfilling Jewish life. Some of its major opuses are the Talmudic tractates, specific codes of law, such as that of Maimonides (1135–1204 CE) and the Shulchan Aruch and the rich and varied Responsa literature, which is still accumulating. Responsa are crucial to the Jewish tradition, as they address head-on the new challenges facing each generation. Today, substantial parts of the Responsa address the ethical dilemmas posed by modern medical technology.
There are currently 13.2 million Jews worldwide, with the greatest concentrations in North America and Israel.3 Europe, including the non-Former Soviet Union, and Latin America comprise the two additional major centers. Historically, the Jewish people have lived all over the globe. Varied ethnicities evolved, determining areas of origin. The two largest Jewish ethnic groups are Ashkenazim, formed of Jews of eastern or western European descent, and Sephardim (also known as Edot Mizrach), having origins in the Mediterranean countries, the Middle East, and northern Africa. A large concentration of Ethiopian Jews has immigrated to Israel over the last number of decades, and they constitute a distinct ethnic Jewish group. Customs and traditions vary with respect to ethnicity.
Cultural differences based on ethnicity run the gamut, from those of mundane matters such as culinary menus for festive occasions, to matters of the spirit, such as the makeup of the prayer book. The Jewish population also differs in the degree of their religious identity and the extent of adherence to religious, especially ritual, practice. In the United States, the main religious identity groups are categorized as Orthodox, Conservative, Reform, and Reconstructionist.4,5 In general, the Orthodox are the most stringent adherents to the Jewish religion. The Conservative group is more liberal in interpreting the scriptures and oral teachings and less stringent in ritual observance, whereas Reform Judaism is the least stringent. Although its followers often celebrate Jewish holidays and religious rites associated with life changes, these practices often stem from cultural rather than religious values.
In Israel, the second largest Jewish population center, religious grouping is categorized as Ultra-Orthodox (Haredi), Religious, Traditional, and Secular. The Ultra-Orthodox applies “stringencies on the basic Jewish law to ensure adherence to the religious law and similarly [apply] such stringencies to dealing with the outside world to ensure protection from negative influences. Knowledge is primarily sought through religious study and religious life alone.”6 Israeli Jews who consider themselves Religious differ from the Ultra-Orthodox in relation to their “integration into the general society while maintaining their religious life and acquiring an education through non-religious and religious study.”7 Their “religious life” embraces full commitment to the Halacha, including its ritual aspects. The term Traditional refers to Israeli Jews who observe religious Jewish ritual practices out of respect for religious commands. Traditional practice differs from Religious practice in that traditional Israeli Jews do not place Jewish law in the forefront of everyday decision making.8 Secular is attributed to Israeli Jews who disassociate themselves from “any connection between Jewish ritual and divine commandment. Secular Israelis can be sub divided into those that do not perform any Jewish ritual and those that perform Jewish ritual as a cultural rather than religious requirement.”9
This chapter is not intended to serve as an authoritative guide to Jewish Halacha, although its underpinnings are rooted in classic Jewish sources. It is meant rather to assist health care professionals in understanding the mainstream Jewish conceptualization of health and illness that is to a greater or lesser extent embraced by most members of the Jewish faith. The decision-making process and behavior of both Jewish caregivers and care recipients are therefore reflected.
Human beings have innate compassion for fellow human beings by virtue of being created in God’s image.10 People are obligated to imitate God by bringing his compassion to fruition by their behavior. The Talmud in Tractate Shabbat (133:2)11 states: “just as God clothes the naked, so must man, just as he consoles the mourners and visits the sick, so too must man.” God created “one” Adam to teach two principles: the infinite value of every human being and the inherent equality of human beings.12 Human compassion must be blind to such factors as color, culture, wealth, and health.
Commitment to compassion means acting, and if necessary, sacrificing to protect all facets of a fellow human’s well-being. One must go out of one’s way to help retrieve lost property, restore health, and forewarn a fellow human being of impending threats to physical and emotional safety. One is obligated to undergo discomfort, monetary expense, and if need be, a reasonable amount of danger, in order to aid those whose lives are threatened (Talmud Bavli, Tractate Babah Metziah, 30:2).13
Life and quality of life are paramount values that trump even autonomy. Maimonides taught that one has no right to say “I will endanger myself and it is no one else’s business.”14 Maimonides further declares that to the extent that an individual is lacking in health and well-being (thereby diminishing quality of life), so will he or she be lacking in the ability to serve God in his or her lifetime.15 We can extrapolate from Maimonides’ teachings that individuals are obligated to intervene on behalf of others, assisting them in fulfilling obligations to themselves. Destitute, alone and/or physically or emotionally handicapped people may perceive life as futile. Social solidarity as a religious obligation dictates that it is the entire community’s business to do everything in its power to ensure that individuals receive the emotional and physical support necessary to empower individuals to choose health and life.
Leaving the sick alone is ungodly.16 The religious duty to visit the sick, even in non-life-threatening situations, applies even to those individuals who are exempt from other obligations toward fellow beings.17 The duty is comprehensive, including assessing and tending to mundane and aesthetic needs, providing emotional and spiritual support, and praying.18,19 These echo the nursing process. Nurses, however, are obligated to “visit” the sick on a level commensurate with their knowledge and experience. Their profession is a divine calling, reflected in the commandment “Thou shalt surely heal.”20 Alleviating pain and suffering is central to healing. This is reflected in the Hebrew root for healing—rafo—which also has means “to ease.”21
In Tractate Nedarim (40:1), the Talmud tells of Rabbi Akiva who was the sole visitor of a gravely ill individual. After carefully assessing and meticulously caring for his needs, the individual regained health and proclaimed with gratitude: Rabbi, you have given me life! Akiva, experiencing an epiphany, gathered round his disciples and preached that refraining from visiting the sick is tantamount to bloodshed.
Rashi (1040–1105 CE), the great medieval commentator, relates that the meaning of the name “Puah,” one of the two biblical Israelite midwives mentioned by name in the Bible (Exodus 1.15), is a cry imitating that of women in childbirth.22 Midwives would habitually mimic the sounds made by the birthing women, displaying empathy in a way that could be experienced by the care recipient on the most fundamental level.
The tanaic work of Avot De Rabbi Natan23 gives insight into how difficult empathy can be by relating a story about a visit that the righteous but most otherworldly, Shimon Bar Yochai paid to a sick individual. Finding him in the midst of cursing God for his plight, Bar Yochai preached: rather than curse, you should pray for mercy. The offended individual responded: if only God would smite you with my illness. Bar Yochai admitted his failure in fulfilling the commandment of visiting the sick. The “caring occasion” and the “teachable moment,” which could have been utilized to help the patient find meaning in his suffering, were missed. The deeply spiritual Bar Yochai was incapable of appreciating the fundamental mundane needs of his fellow human being. True empathizers shoulder part of the illness burden, thus lightening the load.24 Although all are obligated to pray for the sick, righteous visitors are expected literally to “become ill” along with their fellow human beings.25 This intimates that supreme empathy is a sacrificial act that is concomitant with sublime moral stature.
Empathy comes most naturally in situations where sick individuals and their visitors share similar world views culturally, spiritually, developmentally, or by virtue of strong family ties or a very deep friendship.26 Yet empathizing can be a great challenge, even for individuals possessing close ties with the sick. The biblical book of Samuel (I Samuel 1.1–2.10) relates the story of Hannah, a barren woman, very beloved of her husband, who attempted to console her with the words: “Do not cry, I am better for you than ten sons.”27 Although well meant, these words were lacking in empathy. Reading between the lines of the biblical verses, the midrash puts these words in Hannah’s mouth: “Dear God, everything that you created in women, you created for a purpose. Eyes to see, ears to hear, a nose to smell, hands to labor, legs to walk, and breasts to nurse the young. Please grant me a child so that I may put these breasts to use.”28 Her husband missed the point; a husband is not a substitute for a child.
Despite the fact that nurses will naturally differ in many ways from their care recipients, the ability to empathize is central to their profession. Nurses need to develop super-sensitivity to their own “blind spots,” so that they impinge as minimally as possible on the ability to empathize. The Jewish tradition relates to empathy very much like Watson, who champions transpersonal caring, transcending one’s own world in order to enter the world of the other.29 The carer is self-sacrificial, giving up his or her own world view, at least temporarily, so as to enter the world of the “other.” The carer is, however, also rewarded by growing as a human being.
The quality of care nurses provide for the sick is thus partially determined by their ability to accept the legitimacy of the entire gamut of human responses to misfortune. Individuals approach suffering in different ways. Biblical examples are of some who do not question and suffer silently (like Abraham); others pray that the suffering be ended (like King Hezekiah); some actually ask God for continued suffering in order to be cleansed of sin (like King David); while still others rebel openly and self-righteously (like Job). Yet all are called children of God.30 Job’s friends who ostensibly came to console him were counterproductive, for they would not accept the possibility that there was no direct and proportionate correlation between Job’s deeds and the tragedies that befell him.
Individuals confronted with serious illness naturally ask this question, either consciously or subconsciously. They may choose to share their thoughts with their nurse. The written scriptures delineate a simplistic causal relationship between righteousness and health and prosperity. After the Israelites were freed from Egyptian bondage, God promises them: “If you will heed my commandments, I will spare you all the diseases with which I have smitten Egypt, for I am your healer” (Exodus 15:26); “If you serve God, he will bless you with ample sustenance and eradicate disease from among you” (Exodus 15:26). Conversely, straying from God’s teaching will lead to catastrophic consequences, including deadly infectious diseases (Exodus 23:25). Metaphysical causation of misfortune is summed up in Deuteronomy: “I [God] bring death and give life, I smite with illness and I heal, none can escape my hand” (32:39).
The Talmud in Tractate Berachot (5:1–2), however, paints a much more complex picture of why bad things happen and outlines the appropriate human response. An individual struck with misfortune is initially to reflect upon his or her behavior, in case there is a need to right a wrong. For those individuals who have achieved a high level of spirituality, even lack of devotion in prayer and study can be a sufficient cause for misfortune. However, if after having sincerely considered the issue, they conclude that they are not deserving of punishment, they may assume their own righteousness and regard their misfortune as a labor of love, intended to cleanse them and bring them closer to God. Judaism acknowledges that “bad things can happen to good people.”
An individual struck with illness is to be treated as a noble person.31 Visitors, lay people, and professionals are to sit before them as a student sits before an expert.32 Why is this so? Healthy individuals naturally lull themselves into a false sense of immortality. The experience of a serious illness, however, presents itself as a rude awakening; it is a lonely rendezvous with one’s own mortality. Coming face-to-face with this fact of life brings one, almost naturally, to take stock of how one has lived one’s life; it is a cleansing experience. For example, it may bring one to ask: has my time been devoted to truly meaningful things? Are there wrongs that have to be righted in terms of human relationships?
A tragic event such as an illness can thus serve as an impetus to transcend oneself, give altruistically to others, and vicariously experience their joy and accomplishments. Sick people are challenged purposefully to turn a negative situation into a meaningful and positive experience. If accomplished, this is a noble act. Rabbi Joseph D. Solovechik (1903–1993 CE), a giant among modern Jewish scholars and existential philosophers, stresses repeatedly that the reason why tragedies befall people is often unclear. He likens it to looking at a magnificent tapestry upside down.33 Although Jewish philosophy espouses ultimate divine justice, how that justice is meted out, how much of it sooner, later, in this world, or in the world to come is beyond the scope of human knowledge. It is certain, however, that suffering as experience must not be wasted. It can be used to relearn the value of time and relationships, reprioritize goals, and learn submission to the divine will. Judaism perceives a person to be a dialectic being; he or she finds greatness in conquering the world, but can also find greatness in being conquered, that is, accepting suffering and loss, yet coping nobly. A nurse’s presence at the bedside supports individuals through this process. This is not to imply that illness is a welcome guest. Rather it is noble to make constructive use of whatever suffering cannot be alleviated after all options have been exhausted.
The Talmud (Tractate Berachot 5:2) (22) relates a dialogue between Rabbi Yochanan and his colleague, Rabbi Chiah, who was suffering a serious illness. Chiah bluntly stated that he would gladly forgo the rewards for his suffering and instead be free of it now. Rabbi Yochanan stretched out his hand and Chiah was immediately relieved. The story suggest that suffering can potentially take such a heavy toll on a person that even a righteous sage would be willing to forgo its reward for relief.
Additional insight can be gleaned from the answer the Talmud gives to why Rabbi Chiah, a righteous sage in his own right, was dependent on Rabbi Yochanan for relief. Someone who is imprisoned, states the Talmud, is incapable of being freed from prison. Suffering can be so totally debilitating as to render people incapable of facilitating their own healing process, both on a physical and metaphysical plane. Nurses can be potent facilitators for such individuals. In many instances, therefore, individuals resort to prayer, which is indeed a central vehicle both for expressing one’s feelings as well as beseeching God for the return of good health.
Although God is the ultimate creator, he willingly invites human beings—indeed commands them—to be his partners in creation by improving nature. Although this may seem paradoxical on a theological level, God purposefully limits his omnipotence in order to make room for people to reign over earth.34 By manipulating the forces of nature to improve quality of life, people do God’s will and essentially realize their godly image as creators. Hence, curing illness and caring for those who suffer, using technologies that “fool mother nature,” does not constitute rebellion against God according to the Jewish tradition, but on the contrary, celebrates God’s desire, so to speak, to be conquered by humans.35
If illness is a result of people’s imperfect deeds or the need for catharsis, bypassing the metaphysical realm by using natural means of cure might be perceived as useless at best and immoral at worst. This, however, is not the case. Judaism recognizes the simultaneous existence of two planes of causality, the physical and the metaphysical, equivalent to two avenues of treatment. Good deeds and prayer are indeed the order of the day whenever catastrophe strikes, but one is obligated at the same time, and with no less rigor, to utilize all that the art and science of healing have to offer in terms of care and cure.36
The midrash relates a discussion between two great sages of the Mish-nah and an anonymous ailing individual who accompanied them on a journey.37 He asks the sages, “how can I heal myself?” They proceed to recommend a certain medicinal potion. The anonymous man challenges them with the question: “who smote the man with illness?” They answer, “God of course.” “If so,” said he, “you are asking God to interfere with God’s will.” The sages inquire with regard to his livelihood, to which he responds that he was a farmer. “How do you allow yourself to interfere with God’s world by working the land so that it may bear fruit?” they ask. The impatient man responds “how else can I survive?” “So is the case,” say the sages, “with respect to one’s health. Natural avenues of healing are legitimate and a necessary part of life no less than toiling the land.” An individual or a community that disregards this are deemed negligent both morally and religiously.
It is not surprising that the study of medicine was very highly regarded by Jewish scholars. The legendary Talmudist Shmuel, the great codifier Maimonides, and the classic biblical commentators Nachmanides (1194–1270 CE) and Avraham Ibn Ezra (1092–1167 CE) were physicians, to name a few. Throughout the ages, Jewish tradition has avidly advocated fighting natural causes of illness by practicing good hygiene, maintaining a healthy life style, and using science in the service of humankind. Jewish sages championed the discovery of the smallpox vaccination, hailing its discoverer a saint.38 The modern and post modern era have seen an explosion of life-saving and life-enhancing discoveries, many of which have been championed by Jewish halachic authorities. They work in collaboration with scientists and health practitioners to ensure ethically and halachically appropriate use of technology.
Judaism is nevertheless sensitive to the negative potential lurking in the recesses of manipulating nature. The Bible (Genesis 2:15) tells that the Garden of Eden was given to Adam for him “L’ovdah u’lishomra,” literally, to “work” in the garden and care for it. He was given the right, indeed the duty, to utilize the garden’s potential creatively for his own benefit, but with great care. With respect to this verse, the midrash relates that “When God put man in the Garden of Eden, he took him on a so-called guided tour of the garden and said: See how beautiful and praiseworthy are my works; and all that I have created, I have created it for your sake.39 Take heed not to destroy or damage my world, for if you do, there will be no one to repair it or restore it after you.” Thus Adam, and with him all humanity, received ultimate free choice and also ultimate responsibility. Beyond its ecological implications, the midrash has relevance to the preservation of a just and moral social order.
This can be illustrated with the use of organ transplant technology, which can be a double-edged sword. Donating an organ to save a life, both during one’s lifetime and postmortem, is perceived by many contemporary Jewish scholars as a potentially appropriate and even noble act.40 There are, however, possible pitfalls. Scrupulous care must be taken to harvest for transplant only after definitive death has occurred so as to preserve the sanctity of life.41 Autonomous decisions by individuals not to donate must also be respected. Other concerns relate specifically to transplants from live donors, but to elaborate on them would be beyond the scope of this chapter. Suffice it to point out one central issue is the extent to which one may or should risk one’s life for donation. Minimal risk is not viewed as an impediment and is seen by many scholars as the fulfillment of several religious commandments, including “Do not stand by idly while your brother’s blood is being spilt” (Leviticus 19:16). Individuals are, however, commanded to give priority to their own life; hence exposure to substantial or grave danger is not permissible, even in order to save another human being.42
The Talmud (Tractate Babah Metziah 62:1) tells a heart-rending story of two friends who were traveling in an uninhabited land with only one canteen of water. The canteen belonged to one of the two; if he alone would drink, he would survive until reaching civilization. If, however, they would share the water, neither would survive. Ben Petorah thought that the owner of the water should demonstrate solidarity with his companion and share his water. Rabbi Akiva (50–135 CE), whose opinion prevailed, ruled that the “owner” is obligated (or according to an alternate interpretation, permitted) to drink all the water in order to assure his own life. The noble camaraderie echoed in Ben Petorah’s opinion is well-taken. Nevertheless, as Rabbi Akiva stands, individuals are not halachically obligated (perhaps not even permitted) to risk their lives by donating an organ. Certainly, they should not be pressured to do so by health professionals under such circumstances.
However, if individuals choose to endanger themselves for family members, especially parents for children and vice versa, this seems so basic to human nature that it is difficult not to perceive it as a moral and indeed noble act. Rabbi Chaim David Halevi insightfully pointes out that sacrificing oneself for a child is tantamount to sacrificing for oneself and hence does not pose any halachic problem.43 Jewish literature abounds with stories of individuals who endangered themselves for the sake of others in a variety of special circumstances, such as for great leaders in times of national crisis. These are indeed recognized by halachic authorities as exceptional circumstances in which risking one’s life for a greater cause is championed.44 In Israel, advanced practice nurses serve as organ transplant coordinators. They must possess expertise both in scientific and ethico-halachic aspects of transplantation, as well as the religious and cultural vantage points of donors and their families. This knowledge is essential for facilitating technologically successful transplants, while maintaining pluralistic sensitivity and high moral standards.
The Responsa literature contains abundant principles and specific guidelines regarding the ethically appropriate use of health sciences. These include but are hardly limited to artificial life support mechanisms, fertility technologies, and genetic engineering.
Prayer plays an important role for many Jews in all aspects of life. Even Jews who do not consider themselves religious are apt to turn to prayer in times of illness or other turmoil.45 God is traditionally believed to be the source of health and illness and all that pertains to the maintenance, preservation, and restoration of health is ultimately in God’s hands.46 Jewish prayer contains many verses asking God to maintain or restore health in oneself, that of a family member or a nonrelated individual. The Tanach contains many instances where prayer for a sick person promoted their healing. Biblical examples are Moses who prayed for his sister’s Miriam recovery from her affliction with leprosy (Numbers 12:13), the Shunamite woman’s son recovered due to Elisha’s prayer (II Kings 4:33), and King Hezekiah’s prayers gained him 15 additional years of life after he prayed to God to be healed (II Chronicles 32:34).
Halachic Jewish prayer occurs three times daily and contains prayers for health. The Amedah, considered the core of daily prayer, is a compilation of 18 prayers, including a specific prayer asking God to restore health and allows for specific names to be inserted.47 Other prayers pertaining to health and illness are said at specific times or in specific places (e.g., the grave of a righteous person, when praying for the sick). Prayers or the recitation of Psalms, which serve the same purpose, may be offered by patients themselves, relatives, friends, or those who are unfamiliar with the patient. Additionally, many people offer personal prayers for the restoration of health.
Kavanah is a critical aspect of Jewish prayer and refers to the concentration, devotion, intention, and conviction that one uses in praying to God.48 It is common during a hospitalization for traditionally observant patients and their families to be seen with a prayer book or Book of Psalms in their hand so that they can turn to fervent prayer. Many prayers laud the work of the physician but acknowledge that God is the ultimate physician who has the power to heal even those illnesses that are deemed incurable.49
In times of need, many Jews pray at holy sites such as the Western Wall (the remnant of the Jewish Temple, also known as the Wailing Wall) and gravesites of a righteous biblical personality named in the Bible.50 These burial sites are located in Israel and include the Cave of the Patriarchs, where patriarchs Abraham, Isaac, and Jacob and their wives, the matriarchs Sarah and Rebecca, are buried. The matriarch Rachel is buried in Bethlehem and pilgrimages are common for the purpose of prayer. Additionally, pilgrimages are made to gravesites of Jewish scholars, such as the Tannaim and Amoraim (10–220 CE) whose teachings are recorded in the oral law, and many rabbinic figures of early and recent dates.51 The purpose of praying at the grave of a great sage is not to pray to that individual, as prayer is always directed to God, but to have these righteous personalities act as spiritual intermediaries or to have their merit intercede on their behalf.52 Blessings given by a living rabbi, whether in the presence or absence of a sick person, are held in high regard, as this represents a living intercedent with God. Additionally, dedication to religious study, righteous deeds, and other spiritual acts, such as giving charity and helping others, performed with kavanah, is an attempt to gain additional merit with God and overturn any evil decree.
The Jewish mysticism of Kabbala is also a source for customs to help cure the sick by spiritually changing the “evil decree.”53 For example, according to Kabbala, a person’s name is considered to have spiritual importance, as the name’s meaning has a connection to the person’s character. Jewish baby boys traditionally receive their name on the 8th day after birth when they are ritually circumcised, and infant girls are named in the synagogue during the first week after birth. In times of illness, the name may be altered or changed entirely in order to give the person a spiritual renewal and with that a hope he or she is considered a “new person” who is no longer under the evil decree.
Jewish religion obligates patients to seek care from health care professionals; although the centuries old texts use the term “physicians,” in later times this has also referred to other health care professionals. For that reason, health care professionals are duty bound to become proficient in their profession and are mandated to heal the sick.54 The “Daily Prayer of a Physician” acknowledges God as the creator and ultimate healer and beseeches God to grant the physician wisdom, confidence, gentleness, and support in the great task of caring for God’s created beings.55,56 The prayer is attributed to Maimonides, a 12th century Jewish physician and philosopher. This is also the prayer that is recited at many medical school graduations.
Differences in cultural values, such as those pertaining to prayer, may exist between the nurse and patient. As intra-cultural variation is larger than inter-cultural variation,57 these cultural clashes may occur even when the nurse is a member of the same cultural group. For that reason, nurses who share the same culture might experience dissonance between their own and the patient’s prayer customs and values. Just as nurses care for the physical and mental needs of patients, so too, the nurse must provide for the spiritual needs of the patient.58 Obtaining a cultural history, on every patient, not only those from a different culture than the nurse, will assist in understanding the specific cultural needs of each patient. On a practical level, for patients who pray at certain times of the day, organizing care with this in mind should be facilitated. If a patient partakes in ritual prayer, planning the nursing care with consideration of the prayer times will prevent disturbance of the prayer session. If the patient wants to attend a prayer service, if possible, make this feasible. Formal Jewish prayer ritual includes specific customs such as ritually washing hands with a cup prior to prayer and praying in the direction towards Jerusalem. Nurses who have cultural knowledge about these rituals, as well as others, can contribute significantly to an atmosphere that promotes spiritual and cultural comfort for the patient.
Jewish writings include many anecdotes concerning the use of amulets in order to maintain, preserve, or restore health. Amulets are “sacred objects, such as charms, worn on a string or chain around the neck or wrist to protect the wearer from the evil eye. Amulets may also be written documents on parchment scrolls.”59 The practice has been in use for centuries and was considered a component of medical care. There are Jews who refrain from this practice, as there are rabbinic authorities doubting its effectiveness; however, the Talmud (Tractate Shabbat 61:2) lends it legitimacy.
For those who believe in them, segulot (supernatural cures or folk remedies) are engaged in with much kavanah. Some consider such acts as changing or altering one’s Jewish name, giving charity, and performing good deeds as segulot. On a supernatural level, segulot also include such actions as placing a holy book near or under the pillow of the patient, wearing a red thread around one’s wrist or ankle, wearing or pinning to one’s clothing a medallion with an amulet to ward off the evil eye, and obtaining from a rabbi a bottle of “holy water” or “holy oil” that is rubbed onto the patient’s skin.60 These actions are believed to promote healing on a spiritual level. Health care professionals need to assess their patients for the importance they put on spiritual actions, such as prayer and amulet use, and incorporate these practices into the total health care management.61,62
This chapter focuses on selected topics in which Judaism interfaces with nursing practice. These were chosen from a wide range of options. Caring and curing is a primal religious duty for all, especially professionals. The underpinning for this obligation is that both the caregiver and the care recipient are made in God’s image. Caregivers are commanded to imitate God by demonstrating kindness and compassion to others. “Presencing” and displaying empathy are mandated to the degree possible; they are challenging but rewarding actions that join caregivers with the sick as they question and ultimately find meaning in their difficult situation. Caregivers are commanded to explore all avenues for improving quality of life and longevity, including modern technology, taking heed to examine the ethical ramifications.
It is remarkable that although these are religiously rooted principles, many have become deeply engrained in the Jewish collective culture and are espoused by Jewish individuals who do not perceive themselves as religiously observant. An elegant reflection of this phenomenon was enacted by the “secular” Israeli legislation. On 28 Sivan 5758 (June 22, 1998), the Knesset, the governing body of Israel, passed its unique version of the “Good Samaritan Law.” Its name is somewhat unwieldy: The “Do not stand idly by the blood of your neighbor law” (Lo Ta’amod ‘al Dam Re’ekha Law). Yet these words were deliberately chosen as they are the words of the biblical law in Leviticus (19:16). The Act stipulates that if one witnesses a sudden life-threatening situation befalling any individual, one is law-bound to do everything possible in order to extend direct or indirect assistance as needed, barring risking one’s own life. Individuals are obligated both to exert themselves physically as well as to incur financial expense as necessary, for which one is by law reimbursed, either by the benefactor or the government. Although other countries have Good Samaritan laws, the Israeli version is inspired by the biblical edict and is the only one that stipulates that the act of omission—failing to do what is necessary and possible to save life—is not only immoral, but illegal and punishable by a fine.
Familiarity with the Jewish halachic approach to health and well-being and the prevalent cultural customs and practices is important for nurses and others providing health for Jewish care recipients. When ministering care to all patients, however, a thorough cultural assessment is of primary importance rather than relying on outward appearances or other superficial indicators. As with all cultures, intra-cultural variation is greater than inter-cultural variation. This chapter addresses a nonexhaustive but representative core of Jewish principles, commandments, and practices. Its importance lies in serving as a vehicle for nurses of various faiths and cultures to enrich their understanding of issues related to nursing as a whole through the Jewish prism.
1. Spector, Rachel E. Cultural Diversity in Health and Illness. 7th ed. Upper Saddle River: Pearson Prentice Hall, 2009. 352.
2. Ibid., 348.
3. Tal, Rami. The Jewish People Policy Planning Institute: Annual Assessment 2008. Jerusalem. The Jewish People Policy Planning Institute. Web. 20 June 2010. http://www.jpppi.org.il/JPPPI/Templates/ShowPage.asp?DBID=1&LNGID=1&TMID=150&FID=341.
4. Selekman, Janice. “People of Jewish Heritage.” Transcultural Health Care: A Culturally Competent Approach. Eds. Larry D. Purnell and Betty J. Paulanka. Philadelphia, PA: F.A. Davis, 2003.
5. Shuzman, Ellen. “Perinatal Health Issues of Jewish Women.” Transcultural Aspects of Perinatal Health Care: A Resource Guide. Ed. Mary Ann Shah. Tampa, FL: National Perinatal Association, 2004.
6. Zarembski, Laura. The Religious-Secular Divide in the Eyes of Israel’s Leaders and Opinion Makers. Jerusalem: The Floersheimer Institute for Policy Studies, 2002, 11. Web.
7. Ibid.
8. Ibid., 13. Web.
9. Ibid., 11. Web.
10. Talmud Bavli, Tractate Shabbat 133.2.
11. Ram Brothers, and the Widow Ram. Talmud Bavli: Vilna. Jerusalem: Tel-man, 1981.
12. Talmud Bavli, Tractate Babah Metziah 30:2.
13. Talmud Bavli, Tractate Sanhedrin 73:1; Tractate Babbah Kamah 81:2.
14. Maimonides, Moses. Mishneh Torah hu Ha-Yad ha-Chazakah le-haNesher ha-Gadol Rabbenu Moshe bar Maimon. Jerusalem: Eshkol, 1968. Hichot Rozeach U’Shemira al Hanefesh 11:5.
15. Maimonides, Hilchot Deot 4:1.
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