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Lunch will be provided, RSVP to Allison Christopher if you plan to attend
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Case
Ms. SL is a 32-year-old patient who was involved in a severe motor vehicle accident two weeks ago.  She sustained extensive head trauma, resulting in severe neurological injury. Since the accident, Ms. SL has been comatose. Neurological examinations have consistently shown absence of purposeful movements or responses to stimuli. Neurological assessments indicate a very low level of brain activity. She does not meet criteria for death by neurologic criteria. She is fully dependent on life-sustaining treatments, including mechanical ventilation and medications to maintain vital functions. Multiple imaging studies confirm extensive brain damage, indicating a grave prognosis for any meaningful recovery.

The medical team, consisting of neurologists, neurosurgeons, and critical care specialists, have closely monitored her condition. After thorough evaluations, the medical team has concluded that Ms. SL’s neurological injuries are severe and irreversible. They have determined that further aggressive medical interventions, including life-sustaining treatments, would be unlikely to lead to any improvement in her condition. The clinicians feel that her injuries are incompatible with a meaningful quality of life. The medical team, in consultation with the hospital’s ethics committee, has initiated end-of-life conversations with Ms. SL’s family. These discussions are grounded in the following key points:

• Supportive Care: The family has been assured that Ms. SL will receive supportive care, focusing on her comfort and dignity. The medical team is committed to managing any pain or discomfort she might experience.
• Quality of Life: Conversations have focused on Ms. SL’s current lack of consciousness and meaningful response, emphasizing the absence of any signs of awareness or interaction with her surroundings. The family share that from their perspective, they have a different view of quality of life. Within the Jewish tradition, preserving a life is held in high regard, even in this situation.
• Respect for Jewish Beliefs: The care providers show respect for the family’s Jewish beliefs, understanding the sanctity of life in Jewish tradition. The medical team has encouraged the family to share their thoughts, concerns, and any cultural or religious preferences related to Ms. SL’s care. The Jewish Chaplain has been involved and has helped to bridge this patient’s beliefs with their family’s Rabbi. The family gave permission for their Rabbi to help them with the decisions and the medical team was open to this additional person being involved.

In this challenging situation, the medical team remains sensitive and supportive, providing emotional assistance to the family as they navigate the decision-making process. If life-sustaining treatments were to continue, moving forward with the care and support of this patient will require a transition to chronic care soon (i.e., tracheostomy, Percutaneous Gastrostomy tube, possibly a ventricular shunt, and ultimately placement in a facility to assist with supportive care).  If life-sustaining treatment were withdrawn, then there would be consideration of organ donation.

Learning Goals and Objectives:

• Discover Jewish ethical, moral and legal perspectives concerning the termination of life support, specifically focusing on the ethical dilemmas surrounding the extubation of a patient who is comatose.
• Learn about various legal interpretations and typical family dynamics to gain insight into this challenging ethical decision-making process.
• Explore the spectrum of Jewish teachings about the definition of death concerning brain function and the role of life support systems in determining the end of life.
• Discuss Jewish ethical principles such as dignity, sanctity of life, and pikuach nefesh (saving a life) concerning end-of-life decisions.

Opening Questions:

1. What are the important considerations the medical team should be aware of while discussing options with the family?
2. What are the theological tensions within Jewish faith tradition concerning the respectful treatment of the deceased body and the ethical considerations surrounding organ donation?
3. What are some of the differences in approach to end-of-life conversations in the various Jewish traditions (Reform, Conservative, Orthodox)?
4. What kinds of interactions and dynamics are typical for a Jewish family facing a traumatic event and then making end of life decisions?