Questions of Halacha

[medic09]

How are you all dealing with you questions of halacha?

My wife and I have seen several explicit approaches to this among medical folks:

1. I don't ask. I don't want to know. I have a hard enough time as it is.

2. I only ask when I think I can handle the answer. Some things I don't want to know.

3. I ask about anything that seems a question to me.

Obviously, there are no lack of potential issues; as evidenced in some of the threads here. Dress, yihud, tzniut, lashon hara, when to treat a patient of the opposite gender, when not to, how much, carrying out an order to d/c life support, participating in elective abortion,bringing hospital food to a Jewish patient...etc.

And who do you ask? Colleagues, your community rav, a rav who has particular understanding of our work environments?

Lastly, is anyone compiling nurses' questions and the answers, guidance, piskei halacha that they receive? THAT would be very useful. There isn't much practical halacha published out there at the level of patient care that we do. Much is directed at medical decision making or personal mitzvah observance; much less at the patient care issues that dominate what we do.

[Rivka P]

One thing that was suggested to me in my job hunt was to ask a Rav about whether it was OK if I work on shabbos. I decided I really did not want to ask, because frankly, I enjoy shabbos very much and NEED that rest (I guess Hashem knew, go figure) so I don't really even want permission to work on shabbos.
That's how I dealt with that issue. I haven't asked about some of the other things you mentioned, but I probably should. I want to make an event with speakers, I was thinking a lawyer who knows about shabbos issues, but a Rabbi would be good too. My father suggested first making a newsletter, and maybe we could have an ask the Rabbi column.

[medic09]

Rivka, not asking so that you can AVOID working on Shabbat is pretty original! I like that! Usually it is the other way around. Students, nurses, residents all feel pressured in many places and dare not speak up about things like Shabbat and Yom Tov. (Attendings have much less problem, typically; though there, too, they can come under serious pressure.)

Thank you for starting this board! It has great potential. Where are all the other OJNs, I wonder? I'm sure there could be some great participation, in time. And I know of nothing else like this.

[Rivka P]

Yichud should not be a problem, right? I mean we generally keep doors open, unless there's a code red. Curtains seem to me like they would pose no real yichud situation. We had a male PCA on our floor suspended for some sketchy bed-bath situation with a young female patient.

I'm trying to think of private things we would do and close curtains. Mostly changing beds and maybe inserting foleys. I usually have someone else there with me assisting, because an extra pair of hands always helps.

It just occurred to me, maybe the break room could be problematic. The door locks behind you, but anyone with a code can walk in. I imagine the halacha also changes whether it's day or night.

My husband suggested learning Nishmas Avraham on the Shulchan Aruch. He also found a book on Nehorah.com called Madrich Halachti La'achayot.

[chanab]

Hmmm.... I break my silence for an interesting thread (and since my comp is working again).
First of all - I applaud medico09 for being a male nurse! Enabling gender congruent care by putting more men in the field is a great start!
While in school I had asked my community rav about pt contact in terms of male pts, and I was not happy with the answer to say the least. There WAS a lack of understanding in re to the nurses role in pt care and the fact that some non-procedural contact can be therapeutic in some situatiions - especially true in nursing homes pts IMHO. A tap on the shoulder, or even a hug, to a pt who has no one left in their life who does touch them except to bathe them and wipe their butt does wonders in providing that sense of "you're still here, you're still a person". Personally yes, I have gone against the halachic advice I was given - b/c I do think that serving that role is part of the nurses job.
Rivka - if we could find a nurse rabbi to answer questions, we might be set! B/c I don't believe after the above experience that even MD/Rabbi's have a full understanding of where we're coming from.

[achot]

No such thing as anurse rabbi- any Rabbi (Ur LOR is fine) can answer your questions. I can give recommendations but that is not necessary.
This is such a sensitive topic, we cant judge others, just try to do what is right.
CHANAB - be careful and try to stay in the halachic parameters you were given. You'd be surprised how on the mark they are.
I too work in a Nsg Hm, and my male elderly pts require touch, I leave it to my many CNA;s and volunteers to do. Its not your job to provide that therapeutic hug,
You can find non touching ways to show someone that they are important to you and special. You can help them with their davening and Brachot, Netilat Yadayim, bring them somthing special, or help them don Tzitzit , help them be part of a Minyan, bring male volunteers to spend time with them, bring them their favorite foods, bring them a photo of their Rav ( The sephardim love it when i bring a framed photo of Harav Ovadya,) Play jewish music on the radio or tape player, make sure the room is clean and smells nice, make sure they can keep the Shabbat , Listen to their stories, Listen to their ssinging (esp Chazanut) Ask high school kids to come with their guitar and make an Erev Shabbat Party . Bring Lulav and Etrog on Sukot ( even a non-kosher one if you cant find a kosher one) . ETC,. ETC.
Please remember the Halachot are there for our good. Believe Me. May Hashem Bring Moshiach and an end to our tzorot soon!!

[medic09]

Achot,

While I appreciate your attitude and respect for Torah, and the general tenor of your answer, I beg to differ just a bit.

For one thing, many rabbanim don't know about the nitty-gritty of patient care. They read scholarly articles about things like discontinuing life support or using fetal stem cells, but they have little experience with the vagaries and dilemnas of providing hands on patient care to a mixed population in a non-Jewish environment (such as where many of us work for now). That isn't to say that they can't answer the questions; but they often need initial education as to the realities. Halachic decision-making depends not only on a knowledge of Shulhan Aruch; it requires good data input and understanding on the part of the rav. I think it is incumbent and worthwhile for all of us to work with the LOR and bring them into our world, so to speak.

The examples of non-touching things that you give are all excellent; but they don't apply to many of our patient populations here in the Golah. (The real solution, of course, is for all of us to join you as soon as possible!) Here in Santa Fe, for instance, we have the most bewildering assortment of 'religions' one could imagine. What happens when the patient request involves or borders on possible idol worship? Or involves the care-giver providing a religious service? From a slightly different arena, there was an article in an EMS magazine a few years back that advocated that 'no matter your personal beliefs, you should do whatever the patient or family requests' and gave an example of baptizing a baby. I wrote back and blasted them on that one; but it does illustrate the complexities.

I'd like to hear more of my colleagues (your!) difficulties and dilemnas in this. As I noted in the original post, I know that some folks may have a hard time asking the questions all together. This forum (thanks Rivka!) is a good place for us to encourage each other.

[achot]

Mr Medic, I apreciate what you are writing but you are wrong if you think that Rabbis are ignorant of patient care. They are very familiar with the nitty gritty of it all , You'd be surprised at the detail found in halacha, and talmudic study.
I love your solution of joining us in Eretz Yisroel, You are welcome.
Regarding baptism, that is the families right and I personally do not participate in their religious ceremonies, but respect their rights to do them, I don't know of any nurse that has to baptize a baby as part of her duties. I haven't seen it in any instruction manual.
As to helping non jewish male patients, well You can show them that they are important to you by smiling, speaking respectfully, granting requests in a timely fashion, doing your job well with patience, gentleness, and warmth. You can give them double portions of their favorite fruit, or play a round of cards with them, respect their need for privacy when appropriate etc.

[medic09]

Achot, we'll agree to disagree.

I participate in a forum comprised of rabbanim from around the world (though most are in North America, with the second largest segment in Israel). I remain convinced that many have never witnessed or been asked about the everyday occurrences that are normal in nursing. That isn't to say that no rabbanim are familiar with this; but many of the LORs are not. It isn't realistic to expect they would be. They are willing to learn and get involved, but often no one has drawn them into 'our world.'

The request to baptise a dying baby was, as I noted, from prehospital care; but it is an example of the strange sort of predicaments a nurse outside Israel may confront. More common, of course, would be the patient who says 'please pray with me' and then proceeds to address a deity other than the one God. And that DOES happen, I assure you. There are many other examples.

I have found over the last 20 years that there is some range in what rabbanim will consider appropriate, normal, acceptable, to be avoided, and downright forbidden on issues of negiah/contact with a patient of the opposite gender. There is, too, the problem of getting colleagues in a non-Jewish environment to cooperate in these matters. I caused quite a stir in a nurses' forum when I pointed out that for religious reasons a nurse might prefer to have someone else insert a Foley on an opposite-gender patient. Most of the nurses were angered by the imposition and some suspected it was just avoidance of the task. Interestingly, a colleague who was once my preceptor entered that discussion and pointed out that she and I often cover each other in our ED when possible to maximize patient modesty and dignity. (She is a Baptist minister's widow, and has great respect for our notions of tzniut.) But, as anyone here knows, working this out with our colleagues often isn't simple. And sometimes things are too hectic for well-meaning colleagues to help. I still remember a Charge Nurse giving me a hard time when I delayed a non-urgent Foley for a female patient until someone else could do it.

As I learned as a young soldier in Tzahal many years ago (and hence my moniker 'medic09') one needs to enter the arena with a good working knowledge of halacha, and one needs a good rav who knows the realities to consult with. But usually questions arise when the rav is quite far away...

As I noted in the first post, there is also a range of comfort levels among us nurses (and doctors, residents, etc.). I don't have to agree with all the 'approaches' our colleagues employ; but I recognize them and would like to know how we are all coping. I suspect there are a variety of notions out there...

I'm glad we've opened up a bit of discussion of the issues. What say the rest of you?

[Rivka P]

I'm going to comment on the example that you brought in, reb scher. When the need arises to place a foley in an opposite gender patient, I think the best approach is to bring someone else into the room with you, preferably of the patient's gender. It's good to have an extra set of hands anyway, and would put them at ease because they aren't alone in the room with someone of the opposite gender in a vulnerable situation.

Also, achot, it's not true that there is no such thing as a nurse-rabbi. It seems that Reb Scher is exactly that. ;-)

[achot]

Medic,
We can agree to agree, your LOR's are not my LOR's, If I ask my Rav something outside of his realm he knows someone he can turn to- just as if I ask my Dr. something outside his specialty- I would expect him to consult- Just as we are consulting among each other on areas maybe outside our area of expertise.
Of course I experienced pts who want to pray with me to their gods, personally, I remain impassive and let them know I care, I DONT participate in their prayers. I can be empathetic without participating in their religious experiences and ceremonies.
After making Aliya I got such a high knowing I would be able to provide quality nsg care to JEWISH pts. Even though we have Christian and Moslem pts in our Nsg Home, I like that I can provide care to them as well. Gam Hem Naldu BeTZelem Elokim (They too were created in G-d's image) and we honor Hashem by caring for them as well. When asked to join a Sylvester ceremony I declined,
My decision.
I didn't want to give a wrong impression.
I did give that pt great care that day and the days to come and she forgave me.
Unlike most of my coworkers, I have no problem inserting a Foley Cath to a male if no male nurses or doctors are around. I do it "Hands Off' as much as possible , with others in the room of course,. with explanations, patience and gentleness as much as possible, I use Esracaine on the catheter itself to minimize pain and discomfort, I talk about the weather, the patients family and what they ate for breakfast while doing it, and I immediately cover the pt after the procedure to maintain a level of modesty.
However if a pt has a rash in that area, I will have the male CNA spread the ointment,. Something a fellow nurse criticizes me for. The two of us agree to disagree ( a lot!!!)
The range of knowledge and allowances exists in all professions.
I still think its all about how you approach it, deal with it etc. If done with respect, it will be appreciated.
BTW when you ask the Rav a question, its often how you ask and what details you include that can affect the answer. Knowing how to ask a Shaila is as important as who you ask. I always include that if they don;t know, i am willing to wait while they check it up. After all Just as i sometimes have to check up info on a medication, Lord Knows they keep multiplying- I would expect no less from a Rav.
All the best
A

[cganz1]

There is a Rebbetzin in my community (Norhteast Philadelphia) who is a nurse! Her husband is the Rabbi of one of the Shuls near my house, and since she is a practicing med-surg nurse and her husband is a very frum Rabbi (black hat used to live in LKWD type) she can see both sides of the picture. I believe that she would be more than willing to answer any questions that anyone has (she's offered to answer mine and my friends' questions in the past). If anyone wants you can either reply or email me and I'll try to ask her. Interestingly enough there is another nurse whose husband is a brilliant Rabbi who teaches in the day school here, AND my aunt is a nurse and her husband is a Menahel in a yeshiva in Queens. Surprisingly there are many Rebbetzins or chashuvah women who work in the nursing field. Although most of the ladies that I know don't have the internet (it's treif ) maybe we (or Rivka) could interview some of them or have a list of questions/halachic concerns that they can answer and then be posted here.

[achot]

Cganz , your email is hidden so that idea is not really relevant,
What does your Rebetzen say about the halachic questions already brought up?

[Rivka P]

When you view a member's profile, there should be an option to send a private message. You can use that instead of email.