Five Wishes
“Someday I will be a little old Jewish lady.”
While this is, of course, true for me, the statement was shared by anthropologist Barbara Myerhoff in a documentary film. Myerhoff was part of a collaborative project on aging at the University of Southern California. She had the option to choose what group to study, and while anthropologists generally do not study their own community, Myerhoff explained that she was not looking at the group that she belonged to, rather the group that she would join later in life. Neither American Jews nor the elderly had received much attention from anthropologists. Myerhoff took a major risk with her career to focus on a group so entirely overlooked by scholars—but it was a project of both academic and personal import. After all, someday, she would be a little old Jewish lady.
Myerhoff’s study produced a documentary and a book, both recipients of countless accolades. She called her projects “Number Our Days,” a title based on the Psalm (90)—Leemnot yameinoo ken hoda, v’navi l’vav chochma—Teach us to number (to count) our days, that we may obtain a wise heart.
Yom Kippur is our opportunity to count our days, allowing us to wholly focus on what is important. In our generation we know all too well that our attention can be easily diverted.
President Eisenhower said, “I have two kinds of problems, the urgent and the important. The urgent are not important, and the important are never urgent.” From this statement, experts have developed the Eisenhower Matrix, which was popularized by Stephen Covey in his work The Seven Habits of Highly Effective People. It consists of four quadrants.
One quadrant presents things that are urgent and important. Examples provided to explain this section might include an impending deadline or a crisis, such as fire or flood. These are matters that cannot be ignored given that they are literally placed right in front of us and it is crucial that they be addressed in within a given timeline. Urgency has the potential to bring action to a previously ignored matter. For example, the removal of the Confederate flag was no more important this summer than it has been before, but crimes of hate led our nation to move this matter of import to the category of urgent.
The next quadrant presents things that are urgent, but not important. The phone ringing. An email that must be dealt with immediately despite its mundane nature. These tasks necessarily divert our attention but do not lead us towards accomplishing any goals. Urgency is easily mistaken for importance.
There is also a quadrant that is designated items neither urgent nor important. Activities listed in this category include playing games on the computer (guilty), mindlessly watching television (guilty) and other such trivial matters. This is not to say that there is no time nor place for these activities in life, who among us couldn’t benefit from a twelve hour Mad Men marathon, but it forces us to recognize that these activities do not help us towards achieving real goals.
Finally, of course, there is the quadrant marked important. This is where you’ll find pursuits such as relationship building, planning and visioning. It is the quadrant that contains the most valuable practices, yet it is often the easiest to ignore. Exhaustion finds us relegating our activities to the mindless. Urgency steers us towards other endeavors.
YOM KIPPUR
Today there is no urgency.
Today, everything is important.
Today we have essentially been relieved of ordinary responsibilities. There is no work. There is no cooking or eating. There is no concern for our personal appearance.
Today there is no urgency. Having our ordinary agendas cleared for the day presents us with challenges and blessings. It is almost unthinkable to disconnect—to turn our eyes and minds away from the screens we generally rely upon for information, entertainment and connections. It is painful to confront our own transgressions, and to recall times when we fell victim to the misdeeds of others.
Yom Kippur is difficult. We encounter old texts in a foreign language that offer a theological lens, or lenses, that do not resonate in contemporary society. B’rosh Hashanah Y’cateivun, oov’yom tzom Kippur y’chateimun. On Rosh Hashanah it is written, and on Yom Kippur it is sealed, who shall live and who shall die.
This theological slant presents God as little more than a puppet master laying out plans in advance and it seeks to explain suffering and death as the result of sin and a lack of teshuva, tefillah, ootzedakah—repentance, prayer and charity.
I respect our ancestors for trying to understand the world, seeking to make sense out of chaos, and exploring the relationship between humanity and the Divine. The traditional High Holiday theology while unsettling, provides us with crucial value. On this most holy of days we must concentrate on what is important. Stripped down to simplest definitions, what is important is life…and death.
Today we recognize that we are alive, while understanding that it will not always be this way. Our Yom Kippur traditions are not hesitant to remind us of our mortality. From the white garments resembling burial shrouds, to the prevalent metaphor of the Book of Life,–and its unspoken alternative– there is no avoiding this focus. The Yizkor service in the morning will surely heighten this awareness, as we will dedicate our prayers to those we long to see but can only remember, highlighting the words of the psalmist, “A thousand years in God’s eyes are like yesterday gone, like a watch in the night.”
Today, tradition teaches, we are like angels—blameless and pure. Our transgressions having been atoned for and forgiven, our proverbial slates are wiped clean. Thus, we exist with the holiness of the angels. Our midrash teaches, “When Moses ascended to heaven he heard the ministering angels saying to God, ‘Barukh shem k’vod malchuto l’olam vaed—Blessed be the name of God’s glorious kingdom forever and ever.’” You recognize this line that we just recited during the Sh’ma. But its audible recitation is limited to this day. “Moses (having heard this in heaven) shared this declaration with the people of Israel, but they do not recite it publicly, except for on Yom Kippur, when Israel is as pure as the ministering angels.”
Today, because we have rid ourselves of transgressions and announced our intention to cling to holiness in the year to come, we are like angels. Yet this makes our differences all the more clear. The angels are immortal. We are not. And today we must face that. Today we must count our days.
FIVE WISHES
A survey conducted last year found that 90% of Americans think it is important to have a conversation with loved ones regarding how they want to live in the end. However, only 27% of us have actually had these conversations. An article in the New York Times this summer explained—the primary reason people gave for not talking to their loved ones was “it’s too soon.” There is, according to this explanation, a lack of urgency. Yes, it is an important conversation. But, “it’s too soon.”
Ellen Goodman, founder of the Conversation Project, an organization dedicated to helping people discuss their wishes for end of life care, points out, “it’s always too soon until it is too late.”
Tonight I am going to ask you to sit with this, recognizing that it will make some uncomfortable. It makes me a bit uncomfortable. On this most holy night of the year, subjects of import take center stage. Yom Kippur teaches us that we cannot simply brush aside that which we wish to avoid. Rather, to live wholly and with holiness, we address them.
The impulse to forestall end of life conversations is certainly understandable. Regarding our personal future we might shudder to imagine the circumstances, fearing the realities that accompany aging. Or, for those of us who feel ready to have these conversations, we are concerned about burdening our loved ones with what might be considered unseemly thoughts. Regarding the death our loved ones, how can we possible initiate such a conversation? Will it be seen as offensive? Depressing? Or do we simply lack the impetus to engage in such an interaction?
In ten years as a rabbi I have been present many times at the moment of death, and countless more in the hours and days that lead into this final moment, as loved ones often gather for last interactions, last goodbyes. It’s never easy.
It does help when a family has been open with one another about their wishes. This allows loved ones to avoid scrambling to make quick decisions, forced to act despite their heartache, forced to second guess each choice. No one among us wants to add to the grief or confusion of our loved ones. So let’s address some of our concerns and wishes in advance. Let’s prepare.
There are a variety of resources available to help plan for and facilitate this conversation. One that I find particularly helpful and simple to navigate is Five Wishes, provided by the group Aging with Dignity. It explores five integral questions and provides forms for recording individual preferences.
The questions are not easy to hear, and they are even harder to answer. But remember, today is devoted to the important.
Question 1: Who will make decisions for you when you can no longer do so for yourself? Perhaps the simplest of the questions, this invites us to designate a voice to speak for us when we are unable to do so. There are nuanced subsections of this question, but its essence remains. Who is that person in your life?
Does he know that he could be called upon to fill this role?
Would he know what to say?
Question 2: What kind of medical care do you want—or not want—to pursue?
According to a recent New York Times article, “patients, families and health providers are pushing to give people greater say about how they die — whether that means trying every possible medical option to stay alive or discontinuing life support for those who do not want to be sustained by ventilators and feeding tubes.”
We approach life with unique experiences, responsibilities and desires. These can only be considered on an individual basis. Many of us have never considered the question of the medical care we would want to pursue. The answer may change throughout the years as circumstances evolve, but it is never too soon to address this question.
When thinking about treatment options to pursue and decisions regarding medical interventions, it is critical to talk with your doctor. Last September, a national nonpartisan panel of medical, legal and religious leaders issued a far-reaching report saying that the country’s system for dealing with end-of-life care was seriously flawed and should be overhauled. Among its recommendations was that insurers reimburse health providers for advance care planning conversations.
Right now we are awaiting final approval of a Medicare reform that would allow for doctors and other qualified professionals to be reimbursed for office visits designated for a patient to discuss end of life issues. Should this change gain permanence, private insurers would likely follow suit—some have already adopted similar policies. The complex nature of current medical options and opinions demand that individuals have access to health care professionals in order to make appropriate, informed decisions.
This question often presents conflict or misunderstanding among the Jewish community. There is an assumption that we must pursue every option—that we must never hasten death.
Yes, Judaism places the utmost value on life, indeed just before Rosh Hashanah we read the powerful statement in our Torah—oovacharta b’chayim, when presented the choice of life and death you should choose life. Yet, our tradition recognizes that—given the extreme medical advances over the last century—there are times to cease treatment or not pursue a course of action.
There are, not surprisingly, varied opinions among the leading Jewish scholars of this subject. In fact, even the medical directives document provided by our Rabbinical Assembly notes places where scholars differ on the permissibility of certain options. Given the intricacy of various health conditions and the medical options associated with them it is impossible to give a simple answer that addresses the Jewish views for treatment.
Please know that Rabbi Dobrusin and I are always willing to explore end of life issues with you from a Jewish perspective.
Question 3: How comfortable do you want to be? With this question we move from the technical to the spiritual. This is yet another element of life that many of us have not considered, particularly those of us who have never experienced a serious illness or injury—those of us who have not had to choose between comfort and consciousness. This is not the only framework through which to look at comfort. This question invites us to consider what the concept of comfort means to us. Is it familiar music? Soothing touch? Prayer?
Question 4: How do you want to be treated? What a strange question. Don’t we all simply want to be treated with dignity and respect? In a word, “yes,” however the way we get treated respectfully is by articulating our preferences. Some of the sub-headings provided assist us in understanding the purpose and weight of the over-arching question.
Do you want to be with company whenever possible?
Do wish to share details of your situation with your larger community?
Is it important to you to die at home?
Question 5: What do you want your loved ones to know? This question deals more with the time following the end of life rather than the time leading up to death. It asks us to imagine our wishes regarding funeral arrangements and organ donations. It looks at technical details, but the question also provides us with an opportunity to explore and transmit our values.
The practice and exercise of providing a legacy of values has existed in our tradition since Biblical times. Our patriarch Jacob presented his children with a poem of retrospection and prophecy, as well as instructions as to how to live when he was gone. Moses similarly presents the people of Israel, Jacob’s descendants, with prophecy and direction for the future.
This tradition, which we today call an ethical will, likely became more prevalent in the middle ages when written word and literacy were on the rise. And while it is not necessarily a well-known tradition today, it is one that we should reclaim. Some of you will remember that this is the subject we studied together at the Tikkun Leil Shavuot this spring—looking at Ethical Wills that span history. We can learn so much from the document of a stranger. Imagine how much we can learn from the ethical will of a loved one.
Ethical Wills can be brief or long, broad or personal. They can cover a range of topics, yet there is no one specific topic that must be covered in order to categorize a document as an ethical will, nor is there a defined rubric that must be followed. The very questions one chooses to address is, in and of itself, a statement of values. Some areas one might choose to explore include, but are not limited to:
• Formative life events and background
• Important life lessons
• Favorite possessions and stories attached to them
• Mistakes and regrets
• Appeal for forgiveness
Hopefully our loved ones are aware of many of our stories and values simply through having known us. But by documenting our thoughts we provide indelible, invaluable record. We hope that the power of memory will sustain us, and at times it does. Yet the gift of a written document to rely upon when we most seek the wisdom of our ancestors is immeasurable.
In reviewing dozens of ethical wills over the past year, my favorite contemporary one comes from humorist Sam Levenson. It begins:
I leave you my unpaid debts. They are my greatest assets. Everything I own—I owe:
1. To America I owe a debt for the opportunity it gave me to be free and to be me.
2. To my parents I owe America. They gave it to me and I leave it to you. Take good care of it.
And it ends:
Finally, I leave you the years I should like to have lived so that I might possibly see whether your generation will bring more love and peace to the world than ours did. I not only hope you will. I pray that you will.
Composing an ethical will is both an act of legacy and an act of faith. We are hoping for–we expect–more days, more time. Yet we acknowledge the reality that there will be a future unknown to us. We hope to leave a lasting impression.
CONCLUSION
Let’s return to Barbara Myerhoff. What a gift she gave to our people, and truly people everywhere. Her documentary—exploring aging in the Jewish community—is still shown in training courses for clergy and chaplains, decades after it was produced, providing new generations with insight to our community.
But Dr. Myerhoff never became a little old Jewish lady. Sadly, she died of cancer not long after this project. The circumstances of her life highlight the lessons that I hoped to impart this evening. It is important to acknowledge that one day we will likely be old–dying. We must make our wishes clear for this time in our life, for our sake and the sake of our family.
Yet with this acknowledgement we also recognize that we cannot depend on living full, long lives. Therefore we must do more than count each day—we must make each day count.
Hayom, today we gather with kavannah, intent, and turn our focus inward. Hayom taamtzeinu—God, we ask that you strengthen us. Leemnot yameinoo ken hoda, v’navi l’vav chochma—Teach us to number (to count) our days, that we may obtain a wise heart.
Amen