Download www.salford.gov.uk

Mrs Nava Kestenbaum
The Interlink Foundation
0161 740 1877
[email protected]
Aims and Objectives
AIMS:
Part 1:To inform health and care professionals about ways to manage ACP
with Jewish patients, taking into account their principles of faith,
attitudes and social structures.
Part 2: To educate Jewish organisations and individuals about ACP within
existing health and care frameworks such as the Gold Standard
Framework GSF or Preferred Priorities for Care (PPC).
OBJECTIVES:
1. Define Jewish attitudes to palliative care
2. Identify key Advance Care Planning (ACP) documents
3. Completing a Preferred Priorities for Care document or a Thinking
Ahead (GSF) document.
4. Understand the decision making process and relevant contact
personnel for further guidance or support.
Advance Care Planning
•Preferred Priorities for Care (PPC)
•GSF Thinking Ahead
•Advance Decisions- Living Will
•Lasting Power of Attorney (LPA)
Rapid Discharge
Pathway (RDP)
Liverpool Care Pathway for the
Dying (LCP)
Advancing Disease
(Eg. Diagnosis of life
threatening disease,
Alzheimers or admission
to Residential Care)
Death
Last Days of Life
Increasing Decline
END OF LIFE CARE TOOLS
First Days after Death
END OF LIFE CARE TOOLS
Gold Standards Framework (GSF)
Jewish Attitudes to Palliative Care
• Jews do not own their body but are invested with
guardianship over life and soul including making
significant efforts to preserve life despite prognosis.
• Nothing may be done to hasten death – including
withdrawal of water, nutrition, oxygen or medication.
• Information should be presented to sustain hope and
avoid despair leading to the patient giving up.
• Each family is encouraged to consult a competent
Rabbi who can assess every risk benefit decision
carefully for Halachic implications.
• A Rabbi will always take account of a patients pain or
suffering in decisions to provide palliation or ‘heroic’
treatments.
Jewish preferences in care
• Except at risk to life, Jewish patients will want to
practice rituals and have kosher food as far as
possible.
• Generally, elderly Jewish people prefer to be
addressed by their title and surname or familiar
first name – which may be a Jewish name.
• Families will frequently keep a vigil by the
bedside of a seriously ill relative.
• Patients and families will often be concerned
about signing a DNAR .
The Jewish patient – social structure
Spheres of influence
Patient
Clinicians, care team
Wider community
organisations -
Rabbi,
Family ,
friends
Strong
influence on
decision
making
Community
support (Bikur
Cholim, family
support), GP,,
care home, Chai
cancer care
Social
services
LEGAL FRAMEWORK FOR ADVANCE DECISIONS
Key Documents
Jewish Advance
care Planning
Statement of
Wishes and
Preferences
Preferred
Priorities for Care
GSF Thinking
Ahead
(GSF Care Homes)
Interlink’s
Halachic Living
Will
Advance Decision
Making
Lasting Power of
Attorney (LPA)
DNAR instruction
Advance Decision
to Refuse
Treatment
I do not wish to have any post mortem procedures performed including an autopsy or organ removal.
I do not wish to have a DNAR offered to me
Yes, held by spouse / GP / care home
I wish my care to adhere to my Jewish values and customs. I do not want ANH or medication withdrawn without consultation.
Please see my Advance Decision document for who I wish to be consulted in deciding my treatment or changes to care
In use by health and care personnel
I do not want any nutrition , hydration or other life sustaining
treatment to be withdrawn without prior consultation with
representatives including my Halachic consultee.
Information should be presented in such a way that I do not
despair and give up hope.
I request all my food to be strictly kosher unless permitted
by Halacha.
Pain relief which can shorten life should be given only with
clinical, family and Halachic consultation.
I wish to be enabled and supported to pray or perform other
Jewish practices where possible.
I do not wish to have any post mortem procedure performed
including an autopsy or organ removal.
Enter patient representative
and Halachic consultee
PART 2:
Guidance for Organisations and
families
Decision Making for the Patient
Does Patient have
Mental Capacity?
Test if unsure
yes
no
Has patient completed
any ACP documents
no
Best Interest meetings
based on MCA
principles for
yes
Any Lasting Power of
Attorney appointed?
Serious Medical
treatment
Change of Residence
Safeguarding Adults
Patient should be
consulted directly.
Does Halachic Living
Will , PPC or GSF
document identify
consultee
Preferred Priorities for
Care should be
referenced
Family/ representative
should support patient
in decision process
Key Contacts:
Position
Role
Adult Safeguarding Officer
(Hospital, PCT or Local
Authority based)
Helpful when there are
concerns about standard of
care eg. Feeding, personal care
MCA/DOLS Officer (Mental
Capacity Act /Deprivation of
Liberty)
Decision making about
requirements and
implementation of Best Interest
meetings
Director of Nursing
Questions about treatment
options or care pathways
Palliative Care Lead Officer.
IMCA – Independent
Mental Capacity Advocate
Represents patient at Best
Interest meetings where no
family available
Rabbi
Ecclesiastical Authority
Halachic, ethical decisions.
Name
Contact
details
Guidance for patients and families
Patient diagnosed with
dementia, terminal
illness or entering care
home
Begin Advance Care
Planning
Does patient have
mental capacity?
yes
Use planning documents:
•Preferred Priorities for care
•Thinking Ahead (GSF – care
homes)
•Halachic Living Will
•Lasting Power of Attorney
Use planning documents:
unsu
re
Preferred Priorities for
care
Thinking Ahead (GSF –
care homes)
File documents
with GP, hospital
case notes, patients
representative
•
Review every year
or sooner if change
in circumstances
•Relevant for individuals 18+
•A Lasting Power of Attorney supersedes an
Advance Decision directive and may
invalidate it.
Best Interest Meetings
• For the following 3 types of decisions:
– Serious Medical treatment
– Change of Residence
– Safeguarding Adults
• Multidisciplinary input. Must take account of views of relatives or
anyone interested in patients welfare.
• Age, appearance or behaviour are not to be basis for decision
• Beliefs, views and preferences of patients must be considered
• May involve a patient advocate
• Balanced scorecard involving Medical , Emotional and Welfare
assessment of advantages and disadvantages.
• Can appeal decision through second opinion, complaint procedure.
• Decision to withdraw or withhold ANH from patients in vegetative
or comatose state requires Court ruling