Cedars-Sinai Medical Center

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Straight Talk About End-of-Life Decisions

It was an evening for comfort food and straight talk about a subject that doesn't come up often enough in doctors' offices or patients' homes.

Two Cedars-Sinai physicians and two local rabbis joined forces for an event at Temple Emanuel in Beverly Hills recently to offer medical and spiritual perspectives on the importance of not only putting their end-of-life wishes in writing, but also having conversations about them with anyone who might someday have to make tough decisions for them.

Daniel J. Stone, MD, MPH, MBA, Jonas Green, MD, MPH, and senior rabbis Laura Geller of Temple Emanuel and Zoë Klein of Temple Isaiah brought this common perspective to the event: All have all been at hospital bedsides where family members struggled to make agonizing decisions for an unconscious, dying loved one whose wishes were not known.

The discussion about "Sacred Conversations: Learning How to Have End-of-Life Conversations in Your Family and Facilitate Them With Other Families" was part of the weeklong "Jewish Wisdom & Wellness: A Festival of Learning" co-hosted by Cedars-Sinai and the Kalsman Institute on Judaism & Health, Hebrew Union College-Jewish Institute of Religion. The festival included more than 95 events across Los Angeles.

Geller set the tone for the discussion at her synagogue by inviting the audience to help themselves to "comfort food" and then hitting the subject head-on: "This is the Torah, the truth. People die. Knowing this truth and preparing for it helps us do what our tradition teaches us to do — to make meaning and purpose of our lives. That's ultimately what this is all about."

She said Cedars-Sinai has challenged the synagogue help increase the number of people who have advance directives and discussions about their wishes. "I want to say up front that we have an agenda: These are sacred conversations, and there's no better place than a synagogue to facilitate them," Geller said.

Cedars-Sinai is a leader in the nationwide movement to make advance care planning a standard part of healthcare. The medical center is part of the Los Angeles Advance Care Planning Group, a coalition of 10 of the largest health systems in Southern California.

Green, associate medical director for Clinical Effectiveness at the Cedars-Sinai Medical Network, was a lead organizer of the coalition's first conference, held last year at Cedars-Sinai. Stone, medical director of the Cedars-Sinai Medical Group, spoke at the conference and is spearheading a Medical Group campaign with the goal of having an advance directive in every patient's medical record.

"We realized we need to do a better job of educating our patients so they can plan for the end of life the way they would plan for retirement," Stone said during the event at Temple Emanuel.

Green said doctors fail to initiate conversations about end-of-life wishes with patients "because there are a lot of competing issues and because we don't want to be uncomfortable or make our patients uncomfortable. Yet it's so important to do."

He offered several statistics that underscore the importance of end-of-life planning:

  • Only 25 percent of Americans have advance directives.
  • Fifty percent of people are unable to participate in decisions about their care at the end of life.
  • Only 10 percent of the population dies suddenly.

"Most of us will get to a point where we are no longer able to make decisions for ourselves. Unless we're willing to hand over responsibility to someone else and give them carte blanche, then we must have these conversations about our wishes while we can," Green said.

After the doctors walked the audience through key pages in Cedars-Sinai's Advance Healthcare Directive, the rabbis made the case for integrating end-of-life conversations into spiritual practice. Klein presented two handouts that combine instructions about advance directives provided by the physicians with Jewish prayers "to sanctify a very intimate, beautiful, powerful conversation."

Klein said conversations about end-of-life wishes "are not really about endings and pain and suffering." She offered some words that she said capture what these conversations are about: healing, hope, prayer, legacy, courage, adventure, honesty, connection, love, self-care and "living with dignity all the way to our last breath."

Geller asked audience members to sign up for training from Cedars-Sinai physicians that will enable them to help others complete advance directives and discuss their end-of-life wishes.

Stone and Green said Cedars-Sinai will continue to partner with religious organizations to educate the community, and they hope an increasing number of physicians will integrate conversations about advance directives and end-of-life wishes into their medical practice.

As the event concluded, Green added: "Tonight is one of the first steps in moving toward a day when all Angelenos will have had conversations with their loved ones so they can depend on those around them to make decisions on their behalf that will be consistent with what they would want at the end of life."