The incident happened in the ER (emergency Room) where I was working. The patient was terminally ill and on life support.
The patient was Jewish as well as his family. The members of the family did not agree with switching off the life support machine and letting the patient die, and they certainly did not agree on the timing that the hospital proposed.
I spent many days talking to the different members of the family (parents, brothers, sisters), explaining the condition of the patient, explaining how the “unplugging” of the life support machine works, but it wasn’t enough for them. It took me several weeks and a huge amount of energy, I even had to ask for assistance from my colleagues for their support and advice.
We finally found a common understanding after spending weeks discussing and thinking about the situation. However, as this was a difficult decision, the trust between the family and myself (the doctor) was questioned.
1. Identities of the actors in the situation
Medical doctor: non-practicing catholic, male, 45 years old at the moment of the shock.
Patient: A man of 50 years old, in critical condition, Jewish.
Parents and relatives of the patient: six people are present, members of the family, all French, Jewish.
2. Context of the situation
The scene took place in a public hospital; the dialogue about the life issues of the patient was between a male doctor and the family members: 3 women and 3 men.
History and representation of Jewish religion in France:
There are approximately 475,000 Jewish people in France and they are considered as a religious minority. The Jewish community have been victims of many persecutions in the past and still today, there are some tensions between the Jewish religious practices and the republican conception of religion in France which is defining by the principle of “laicité”. For example, the school classes held on Saturdays conflict with the obligation for the Jewish to participate in “Shabbat” this day. Also, we can notice that sometimes the Jewish are perceived as very community oriented (communitarianism).
3. Emotional reaction
I felt that I was wasting my time with a condemned patient while other patients have more important needs. The time that I spent on this patient could have been spent on helping other patients that actually had the opportunity to be saved. I also felt a kind of helplessness; because it was very difficult to resolve this situation which challenged me as a doctor, therefore I asked my colleagues for help.
4. Representations, values, norms, ideas, prejudice: The frame of references of the person who experienced the shock.
1) The role of religion in health practice: in France the principle of “laïcité” (a specific French interpretation of secularism) assigns religion to the intimate, private domain as an extension of the republican values. Public servants are forbidden to display in their workplace any identifiable religious symbol, public institutions are not obliged to take into account the influence of religion in the provision of their services. In the medical practice, this implies that medical staff are not obliged to take into account religious demands of patients and their family, but they can chose to do so.
2) The professional identity of the medical doctor: the doctor has a responsibility towards the patient and his family concerning health issues. This “doctor” status gives him the authority to guide the patient and his family to make the best decisions. He is the one who has the knowledge and is best placed to assist in life and death decisions. However, we should bear in mind while looking at this incident that his professional identity is only based on a rational knowledge and not on a belief system.
3) Representation of the “right to life” as a technical / legal issue and not spiritual: the legislation in France (Leonetti Law; 2005) concerning life issues for patients in very critical conditions states that: euthanasia is not a right; the therapeutic obstinacy is illegal; the sick patient has the right to refuse treatment; the doctor should do everything possible to alleviate the pain of his patient; the patient can express in advance their wishes. In this case, the doctor knows that the patient does not have any chance of survival, therefore there are no implications regarding legal or medical issues.
4) Family confidence: the doctor has a subjective vision on the expected reaction of the families that go through this hard situation. It requires trust and a mutual respect of values. This particular situation does not require conflict about religious issues. The family has to face the death of one of its members and needs the support and guidance of the doctor, trust is needed.
5. What image emerges from the analysis of point 4 for the other group (neutral slightly negative, very negative, "stigmatized", positive, very positive, real, unreal) etc?
6. Representations, values, norms, prejudice: The frame of references of the person or group that is causing the shock / that caused the shock in the narrator.
1) Religion is part of heath practices: the influence of religion is not limited to the public sphere because religion is part of all domains of life. The family seems to be faced in this public hospital with a very strong situation of death. Usually people that follow a religion and practice it, find answers and reassurance from their faith while going through a difficult time. Facing the death of a loved one, like in this incident could, guide the family to find peace and answers from their faith.
2) The interpretation of Jewish religion: In the Jewish religion reducing life by euthanasia is not allowed. In the same way it is not allowed to do anything that can accelerate death. The Jewish religion states that life is sacred because it is only God that can give it and take it away. Therefore, humankind cannot refuse to use some technological ways to stay alive. They have to resist the “Temptation of weakness and desertion”. However, there is a contradiction in the interpretation of the Jewish religion because there is another interpretation, which eases the doctrinal statements: it is allowed to reduce the life of a sick person who does not have any chance of survival.
3) Respect of the family member: the respect of the family member and of his religious faith is the most important in this kind of situation; to respect the tradition in terms of religion is to honor the wishes of the family members.
7. Does the situation highlight any problem concerning the professional practice, or in general about the respect of cultural differences in intercultural situations?
This situation highlights the problem of the “laïcité” the special political secularism followed in France, which does not make it easy to consider the influence of religions in health practices. At the origin, laïcité was adopted to ensure freedom of religions, separating state from religious practices, confining these to the private sphere. State or municipal institutions are not obliged to adapt to different religious practices of users and patients, and such elements are not included in the training of medical professionals either, even though such knowledge could allow easier communication with the family members in the process of healing or ending life.
According to several researchers (see the “Terror Management Theory”) death is the key motivator for the adherence to religious belief systems, as the belief systems provide a certain protective buffer against the existential anxiety triggered by the awareness of our mortality. This also implies that near death people may tend to cling to their religious prescriptions even more than in other situations. Accommodating these needs can make a significant difference in the wellbeing of patients or their relatives.