Three old fellows are talking about what they want the rabbi to say at their funerals.
Sam says, “I want the rabbi to talk about how much charity I gave.” Chaim says, “I want the rabbi to talk about what a devoted husband and father I was.” But Avi says, “All I want is for the rabbi to say, ‘Look! He’s moving!’”
According to recent surveys, about 40% of Americans are now religiously unaffiliated. More importantly, only 40% said that religion was “very important” in their lives, down from 57% in 2007.
But there is a saying that there are no atheists in foxholes. Thus, a widely quoted paper by Dr. Alan Astrow of Brooklyn Methodist Hospital described a survey of 727 oncology outpatients from several Brooklyn hospitals conducted in 2013-2014. About 92% reported an affiliation with a religious denomination; 59% considered themselves spiritual but not religious; but over half wanted help with their relationship with God.
Another study by Holly Prigerson and colleagues interviewed 158 cancer patients from eight major cancer centers with less than six months to live. Of these, 123 (78%) indicated at least some belief in the possibility of miracles; 46% indicated the strongest level of belief on the Likert scale (1-5). Black and Latino patients showed a stronger religious belief in miracles than Caucasians, while higher education had an inverse effect. Interestingly, younger patients also had a stronger religious belief (there was some degree of belief in miracles even in the absence of religion).
I am neither a rabbi nor Jewish scholar but look at these issues from the perspective of a physician and scientist. So how can religion help the dying patient? As above, it can provide or increase the belief that a miracle may improbably occur. Hope, even if unlikely or unrealistic, can be a comfort.
Are there indeed miracles? It depends, I would assert, on how you define it. The same way we might consider the sun rising each morning as a miracle, the development of a new marvelous medical intervention/technology can be seen as a medical miracle—heart transplants, an mRNA vaccine, and the like. But more apropos of our discussion, I would define a miracle as an unexpected recovery despite a definitive diagnosis of an incurable cancer. Oncologists are extremely good in prognostication, and thus this should be extremely anomalous.
Years ago, there were several published anecdotal reports of documented advanced melanomas which, without treatment, spontaneously regressed and disappeared. The reports described these as miracles (I would, too). They led to a line of inquiry that resulted in immunotherapeutic approaches to melanoma that have been widely beneficial.
I would say that I personally have had seven miracles in my practice (yes, I am counting), but I am certain that other oncologists, with busier practices, have witnessed more. My personal description of miracles is the complete disappearance of a tumor in a patient with a metastatic incurable solid tumor with the use of a proven chemotherapy regimen, in effect a dramatically better than expected outcome. I am citing the classical chemotherapy era—the advent of immunotherapy and precision medicine has probably increased the frequency of such miracles. I have never witnessed, and never expect to witness, a long-term remission or cure in someone in a terminal state at the end of life. But perhaps others have seen this.
Previous studies have suggested that religious support provides a feeling that life is worthwhile. Also, those with strong religious support from their community or religious leader had a stronger tendency to die at home, a preferred outcome for many. Those who received religious/spiritual care also had less physical pain and used less opioid analgesics.
What about the afterlife? As compared to other religions (Christianity or Islam), Judaism seems to emphasize this world and does not put a great premium on the afterlife. The Rambam tells us that we must believe that techiyat hametim (resurrection of the dead) is from the Torah and there are frequent references to the awakening of the dead in Job, Daniel and elsewhere. There are references in a few places to sheol but sheol does not sound too inviting.
Personally, I would rather think of the next world as being like the story of Bontshe Shveyg by I.L. Peretz and hope I merit Bontshe’s reward. But I suspect that most of those nearing death who are religious have some sort of image of such an afterlife (sitting around studying Torah and eating leviathan steaks?). Interestingly, I cannot find a study that has surveyed the terminally ill regarding their images or hopes of the afterlife, or of heaven and hell, and therefore how that may impact their equanimity. There is no doubt that religion does provide support to the community itself as well as to the caregiver, and that is also no small thing.
Alfred I. Neugut, M.D., Ph.D., is a medical oncologist and cancer epidemiologist at Columbia University Irving Medical Center/New York Presbyterian and Mailman School of Public Health in New York.
This article is for educational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment, and does not constitute medical or other professional advice. Always seek the advice of your qualified health provider with any questions you may have regarding a medical condition or treatment.
