Humor and Spirituality Near the End of Life Marvin E. Herring, MD Clinical Professor Family Medicine UMDNJ-SOM herrinmg

1. Humor and Spirituality Near the End of LifeMarvin E. Herring, MD Clinical Professor Family MedicineUMDNJ-SOMherrinmg@umdnj.edu

2. Humor and Spirituality Near the End of Life Objectives – Attendees will be able to: 1. Understand why spirituality and humor are bound to any processing of end-of-life issues 2. Begin or revisit exploring personal concepts of End- of Life issues. 3. Appreciate faith-based contributions to end-of-life care, illustrated by Japanese and Jewish precepts. 4. Recognize applicability to Palliative Medical Care.

3. Aspects of Mortality Death is Universal

4. Aspects of MortalityKnowledge of Mortality

5. Immortality is not an option.

6. Knowledge of MortalityFear and Uncertainty

7. Knowledge of MortalityFear and Uncertainty “Tell me, Father, is there a 'Next-To-The-Last' rites?"

8. Knowledge of Mortality–What Comes Next? No Proof

10. Fear from uncertainty leads to the hope of something more to come, an afterlife.

11. Coping with Dying and the Fear of Dying Denial Humor Faith Acceptance and Embrace

12. Denial

13. Humor and Faith Humor eases fear and anxiety Humor makes angst manageable Humor provides a communication interface. Uncertainly breeds hope of an afterlife Faith diminishes anxiety Faith - The promise of an afterlife becomes an assurance of an afterlife.

17. Faith and Mortality - The Japanese Japan Until the 5th century, Shinto Belief Systems. Death from smallpox, scarlet fever, measles, typhoon, flood,drought, famine, blindness, war. Living past one year a milestone. Talismanic prayer - lucky gods, symbols of long life , immortality. Gosho Ningyo - fat chubby child- figurines given as gifts- happy, fat = healthy.

18. Faith and Mortality - The Japanese Adoption of Buddhism as a promise of a next life being better - Zen, fatalism, and acceptance of death as a blessing, a bridge, a "that's it." Death poems. “Although the consciousness of death is in most cultures very much a part of life, this is perhaps nowhere more true than in Japan, where the approach of death has given rise to a centuries-old tradition of writing jisei, or the 'death poem.'  Such a poem is often written in the very last moments of the poet's life." Crossing The Rubicon http://northernva.typepad.com/crossing_the_rubicon/2006/01/japanese_death_.html

19. Faith and Mortality - The Japanese A bright and pleasantautumn day to makedeath's journey. Fukyu Age 79 Farewell...                                I pass as all things do do         dew on the grass.      Banzan The owner of the cherry blossomsturns to compostfor the trees. Utsu Age 50 This final scene I'll not see   to the end... my dream is fraying. Choko

20. Faith and Mortality- Judaism and the Afterlife The Jewish religion, a monotheistic religion based on the laws and teachings of the Holy Scripture and the Talmud. (Webster's New World Dictionary) Holy Scripture - the Torah (Five books handed down to Moses at Sinai) Talmud - The compilation of discourse, dialogue, rabbinical teaching, with major emphasis on being measured by ethical living, deed-doing, preserving tradition and study of Torah. 1st- 6th centuries CE.

21. Torah Handed Down To Moses At Sinai

22. Faith and Mortality- Judaism and the Afterlife The Biblical Era - Death comes to all, with little hinting at afterlife. The Rabbinic Era - Punishment, even of the pious, and the reason for "discovering" resurrection in the teachings. (Destruction of the Temple 70 CE) .Sadducees .Pharisees .Essenes

23. Faith and Mortality- Judaism and the Afterlife (After Josephus – Greco-Roman Historian 38-100 CE ) Sadducees Rigorous fundamentalists. Re: afterlife - "the souls die with the bodies." We come we live, we go. That's it!

24. Faith and Mortality- Judaism and the Afterlife(After Josephus – Greco-Roman Historian 38-100 CE ) Pharisees - tradition is molded by contributions from a "continuous succession of fathers.” “Souls have a deathless vigor.beneath the earth there are rewards (virtue) and punishments (vice). For the latter, everlasting imprisonment…the former shall have the power to revive and live again (..on account of which, they are able to persuade greatly the body of the people).”

25. Faith and Mortality- Judaism and the Afterlife Pharisees:– One sub sect - We are resurrected body And soul. Another - We are clothed at The resurrection..

26. Faith and Mortality- Judaism and the Afterlife (After Josephus – Greco-Roman Historian 38-100 CE ) Essenes- a Platonic belief that the souls, freed from the body, "rejoice and mount upward."

27. Faith and Mortality- Judaism and the Afterlife Kabbalah - Mystic Judaism - Kabbalah became a reference to doctrines of esoteric knowledge concerning God, God's creation of the universe and the laws of nature, and the path by which adult religious Jews can learn these secrets. Hasidism- Jewish religious movement founded in Poland in the 18th cent. by Baal-Shem-Tov. Its name derives from Hasidim (The Pious), which stressed the mercy of God and encouraged joyous religious expression through music and dance. No fear of death - Embraced the joy of passing on, a triumph of faith over fear.

28. A Hasid Looks at Mortality.

29. Humor and Faith Promise of Resurrection Acceptance and Embrace Humor eases death fear and anxiety. Humor makes death angst manageable . Humor provides a communication interface. Uncertainly breeds hope of an afterlife. Faith diminishes and conquers death anxiety. Faith - The promise of an afterlife becomes an assurance of an afterlife.

30. Spiritual Dimension of Mortality Death is simply a shedding of the physical body like the butterfly shedding its cocoon. Elisabeth Kubler-Ross Dr. Elizabeth Kubler-Ross visited the Maidenek concentration camp in 1946. When she got to the children's barracks, it was particularly sorrowful, with toys and shoes strewn about, but there was something else, too. The walls were covered with hundreds of butterflies, scratched and etched with fingernails and pebbles

31. Spiritual Dimension of Hospice It was the inability of the medical model to deal with the reality of patients who die that motivated Dame Cicely Saunders and the interdisciplinary team she gathered in London in the 1960s at St. Christopher's Hospice. Accepting that death is a normal part of human life, Dame Saunders and her team established a system of comprehensive care that embraces the physical, emotional, spiritual, existential, and relational dimensions of dying. Park Ridge Center for Health,Faith and Ethics http://www.parkridgecenter.org/Page515.html

32. Humor and Faith at the Clinical Bedside Humor and Faith, both tangible aspects of the human spirit, are allies in the clinical management of those souls and their loved ones who are dealing with life-limiting illness. Longer a part of the healer's tools than the modern sophisticated interventions, they have demonstrated potency, and stand as cornerstones of palliative care.

33. Resources • Japanese Death Poems: Written by Zen Monks and Haiku Poets on the Verge of Death. Yoel Hoffman • The Death of Death: Resurrection and Immortality in Jewish Thought. Neil Gillman • Wikipedia – The Free Encyclopedia Google Search - Wikipedia Press Search