A Natural Family with a Supernatural Mandate – Lekh L’kha 5779

The Silicon Valley Introduction to Judaism class began this past week.  It is a wonderful example of collaboration in our Jewish community.  I, along with Conservative, Reform, and Reconstructionist colleagues, teach this class every year.

Adult students have an opportunity to learn from Rabbis of different denominations.  Classes rotate, depending on who is teaching that night, between the Jewish Community Center, Congregation Sinai, Congregation Beth David, Congregation Shir Hadash, and Temple Emanu-El.

At the first Introduction to Judaism session, students are invited to introduce themselves and share their reasons for taking the class.  Every year, there are a variety of reasons given.

Some students are Jewish adults who either never received a Jewish education, or who feel that they want to learn about Judaism in a more sophisticated way, as compared to the child-focused education they received years ago.  Some are members of synagogues.  Some are not.

There are also non-Jewish students who are lifelong learners.  Their spiritual and intellectual journeys have led them to learn about different faiths and traditions.

Some class participants are interested in converting to Judaism.  This can include those who have a Jewish partner, as well as those who have decided to explore Judaism on their own.

Finally, some non-Jewish students do not intend to convert, but are committed to supporting their Jewish partners in building a Jewish home and raising Jewish children.

As students describe the journeys that led them to the Introduction to Judaism class, there are often incredible stories.

Some share strange, mysterious family traditions.  Often they involve lighting candles at particular times during the year, or avoiding certain kinds of foods. In some families, there are secrets that are known only to the older members from earlier generations, who hush up in seeming embarrassment whenever the topic arises.

Usually, these suspicions of a Jewish past point to a possible Sephardic family connection.  But not always.

With the growing popularity and availability of DNA testing, it is now possible to confirm long-held suspicions of Jewish ancestry.  That is increasingly serving as the impetus for people to explore Judaism as a way to regain a lost family heritage.

Also at the first session, we divide students into small groups and give them an assignment: Write a one sentence definition of Judaism that is grammatically and syntactically correct – no run-ons.  It is a very difficult assignment which students have a tough time completing.  That is kind of the point.

Judaism is not a religion in the way that we typically think of religion.  Simply by being born to a Jewish mother,  a person is Jewish regardless of what he or she believes.  Don’t learn from this, however, that Judaism does not have particular beliefs.  It does.

So does this make Judaism a race?  Not at all.  For if Judaism was a race, it would be impossible to convert.  And yet Judaism has always welcomed converts, as we will see shortly.

Professor Jon Levenson expresses the difficulty in defining Judaism succinctly in his book, Inheriting Abraham.

The people Israel is neither a nationality in the conventional sense nor a church-like body composed of like-minded believers or practitioners of a common set of norms.  Having something in common with both of these more familiar identities, it reduces to neither of them.

Levenson has stated the difficulty of coming up with a definition.  Then he offers us one:

Rather, as the call and commission of Abram already indicate, it is a natural family with a supernatural mandate.

“A natural family with a supernatural mandate.”  We are family, and we strive to rise above our base nature as human beings to embrace a set of divinely-given, shared practices and values.

This morning’s parashah, Lekh L’kha, opens with God instructing Abram to leave behind his home and his father’s household and travel to the land that God will show him.  Without asking any questions, Abram packs up his household and begins the journey.

וַיִּקַּח אַבְרָם אֶת־שָׂרַי אִשְׁתּוֹ וְאֶת־לוֹט בֶּן־אָחִיו וְאֶת־כָּל־רְכוּשָׁם אֲשֶׁר רָכָשׁוּ וְאֶת־הַנֶּפֶשׁ אֲשֶׁר־עָשׂוּ בְחָרָן וַיֵּצְאוּ לָלֶכֶת אַרְצָה כְּנַעַן וַיָּבֹאוּ אַרְצָה כְּנָעַן:

Then Avram took Sarai his wife and Lot his nephew and all of their property which they had acquired and the persons that they acquired in Haran, and they went towards Canaan and they came to the land of Canaan.  (Genesis 12:5)

A midrash focuses on a peculiar phrase in this sentence.  v’et ha’nefesh asher asu.  Many translations say “the persons that they acquired,” which refers to the many servants that had joined their household.  Abram had done quite well for himself in Haran, apparently. 

An often-cited midrash (Genesis Rabbah 39:14) understands it a bit more creatively.  Literally, I might translate v’et ha’nefesh asher asu as “the soul that they had made.”  Is it possible to create life?

Rabbi Eleazar ben Zimra explains that if all of the people of the world were gathered together, we could not even make a fly, much less a human being.  The Torah says that the soul that was made refers to all the people that Abram and Sarai converted.  We learn that whoever brings idolaters into the fold is considered to have created them.

In other words, Abraham and Sarah were busy in Haran.  They were teaching their neighbors about God, and leading them away from idolatry.

In Levenson’s terms, they were joining the family.  This family is comprised not of people who are related by blood, but by those who share beliefs and values.  That is who Abraham and Sarah brought with them to Canaan.

Rambam, the great 12th century Rabbi, physician, philosopher, and community leader was the leading authority in his day.  People would write to him from all over the world for advice and legal rulings.

A question was once asked of him by a man named Ovadiah, a convert to Judaism.  Ovadiah notes that the language in many of the prayers uses us or we, in reference to events that occurred to previous generations.

Eloheinu v’Elohei avoteinu — “Our God and God of our ancestors”

Asher kid’shanu b’mitzvotav — “You who have sanctified us through Your commandments”

She’asah nissim la’avoteinu — “You who performed miracles for our ancestors”

Ovadiah asks Rambam if he, as a proselyte, whose ancestors were not part of the Jewish people, is allowed to recite all of these words.  We can only imagine what experiences Ovadiah might have had that led him to ask this question.

Rambam, in his answer, does not mince words.  He wants to make sure that Ovadiah, and anyone else who might think to raise a similar objection, gets the point.  His answer begins: “You must recite it all in its prescribed order and should not change it in the least.”

In his explanation, Rambam refers to Abraham, who taught people about God and urged them to reject idolatry.  Abraham instructed everyone in his household to follow God’s ways by engaging in righteousness and justice.

For this reason, anyone who converts to Judaism, throughout the ages, is considered to be a student of Abraham and a member of his household.  In other words, part of the family.

Not only that, Abraham is considered to be the father of all converts.  Jews-by-choice, when taking on a Jewish name, are considered to be the children of Abraham and Sarah, and are therefore referred to as ben or bat Avraham Avinu v’Sarah Imeinu—“the son/daughter of Abraham our Father and Sarah our Mother.”

Therefore, when a Jew by choice recites “our God and God of our ancestors,” it is a true statement.

While discovering Jewish roots in a DNA test may lead a person to explore their roots, it is not a determining factor, at least from a religious point of view.  Halakhah, Jewish law, does not tend to operate on the microscopic level.  

A few years ago, there was a young American woman from a Russian-speaking family who wanted to participate in a birthright trip.  She was asked to take a DNA test to prove that she was eligible.  She was ultimately denied.

This is unfortunate, and is certainly inconsistent with Jewish law.  I hope it is not a precedent.

Jewish identity is not in the blood.  It is in the family stories that are passed down from our grandparents.  It is in the moral lessons that parents impart to their children.  Jewish identity is also something that can be chosen by those who seek to be part of the Jewish family.

Does this mean that there will sometimes be questions and arguments about who is in and who is out?  Absolutely.  But we are a family, after all.  And families are messy.

Bringing Home With Us (on the occasion of my daughter’s Bat Mitzvah) – Lekh Lekha 5777

A Rabbi was once giving a lecture in which he claimed that from it’s earliest days, Judaism has always promoted the parent-child relationship.  Suddenly, a heckler stood up from within the audience, and challenged his assertion.

“Isn’t it true that God’s first commandment to Abraham was to leave his father’s home?”

“It is true,” the Rabbi responded, “but he was seventy-five at the time.  He was entitled.”

I have had the privilege of officiating as Rabbi at many Bar and Bat Mitzvah celebrations over the past decade.  But there is a special joy to being here as my own child becomes Bat Mitzvah.

I also try to remind myself that being the child of a Rabbi can be tough.  There is even a special nickname just for kids of clergy: PK’s – “Preacher’s Kids.”

There are the pressures of living in the fishbowl.  The boundaries between private life and public life are often blurred for Rabbis’ families.

PK’s see their parents living public lives in the same community in which they themselves are raised.  Parents sometimes place expectations on their PK kids to live up to a higher standard because the family is living in the public eye.

And, communities sometimes hold PK’s to higher standards, expecting them to have the same knowledge, religious commitment, or leadership qualities of their parents.

For the child of Rabbi, this pressure is nowhere more on display than at a Bar or Bat Mitzvah.  We are sure aware of it as parents, as we celebrate a personal simchah within the community that we serve.  Noa, I am sure that you feel it as our daughter.

Dana and I are grateful to the Sinai community for respecting boundaries and giving our children the freedom to be regular kids, almost all the time.

The truth is, these issues are not unique to PK’s.  All of us struggle in one way or another with the legacies left to us by our parents.  We all must find a way to differentiate ourselves, to break free, to step out of our parents’ shadows.

Some of us, as we get older, choose to emulate the qualities of the homes in which we were raised.  Others go the opposite direction, rejecting the examples of those who brought us into the world and guided us in our early years.

For all of us, though, there is a tension between leaving the home of our childhood vs. bringing the home of our childhood with us.

This morning’s Torah portion, parashat Lekh L’kha sends something of a mixed message with regard to continuing our parents’ legacies.  It begins:

וַיֹּ֤אמֶר ה֙’ אֶל־אַבְרָ֔ם לֶךְ־לְךָ֛ מֵאַרְצְךָ֥ וּמִמּוֹלַדְתְךָ֖ וּמִבֵּ֣ית אָבִ֑יךָ אֶל־הָאָ֖רֶץ אֲשֶׁ֥ר אַרְאֶךָּ:

The Lord said to Avram: Go forth from your land and your birthplace and your father’s house to the land that I will show you.  (Gen. 12:1)

God could have told Abraham simply, “Pack your bags and go.”  Instead, God emphasizes the departure in triplicate.

Nachmanides, the 13th century Spanish commentator, explains this threefold instruction:

It is difficult for a person to leave the land in which he, along with all of his loved ones and companions, has lived; and even more so when it is the place in which he was born; and even more so when his father’s entire household is there.  Therefore, it was necessary to tell him to leave everything – out of his love for the Holy One, blessed be He.

What a tremendous request this is from God.  Abraham is being asked to make a clean and total break from his past.  And this is really something.  Abraham will never go back.  He will never see any of his family members again.

It is ironic, because one of the central components of God’s covenant with Abraham is about family.  “Look toward heaven and count the stars, if you are able to count them…  So shall your offspring be.”  (Gen. 15:5)  God promises the land of Israel to these yet-to-be-seen descendants of Abraham.

Towards the end of the parashah, God instructs Abraham to circumcise himself and his household, explaining that it will be a sign of the everlasting covenant between God and Abraham’s children.

In next week’s parashah, as God is deciding to consult with Abraham over the impending destruction of Sodom and Gomorrah, God reveals another aspect of Abraham’s legacy.  “I have singled him out, that he may instruct his children and his posterity to keep the way of the Lord by doing what is just and right…”  (Gen. 18:19)

Ever since, the Jewish people have treasured the transmission of values from one generation to the next.  So many aspects of Jewish law and custom emphasize this.

How do we transmit our values?  Of course, we place great focus on learning – Talmud Torah – and not just for an elite class of scholars.  Universal education for all – that is the Jewish way.

But we also recognize that, as a medium for transmitting values, formal education alone is insufficient.  Jewish values must be lived.  All of our holiday celebrations take place in the home.  The most obvious of these, of course, is Passover, with its encouraging of children to engage with their elders through questions.  But our other holidays also involve multiple generations celebrating together.  This is how values are transmitted – not by classroom learning, but by intergenerational living within a household and amongst a community.

It is profoundly ironic, therefore, that God asks Abraham to sever his relationship with previous generations, his father’s household, and his community.

This break is a necessary step for Abraham.  His particular household and community is thoroughly immersed in idolatry and immorality.  The Rabbis develop this idea in numerous Midrashim about Abraham’s youth.  In the most well-known of them, Abraham’s own father, Terach, is an idol merchant.

For Abraham to fulfill his destiny, he must first break free from his father’s shadow.

Other figures in the Book of Genesis struggle with this as well.  Midway through Parashat Lekh L’kha, tensions are rising between Abraham and his nephew Lot’s shepherds.  The time has come for Lot to leave home, to strike out on his own.  He needs to get out of Abraham’s shadow to live his own life.  Unfortunately, he does not choose well, settling in Sodom, which is such a depraved society that God annihilates it in next week’s parashah.

Later, Isaac has trouble breaking free from his father, Abraham’s, strong personality.  But Jacob, and in the subsequent generation, Joseph, leave their homes and families to spend significant portions of their lives on their own.

As a Diaspora people for thousands of years, we have developed the ability to bring home with us in our journeys.  It is this ability which has enabled the survival of our people.

In Abraham’s day, most people were born, lived their lives, and died within the same community.  Nowadays, it is common for children to move away.  This raises the stakes even higher for parents to instill a deep sense of home in their children.

Maybe it is too soon for me to be thinking these thoughts.  After all, Noa, you are only in seventh grade.  I don’t think you are quite ready to leave home yet.  Nevertheless, as you make this transition into adolescence, it has been on my mind.

As a father, I see it as my primary duty to raise children who will bring home with them wherever they go in life.

For me, this means children who are grounded, who know themselves, and who have humility about their limitations and their strengths.  They feel a deep sense of peoplehood, and a mature understanding and sincere commitment to Jewish practices and beliefs.  They are curious, and love to learn.  They feel connected to Israel and speak Hebrew, the language of the Jewish people.

They know the stories of their own family, and their connection to previous generations gives them a sense of rootedness in a rapidly-changing world.

They are resilient, able to be flexible and respond thoughtfully to unexpected challenges.  They recognize the importance of community, and they have people in their lives who care about them.  They are generous, and give freely of themselves to support others in their need.

While I would like to say that our children will also live near us, I must recognize that all of Dana and my family members have flown in from out of town to celebrate Noa’s becoming Bat Mitzvah.  That is the unfortunate reality of contemporary life.  God’s request – for Abraham to leave his land, his birthplace, and his father’s household – which was so radical in its day, is commonplace now.

My more realistic hope is that, when my children move out, they bring their “home” with them.

Noa, you are an inspiring young woman.  From a young age, you have demonstrated a level of self-awareness that has taken me until adulthood to achieve.

You spoke about your desire to develop more patience.  That is certainly an admirable quality to pursue, and one that will result in greater happiness.  But impatience is not all bad.  A healthy dose of channeled impatience compels us to change the status quo, right wrongs, solve problems, and make discoveries.  But, try to be more patient with your family.

Noa, you are a naturally curious, skeptical person.  You often express your doubt regarding religion and belief.  I applaud those questions, and I often share your doubts.  I encourage you to be as open-minded to hearing answers as you are willing to ask questions.

Throughout your life, you have embraced Jewish practices and traditions with enthusiasm and joy.  I have loved watching your challah baking, sukkah building, and Torah reading skills develop over the years.  As soon as you were old enough, you chose to join me on the early walk to synagogue most Shabbat mornings.  I have loved that weekly time together.

These are religious activities that connect you to your tradition and your past.  They will be tangible ways for you to bring your “home” with you as you go out into the world.

Noa, may your curiosity continue to inspire you to learn Torah, asking critical questions while embracing the ancient wisdom of those who have come before us.  May you continue to fulfill the mitzvot and customs of Judaism with joy and enthusiasm.  May you always remain deeply rooted in community, family, and home, wherever your journey takes you.  I love you.

Let’s Talk About Death So That We Can Live – Yom Kippur 5776

This is going to be a difficult sermon for some of us to listen to.  But it is an important one for all of us to hear.  And today, Yom Kippur, more than any other day, is the time for us to hear it.

On this day we face our own mortality, and admit to ourselves that so much of our destiny is out of our control.  Any of us could die tomorrow.  We could be hit by a bus or diagnosed with cancer.  We owe it to ourselves, and to our loved ones, to begin a serious conversation about our own deaths.  Let this be our resolution for the new year.

Our Jewish tradition is totally unequipped to answer questions about end of life issues in the modern era.  The prayer that I have been spending a lot of time with these High Holidays, B’rosh Hashanah Yikateivun, lists the various decrees that are at God’s disposal – who by fire, who by water, who by sword, who by beast, hunger, thirst, earthquake and plague.

Notice something common to all of these deaths.  They are all sudden.  There is nothing in this medieval prayer about Congestive Heart Failure, breast cancer, kidney disease, or Alzheimer’s.

While the language of the mahzor suggests that God has decreed our fates for the coming year and there is little we can do about it, the truth is quite the opposite.  We have an unprecedented ability to extend life, in some cases indefinitely.  We do not yet have the religious language to address all of the new challenges this presents.

This is not unique to Judaism.  Until the onset of modern medicine, most human death came suddenly.  People died from things like a kitchen injury that got infected, or the flu.

For the last one hundred years, though, humanity is increasingly gaining the ability to prolong dying.  The quick progression of medicine has taken us completely off guard.  We are no longer prepared to confront our own mortality under these circumstances.

In 1900, the average life expectancy in the United Staes was under fifty years old.  By the 1930’s it had risen to over sixty.  As of 2012, it was nearly seventy nine years old.

One hundred years ago, most people died in their own homes.  Nowadays, about a quarter of us die at home.  The rest of us die in hospitals, nursing homes, and other managed care facilities.

And that means that we, our loved ones, and the medical establishment, are faced with decisions that no previous generations ever had to consider.

You may have experience with this.  Some of you have had to make decisions about whether to continue treatment for a person you love.  Perhaps you felt confident that the decision you made was perfectly in line with the decision that your loved one would have made.  Or perhaps there was doubt.  You were not one hundred percent sure.  Maybe there was disagreement between siblings.  Perhaps there is still guilt and uncertainty about the decisions that were made, or about things that were said.  These scenarios are unfortunately all too common.

My grandmother, Baba Fania, may her memory be a blessing, passed away six years ago.  She was eighty four years old, and was struggling with Congestive Heart Failure.  Baba Fania lived in her own home until almost the end.  A few weeks before she passed away, she moved to a rehab center.  There were trips back and forth from the hospital.

She continued to decline, and I, along with my parents and brother flew down to Southern California to join my aunts and their families.

When I arrived, Baba Fania was in the ICU, the Intensive Care Unit.  Her heart rate had dropped dangerously low, and so the medical team had put her on an intravenous medication to bring the rate back up.  It was not a permanent solution.  They tried to wean her off the IV, and when her heart rate dropped again, the treatment was restarted.

Then, the Resident who was running the ICU initiated a conversation with us that does not occur frequently enough.  In his own words, he said “ICU’s have a tendency to take over.”  A treatment is started, and it leads to one after another and another progressively more invasive intervention.

Our medical system is very good at finding alternative treatments to fight illness.  If the first round does not work, then there are second and third rounds to follow.  But our system does not do a good job of determining when to stop.

Doctors, after all, are trained to treat illness.  They wage war against death, the enemy.  When a patient dies, the battle has been lost and the doctor has failed.  Of course, the deck is stacked, and death always wins in the end.  Nevertheless, we ignore what is inevitable because it is too difficult for us.  That is why the conversation about whether a treatment should be undertaken in the first place often does not happen.

We were lucky.  In our case, it did.  My aunts and father discussed what their mother’s wishes would have been in this situation, since she was unable to answer for herself.  They agreed that my grandmother would not have wanted to initiate a series of interventions which had little chance of extending her life and had every chance of increasing her suffering

The decision was made to wean her off the heart medicine one final time.  If she could not support herself, then no further interventions would take place and my grandmother would die.

And that is what happened.  The medication was withdrawn and she was transferred out of the ICU into a regular hospital room.  She died there a day and a half later.  I was in the room at the time with my aunt and uncle.

We were really lucky.  Lucky that my father and his sisters were in agreement about what to do.  Lucky that my grandmother had filled out a health care directive, and that everyone was aware of it.  Most of all, lucky that the physician running the ICU that day took the time to have a big picture conversation with us rather than speaking about the next treatment options – because it very easily could have gone in that direction.

As a I look back from a six year vantage point, I wonder if it might have been better if my Baba Fania had never gone to the hospital in the first place.  She could have been enrolled in a hospice program that would have focused on quality at the end of her life.  She could have stayed in the home that she had lived in for forty six years.  She could have died in her own bed, surrounded by her children, grandchildren, and the hundreds of photographs that lined her walls.  But the discussions that would have led to that decision never took place.

It is nobody’s fault.  Most of us do not know how to have that conversation.  It is not part of our culture to talk openly about our own mortality.

The dialogue that needs to happen rarely does.

The truth is, most of us know virtually nothing about dying.  We do not understand how the health care industry functions – and this includes the people who work in it.  We know little about the various treatments and their attendant risks and complications.  We do not understand the choices that we are going to have to face.  What we imagine it is going to be like and what it actually is going to be like are vastly different.

As someone who is married to a physician and is in the business of spiritually helping people with issues relating to mortality, I probably have more exposure to these kinds of conversations than most people.  I first completed my Advance Health Care Directive when I was twenty five years old.  Dana, fresh out of medical school and entering her residency, came home and insisted that we fill them out.  Death is a fairly common topic of conversation in our home, including with our nine and eleven year old children.

And yet, I will be the first to admit that I know practically nothing.  I do not know what it is like to receive chemotherapy, unlike some people in this room.  I do not know what it is like to have the first round of treatment fail, and to have to turn to second or third tier drugs.  I do not know what it is like to be on a ventilator, or in a medically induced coma.  I have never had to go into a procedure knowing that I might not wake up from it.  So how can I possibly be expected to make a decision now about what I would want done if and when any of those scenarios become real?

So what can we do?

Many of us have filled out an Advance Health Care Directive.  We have designated a Proxy, a person who will make decisions for us if we become incapacitated.  We may even have discussed it with our physician.  We have taken responsibility.  I am sad to say that the form is close to worthless.

The California Advance Health Care Directive asks two essential questions.  The first asks do you or do you not want your life to be prolonged if you have an incurable and irreversible condition that will result in death in the near future, or if you are unlikely to regain consciousness, or if the likely risks and burdens of treatment would outweigh the expected benefits?

The second question asks whether or not you want pain relief, even if it may hasten your death.

That’s it.  In the event of an emergency, two questions cannot possibly cover the range of scenarios that could arise.  And that is assuming that the directive you filled out made its way into your medical file, and that somebody actually bothered to look at it.  And, that the family members in the room with the physician are doing their best to decide what you would want rather than what they want.

No.  Those are not the right questions.

What is needed is not so much the answers to a list of medical scenarios, but rather a conversation about what is important to us.  Begin a conversation with the people in your life who are going to have to be with you at the end of it.

I once attended a class with a Geriatrician who had a lot of experience working with patients and families around end-of-life issues.  He described the relationship with the health care proxy, the person entrusted to make decisions for another, as a sacred “covenant.”

Nobody can account for all of the possible medical scenarios which he or she might be faced – so don’t bother to try.  What is more important is that the person entrusted with making decisions for you knows your values.

What matters to you?  What are you living for?  What in your life, if you lost it, would make you feel that living was not worth it any more?  What do you want your final weeks and days to be like?  Where do you want to die?

When the person you have trusted knows this about you, then if he or she ever has to make a decision, it will be your decision.

In a 2010 New Yorker article called “Letting Go,” Dr. Atul Gawande tells the story of a colleague.  Dr. Susan Block is a palliative-care specialist who has had thousands of difficult conversations with patients and family members, and is a nationally recognized trainer of doctors and other professionals entrusted with managing end-of-life issues.

Some years ago, her work became personal.  Dr. Block’s seventy-four-year-old father, a retired psychologist from UC Berkeley, was admitted to a hospital in San Francisco with a mass growing in his spinal cord. The neurosurgeon said that the procedure to remove the mass carried a twenty-per-cent chance of leaving him paralyzed from the neck down.  Without the operation, it was a one hundred-percent certainty.

The evening before surgery, Dr. Block and her father chatted about friends and family, trying to keep their minds off what was to come.  Then she left for the night.  Halfway across the Bay Bridge, Dr. Block realized, “Oh, my God, I don’t know what he really wants.”  So she turned the car around and went back to her father’s bedside.

Even for her, an expert in end-of-life discussions, the conversation “was really uncomfortable.”  “I just felt awful having the conversation with my dad.”  She told him, “I need to understand how much you’re willing to go through to have a shot at being alive and what level of being alive is tolerable to you.”

It was an agonizing conversation for her, but he said something that totally took her by surprise —”Well, if I’m able to eat chocolate ice cream and watch football on TV, then I’m willing to stay alive.  I’m willing to go through a lot of pain if I have a shot at that.”

“I would never have expected him to say that,” Dr. Block said.  “I mean, he’s a professor emeritus. He’s never watched a football game in my conscious memory.  The whole picture—it wasn’t the guy I thought I knew.”

After the surgery, he developed bleeding in his spinal cord.  The surgeons told Dr. Block that, to save his life, they would need to go back in. But he had already become nearly quadriplegic and would remain severely disabled for many months and possibly forever. What did she want to do?

She recalls, “I had three minutes to make this decision, and, I realized, he had already made the decision.”  She asked the surgeons whether, if her father survived, he would still be able to eat chocolate ice cream and watch football on TV.  “Yes,” they said, and so she gave the go-ahead for another operation.

“If I had not had that conversation with him,” she later said, “my instinct would have been to let him go at that moment, because it just seemed so awful.  And I would have beaten myself up.  Did I let him go too soon?”  Or she might have gone ahead and sent him to surgery, only to find—as occurred—that he survived only to go through what proved to be a year of “very horrible rehab” and disability.  “I would have felt so guilty that I condemned him to that,” she said.  “But there was no decision for me to make.”  He had decided.

After a difficult recovery, Dr. Block’s lived for ten more years. When complications developed that made it impossible for him to eat, he decided to stop fighting.  He went home on hospice care, received treatment to make him comfortable, and died with his daughter at his side.

Talking about our own mortality is one of the most difficult conversations we can have.  It seems so scary and daunting.  Where do we begin?  Let me offer a few conversation starters:

Describe a time when you were part of a difficult medical decision, either for yourself or for someone else.

Have you ever been present when another person died?  Talk about what that was like.

Then you can begin to talk about your own death.

Complete the following sentence:  What matters most to me at the end of my life is…

Is there something that, if you could no longer do it, would make you not want to continue medical treatment?  The equivalent of eating ice cream and watching football for Dr. Block’s father.  One Rabbi told his family that if he can no longer tell stories to children, he does not want to continue living.  What is it that makes your life worth living?

Where do you want to spend your final days?  How important is that to you?

The answers to these questions are different for all of us.  One person may want every possible treatment, regardless of the impact on his quality of life.  Another may feel that she would not want to continue if she could not feed herself.

The answers to these questions are likely to change.  This means that the subject of our mortality should not be a one-time conversation.  It is a topic that we should introduce now, when we are healthy and at full capacity.

I have had conversations about death with some of you, and I am honored to continue to help you work through these issues.  But I am not the most important person to speak with.  This conversation should be had with all of the people who are likely to be with us when our health declines.  This could mean spouses, children, siblings, parents, and close friends.

One of the greatest gifts we can give to the most important people in our lives is a conversation about our death.  We can save them from having to make an agonizing decision.  We can save them from years of guilt.  And we can prevent the kind of family squabbling that occurs when children, siblings, and spouses project their own fears on their loved one because they do not actually know what their loved one wants.

You owe it to yourself, and you owe it to them, to talk about your death.

Our Jewish tradition focuses on living in the present.  We do not have any certainty about what awaits us in the world to come, and it is certain that death waits for us in this world.  So we focus on our time here in the world of the living.  That time is made immensely more precious when we can face our mortality openly and honestly with the people we care about.

Today, or sometime in the next couple of weeks, begin the conversation with your loved ones.  Let’s talk about death so that we can live.