Health & Wellness | Jewish News

Medical Directives versus Medical Orders

Stephanie Peck — Thu, 12 Jun 2025 17:39:47 +0000

An 84-year-old woman in the intensive care unit asked if the facility had a copy of her advance medical directive to support her healthcare wishes. The doctor explained that, in the hospital, this legal document did not serve the purpose she intended and instead detailed the importance of a POLST, or portable medical orders for life-sustaining treatment. The state of Virginia adopted this document in 2023, modeled after the Oregon POLST form which has been in use for more than 20 years.

While advanced directives and portable medical orders appear similar, the differences between the two are consequential when considering a patient’s healthcare at the end of their life.

David Kamer, an attorney with Kaufman & Canoles, outlines the importance of having an advance directive, which is comprised of two elements: a health care power of attorney and health care instructions. In an advance directive, an individual names one or more agents who are given the power to make health care decisions on the individual’s behalf if this person is unable to make an informed decision. The individual can decide what types of powers the agent can have. Examples include whether the agent should have the power to admit this person to a mental health care facility or whether the agent should have the power to decide on a specific treatment even if this person objects.

“An advance directive is also an opportunity to provide specific instructions about care after a person is no longer able to make decisions. It provides instructions about end-of-life care – meaning, whether to provide life-prolonging procedures, such as tube feeding, IV fluids, or use of a ventilator. But it might also be instructions about things such as who is permitted to visit, types of music to play, specific physicians to use, or specific types of treatment to use or not use. In addition, an advance directive can be used to provide instructions about organ donation,” Kamer says.

In contrast, a POLST is a physician-signed order form which communicates and puts into action treatment preferences, such as cardiopulmonary resuscitation orders when a patient is near the end of their life. The Virginia POLST website recommends this form for those with a terminal illness, or those dealing with a chronic progressive illness, such as advanced heart or lung disease or cancer that has spread. Medical orders like POLSTs can be consulted in an emergency, such as in an ambulance or by an emergency medical professional.

Dr. Rosie Newman, a retired geriatric and inpatient palliative care physician, completed a POLST form four to six times per day during the last five plus years of her medical career. “This (the POLST) spells out the desire to avoid interventions focused on life support and rather focused on comfort and a natural death,’ she says. “This is care that aims to remain out of hospital except when comfort cannot be provided in another setting.”

The current standard of care during an emergency is to do everything possible to save someone’s life unless there is a medical order to the contrary. A POLST is based on the ethical principle of respect and patient autonomy and the legal principle of patient self-determination. According to its website, all competent adults have the right to make their own healthcare decisions. A POLST is designed to help healthcare professionals know and honor the treatment wishes of their patients.

Dr. Marissa Galicia-Castillo, director of the Glennan Center for Geriatrics and Gerontology, also serves as the director of the Brock Fellowship in Hospice and Palliative Medicine (which she was instrumental in establishing) and serves on the board of Dozoretz Hospice House of Hampton Roads. She outlines that an advanced care plan provides guidelines for medical care, but it is not an order like a POLST. (Other acronyms for similar orders include POST, MOST and MOLST, and Virginia will accept these documents from other states, as well).

The POLST form simply asks how the individual wants to be treated at the end of life: comfort measures only, selective treatments, or full treatment including artificial nutrition and hydration. “We try to fill-out POLSTS as often as we can, but people don’t want to talk about it,” Dr. Galicia-Castillo says. Since a serious illness often results in palliative care, she recommends having this conversation when the patient is as well as possible and not in distress.

Kamer recommends that everyone also have an advance directive. “The Virginia Code sets out an ordering of who serves as agent to make health care decisions in the absence of an advance directive, but that agent might be someone who would not have otherwise been chosen,” he says. Without an advance directive, a person’s wishes about end-of-life care or other types of health care might not be carried out, as they will be unknown to the agent and the health care providers.

An advance directive can be created online, and Kamer recommends using the form available on the Virginia State Bar website or forms made available by hospitals. However, a lawyer can be helpful in explaining the concepts contained in an advance directive. A POLST, on the other hand, should be obtained from, and completed with, a health care professional. It should not be provided to patients or individuals to complete on their own.

Connect Virginia is a state registry for advance directives where Virginia residents can securely store their completed documents. Health care providers and designated persons can have access to the account. Kamer adds, “To ensure that all relevant parties know about someone’s advance directive, aside from registering it, I recommend giving a copy to one’s physicians and named agents. If the person is comfortable with it, I would also suggest giving a copy to family members and close friends or letting them know where to find a copy.”

While 30+ states recognize the National POLST form, there is no national registry. In Virginia, the form can be uploaded to Sentara’s EPIC system, free of charge, while other hospital systems charge a fee for the upload. “It’s a chunky system, not consistent,” Galicia-Castillo says. She also recommends the U.S. Advanced Care Plan Registry, a secure, online database to store advanced directives, including DNRs (do not resuscitate) and POLSTS. Through its mobile app, emergency responders can search a document by address, allowing personnel to review a DNR or POLST before arriving at the scene.

Newman adds, “Sadly it was not unusual to have this document missing between the hospital and the rehab site – making my job one of calling to be sure the staff saw the POLST and that a copy was now on file in this new setting. Which is why we say transitions of health care locations are the weakest link in healthcare where things can go wrong despite all the best efforts at both sides.”

Both Kamer and Galicia-Castillo stress that a person is never too young to prepare these documents. “It should become a normal part of becoming an adult,” says Galicia-Castillo.

Kamer agrees, “It can be difficult and uncomfortable to think through these serious issues, particularly for young adults, but life is unpredictable. It’s better to get through it and put the subject out of mind than to never deal with it.”

Dr. Louise Lubin inspires JFS staff with message of self-compassion and resilience

Brooke Rush — Thu, 12 Jun 2025 17:29:29 +0000

Amid the demands of social services work, the staff at Jewish Family Service of Tidewater recently gained valuable insights and inspiration during a seminar led by Dr. Louise B. Lubin, a distinguished clinical psychologist with 40 years of experience.

With a focus on self-love, compassion, and burnout, Dr. Lubin offered a deeply empathetic perspective drawn from her career in adult, marital, and family therapy. The session took place on Thursday, May 1.

Drawing from her book, Many Paths to Healing, she shared a poignant passage that resonated with many in the room:

“Life is not fair. People do not always get what they deserve. Bad things happen to good people. It is up to me to sort out how I am going to accept what is, rather than focusing on what should be. Staying stuck in blame toward others or myself keeps me from living more fully with an open heart and compassion.”

The quote encapsulates the core of Lubin’s message: the path to healing begins with acceptance and is sustained by kindness—especially toward oneself.

During the seminar, Lubin introduced the concept of “warming up” self-talk, a simple yet profound shift in how individuals can nurture themselves mentally and emotionally. She encouraged participants to ask: What would I say to a dear friend? What would I like to hear that would allow me to rest and relax? What do I need?

These questions, Lubin explained, help redirect the often-critical internal dialogue toward one that is affirming and restorative.

Lubin is a retired faculty member of Eastern Virginia Medical School and a lifetime member of leading national psychology organizations. Her “Many Paths to Healing” programs have helped patients build emotional resilience across hospitals and medical practices, offering patients vital tools for emotional resilience in the face of chronic or life-threatening illness.

Reflecting on the significance of Lubin’s visit, Kelly Burroughs, CEO of JFS, says, “Dr. Lubin reminded us that in order to heal others, we have to care for ourselves. It was great for our staff to hear about self-care from such an experienced professional.”

At JFS, where the mission is to promote quality of life through services rooted in the tradition of Judaism, Dr. Lubin’s message served as a vital reminder: compassion must begin at home, within ourselves.

To learn more, visit Dr. Lousie Lubin’s website at manypathstohealing.com.

Body, Soul and Summertime

Rabbi Alexander Seinfeld — Thu, 20 Jun 2024 18:41:24 +0000

Food is always a Jewish topic, and every Shabbat and Jewish holiday are new opportunities to overindulge.
Maimonides famously says (Deot 4:15) that overeating is unhealthy and everyone knows that keeping healthy makes good sense. But to what extent is a healthy body, per se, a Torah issue?

Anyone who suspects that health and fitness is only a modern concern might consider the Talmud’s opinion:
Rav Huna said to his son, Rabah, “Why aren’t you a disciple of Rav Chisda, whose teachings are sharp?” He said, “Why should I – whenever I go, he lectures me on mundane matters. For example, he gave me instructions on how to relieve myself safely.” He said, “He’s immersed in matters of health and you call them mundane? All the more so should you go to him!” Shabbos 82a

This Talmudic ethic echoes a midrashic warning that the vast majority of people die prematurely due to neglecting their health and well-being:

Ninety-nine percent die before their time due to neglecting their health. – Midrash Raba

When I first learned about the mitzvah of guarding your health, many questions came to mind: What are the parameters of the mitzvah? Is it possible that the ultimate guide to ethics and holiness includes guidance on food, exercise, and other specific health topics? Might the Torah’s approach to health provide guidance in addressing major public health challenges such as obesity and COVID-19?

Years of researching these questions in the Torah literature has culminated in a collection of more than 60 major teachings, some of which have never before been translated. The health topics covered by the Torah include:

Holy eating
Healthy eating
Sugar, obesity, and healthy weight
Special Jewish food challenges
Exercise
Sleep
How to raise children with healthy habits

The first step on this journey is to develop a Torah-guided relationship to the body. Mastering this framework is the key to long-term changes. Changing a habit temporarily is relatively easy, but long-term sustained change in even a single habit is one of the hardest challenges in life. Motivation is key, and learning a Torah body-framework will hopefully lead to an increase in overall well-being for all who make a modicum of effort. In the long term, a healthier body-relationship should lead to a longer life that is more thoughtful, disciplined, spiritual, and elevated.

Yet even someone immersed in Torah wisdom can sometimes lack motivation to consistently pursue healthy daily living. At such times, I personally try to recall the words of Rav Shimshon Raphael Hirsch:

A person can only reach his fullest spiritual potential if he is physically strong, per the Talmud, Shabbat 92a.

As much as summertime and Shabbat and Jewish holidays are food challenges, they are also an opportunity. Every time you consciously make something even slightly healthier – by reducing the sugar or increasing the vegetables – you’re fulfilling a mitzvah. When you encourage healthy habits in children, you’re giving them a lifelong gift.

Adapted from the book, Body & Soul: The Torah Path to Food, Fitness and a Healthy Life. To contact the author, visit TorahHealth.org or follow the Body & Soul class on TorahAnytime.com.

Build strength for a good life

Jewish News VA — Thu, 29 Feb 2024 21:45:58 +0000

“Strong legs, long life.”

This is the mantra voiced by Tom Purcell during the LifeFit class he leads on Mondays, Wednesdays, and Fridays at the Simon Family JCC. It is just one among many positive thoughts Purcell shares during every class – all promoting fitness and wellness in body, mind, and social interaction.

A cornerstone of the class is building strong legs to support balance and upper body stamina. A staple of the exercise routine is standing and sitting repetitively while balancing a ball between one’s knees. The focus is on the legs doing all the work. While this exercise is initially met with groans, it ends with satisfying “oohs,” which Purcell says, he loves to hear. “Strong legs, long life,” he shouts out.

Indeed, strong legs are essential for supporting the spine and upper body. Along with that, nurturing good balance and building muscle to replace fat are also essential for longevity and physical independence. All the exercises which alternately employ hand weights and balls are designed to reach those goals. After standing and chair exercises, the class moves to mats for abdominal exercises and the ever-popular plank, a real barometer of overall fitness. Some participants can plank for more than two minutes, a real testament to the fitness level they have attained.

The Lifefit participants tend to be more than 65 years old, and the beauty of the class is that all the exercises can be self-edited to meet each person where they are in their personal fitness journey. Purcell often reminds everyone to do what they can, and he offers alternative modes of doing a given exercise. Even if someone can’t get to the floor on a mat, he offers alternative ways to get the ab work into a routine on a chair.

While physical fitness is imperative as people age, according to Purcell’s playbook, so is nurturing the mind and “social wellness.” One technique he uses to sharpen participants’ minds is to encourage everyone to remember the order and mode of exercises he leads each day, and he often mixes up the combinations to keep everyone thinking.

This is a very cohesive and consistent population of fitness seekers, and they love to visit and share their stories. Many have been exercising together for years. There is quite a buzz of conversation at the beginning of each class and there are sparks of kindness with inquiries and updates on those who might have been out for a while due to illness or injury.

Fridays are always a highlight with Purcell cooking up trivia competitions or asking for fun facts and favorite movies. Amidst the hard work there is a lot of humor and laughing. As Purcell often says, “work hard, but also laugh every day and remember to get in an act of kindness.”

To register or for class information, contact Tom Purcell, wellness director, at TPurcell@UJFT.org or 757-321-2310.

February is Heart Month: Tune it up!

Tom Purcell — Thu, 08 Feb 2024 22:06:50 +0000

The heart is the engine that circulates oxygen throughout the blood stream to keep the body vital. A continuous engine, the heart can run for more than 100 years without stopping. With an electrical current that’s not plugged into a wall, the heart is a self-contained energy source of complex cells. When working efficiently, the heart will beat on average between 60 and 90 beats per minute.

This constantly working engine supplies the blood’s oxygen through the body via vessels and arteries – very similar to a car’s engine moving fluid (gas and oil) throughout the vehicle so it can run.

For someone who lives to be 80 years old with an average heart rate of 80 beats per minute, the heart would beat more than 3.3 billion times! Cardiovascular exercise can help maintain the involuntary muscles of the heart so it can continue with a strong stroke volume to produce the strength necessary to regulate oxygen for life. While a car is taken for a tune up every three months or 3,000 miles to operate properly, cardiovascular exercise should be conducted weekly, if not daily, for the heart/engine to perform at a high level.

So, take a walk, go for a swim, or join a gym to “tune up” your heart “engine” today to ensure a smooth ride traveling through life.

Tom Purcell is Simon Family JCC’s wellness/fitness director. He may be reached at tpurcell@simonfamilyjcc.org.