Birthrights & Deathrights, a 21st Century View

Birthrights & Deathrights, a 21st Century View

Picture taken by Judith R. Sands

The concept of “Birthrights,” the privilege of inheritance, or right of possession, is a biblical honor traditionally associated with the first born son. Over time, the rules and customs associated with inheritance, have changed and become broader. Birthrights have caused heartache to many a parent and child.

I challenge you to think about the patriarch Isaac, the humble one, the patriarch we know the least about. Looking at Isaac from a 21st-century perspective:

  • Isaac is the very late in life child, whose father tried to sacrifice him.
  • He suffers from post-traumatic stress and had major trust issues
  • His half-brother was sent away
  • He had only one wife
  • Did not get a second Hebrew name
  • Never got to travel outside the land of Israel
  • Had twin children with acute sibling rivalry that is still raging today

Isaac is described traditionally as having no great faults, no striking virtues, and also described as the “Master of Suffering.”

I am asking you to come with me on an uncomfortable and unusual journey. I want to focus on Isaac’s last phase of life, the time frame leading up to the deathbed.  Typically, when I reference end-of-life or death, it is a conversation stopper. Indulge me. Deathrights. Yes, the concept may seem rather prickly, unfamiliar, and strange. This part of the story is not vividly described, and I want to offer a 21st century and somewhat clinical perspective to this endlessly rich and very relevant story.

Abraham was the father of pre-need planning, he wanted to be sure there would be no issues with Sarah’s final resting place. So he purchased the Machpelah in Hebron and established the family plot. This was a GIFT, one less detail for Isaac’s family to contend with, at the time of his death.

Details of Isaac’s later years are sketchy, his weak eyes, a metaphor for his inability to see what his twin sons, Jacob and Esau, needed from him. The dramatic events associated with, and leading up to his deathbed vigil, need further exploration.

It is doubtful that Isaac had an Advance Directive, the set of documents that he would have completed articulating and recording, how he wanted to be cared for during the last phase of his life. Isaac did not have access to the life-prolonging medications, technology, and treatment options that are available today.

Isaac probably wanted to be kept comfortable, have his symptoms controlled, be pain free, with loved ones around; without having to deal with family conflicts or unresolved business issues.

Maybe he had Palliative Care services for symptom management prior to his Home Hospice care. 75% of Americans want to die at home, yet only 25% actually get that preference honored.

The Living Will outlines the interventions wanted and not wanted during the last phase of life. Unfortunately, that can come at any age; these documents become effective when we are unable to speak for ourselves.

Who was the healthcare Power of Attorney or surrogate; the individual Isaac designated to speak on his behalf, when he was unable to express his wishes?

  • Was it Esau, as the oldest son in this patriarchal society, prior to his birthright being diverted?
  • Was it Jacob?
  • Was it Rebecca as the wife? Did she have Isaac’s Advance Directive knowledge?
  • Did Isaac and Rebecca have that crucial conversation, and share with each other how they wanted to be cared for if they could not articulate their wishes?
  • Who had the authority and responsibility, for both healthcare & financial decision making?
  • Most states, not all, acknowledge that the spouse has the legal authority to make these decisions.

Isaac had a Circle of Care, the group of individuals who came together to care and support him.

  • For Isaac, it was a dysfunctional family, plagued by feuding, deceptive children with unresolved conflicts. His family, like many throughout the generations, contended with favoritism, conflict, and lack of trust.
  • These dynamics impacted the communication and interactions with the loved one.

Hopefully, Isaac took advantage of the Medicare Annual Wellness visit and discussed Advance Care Planning with his physician. This preventative health service is without a deductible or co-pay. What a way to save a few bucks! Eliminating cost as a barrier, to this very important conversation.

Hopefully, Isaac got all the benefits of Comfort Care; that is Hospice Care, to alleviate and manage his symptoms of restlessness, agitation, pain, shortness of breath, or other signs of discomfort. No doubt his Palliative Care or home hospice team worked closely with the family to support and comfort them, as they addressed Isaac’s needs.

  • It is hard to say whether Isaac was the victim of health care fraud. With all probability, his Medicare or insurance cards were not used inappropriately. Yet the fraud highlighted in the Torah relates to the birthright is well known.

Why am I proving a 21st Century perspective on this Isaac? November is National Hospice and Palliative Care Month. Professionally, I worked with many families having to make end-of-life decisions. Unfortunately, there were too many times where loved ones did not verbalize or document their wishes. This places an undue burden on family members and care partners. This can result in unnecessary conflict between family members who may have competing perspectives and wishes for end-of-life decision making.

The Advance Directive needs to be communicated so that those loved ones left behind should not have to make unnecessary decisions. As mom went through her home hospice journey, she often said: “What do families do without someone with your knowledge and experience?”

There are a number of resources to assist you while coming to terms and thinking about end-of-life wishes. One of my favorites is the Conversation Project from the Institute for Healthcare Improvement (IHI) which is dedicated to helping people talk about their wishes for end-of-life care, for both adults and children. The Conversation Project provides clear information about available options, in many languages.

Another wonderful resource is Death Over Dinner. It can be utilized by a group of individuals who come together over a meal, to explore end-of-life wishes. A family may dedicate the Thanksgiving meal as a time for the senior generation to share their end-of-life wishes and provide a safe space for discussion and clarification. I am happy to help you secure these helpful resources.

Honoring your child, discuss your preferences with your children, share how you want to live during your final days.

  • This is especially important if there are estrangements. Unresolved family issues too often resurface at a time of crisis and your wishes may not be honored, if the wishes are not clearly known to all involved.
  • For those who are not in traditional relationships, share these wishes and expectations with a friend or partner, I call this honoring a friend. Hopefully, this is a mutual process where you can advocate for each other.
  • Having Advance Directive paperwork formalizes the process.
  • Advance Directives should be updated and modified over time.

The final phase of life can be a time for blessings, a time to address unresolved family issues, a time to be mindful and appreciate what life still has to offer. A time to put closure on your affairs, the way you want, alleviating that responsibility from others.

Something all of us should and can do, is support a caregiver. Caregiving is challenging, it is an ever-changing demanding role.

  • Caregiving typically becomes more demanding and complex as a loved one declines.
  • Specific acts of kindness – such as a meal, a ride or running an errand, make the caregiving routine so much easier.

Know your wishes, share them, and unburden your loved ones.


Home Hospice Navigation: The Caregiver’s Guide

Judith R. Sands