I have been fascinated by the recent court case in Iowa involving Mr. Henry Rayhons, who was arrested soon after his wife, Donna, died last August. Why? Mrs. Rayhons had been diagnosed with Alzheimer’s and was in a facility which Mr. Rayhons visited regularly. The offense? Mr. Rayhons was arrested and charged with third degree felony sexual abuse, accused of having sex with his wife. It seems, according to news reports, that this took place despite the fact that the staff told him they believed his wife was unable to consent to the act.
The case opens the door to what I believe should be a serious conversation about stages of life, and the circumstances in those stages that the revolution in longevity is creating. As The New York Times wrote: “The case pivots on longstanding medical and ethical concerns that will become only more pressing as the population ages and rates of dementia rise. How can anyone determine whether a person with dementia can say yes to sex? Who has the right to decide?” Indeed, people commenting on this case were quick to mention that this act of intimacy may be a gift, a gift to someone who is isolated and alone and confined to a nursing home, where touch and human contact is too often professional and not personal.
This case also speaks to a growing need for our society to create new definitions for a changing world. Medical technology has made some of the categories that we live with, especially in the last few years of life, open for discussion and, perhaps, redefinition. Jewishly as well. Take for example the traditional concept of goses, which traditionally refers to a moribund patient whose death is imminent. The tradition says this “imminent” phase is three days.
This, in our time, is almost meaningless given the fact that medical technology has made that time frame obsolete. The concept can be useful in helping families cope with — and make decisions about — end of life care and treatment. Many rabbis teach this legal category to mean those moments when life is ebbing, when comfort care becomes a greater mitzvah than aggressive care.
As the Boomers age out and longevity becomes more a norm, these discussions about new life stages and their challenges will be of greater importance. The Alzheimer’s Association predicts the number of Alzheimer’s cases will reach about 15 million in the coming decades, up from the current 5 million. Are these individuals goses? Are they in some other legal Jewish category, even terefah (marked by death)? The spouse that is living guilty of adultery if, in the process of living that life, he or she becomes involved with another person?
This scenario is not fictional. In every workshop that we conduct for Jewish Sacred Aging on creating new rituals, someone has come forward to admit that this is something they lived or know of someone who is living with this.
How we as a Jewish community respond to these new realities will be important in being present for our people as we all age. There are deep, personal spiritual issues involved here.There are concerns about what words mean as well as the very clear tensions between my choice for my life and what a tradition says. We must discuss these new realities and deal with them from a position of sacred text and concern. And by the way, On April 22 Mr. Rayhons was found not guilty.
Rabbi Joshua Waxman responds:
Rabbi Address raises a number of important questions connected to the unprecedented longevity that modern medical science affords. Rabbi Address, whose remarks on the subject at my synagogue earlier this year were very well received, is a leader in considering the implications of ethics and aging, including the difficult case of Mr. and Mrs. Rayhons that he describes. As Rabbi Address notes, the typical categories and assumptions that we hold, both consciously and unconsciously, may no longer be suited to the contemporary landscape of aging.
Another local leader in this field is Rabbi Address’ colleague Rabbi Dayle Friedman, who has focused her recent work on the spiritual challenges and opportunities that aging affords us. In her new book, Jewish Wisdom for Growing Older: Finding Your Grit and Grace Beyond Midlife, Rabbi Friedman writes, “Growing older inevitably places us in confrontation with loss, limits, change, and disappointment. As unwelcome as these challenges are, it is precisely in facing them that we can deepen our wisdom.”
What unites both Rabbi Address and Rabbi Friedman’s concerns is the awareness that the problems involved in confronting aging and mortality take on added urgency in this era of dramatic new technologies that increase lifespans long beyond what was previously possible — or, in some cases, even what is desirable for both the patient and the family.
Grasping the preciousness of life and harvesting the hard-won lessons of suppleness, openness and acceptance is in itself a life’s work and these are lessons that are firmly rooted in our limitations and finitude. How we engage these new technological and medical advances that create tremendous opportunities — but also provide the illusion of being able to overcome our limits — is the great spiritual challenge that these developments hold for all of us.
Rabbi Joshua Waxman is the spiritual leader at Congregation Or Hadash in Fort Washington.