Jessica Zitter is a Jewish mother, doctor, and author of “Extreme Measures: Finding a Better Path to the End of Life.” The book details her journey from believing that technology should be used to save a patient at all costs to a more nuanced approach that prioritizes a terminally ill patients’ values and preferences when making care decisions.
Using individual patient stories as a backdrop, Zitter explores how doctors, patients, and families can work together to understand the range of treatment options and potential outcomes in order to make informed decisions about the way they want to experience their final days of life. Her work is also highlighted in Extremis, a gut-wrenching Netflix documentary that follows Zitter and her team as they help families make care decisions for their loved ones in the ICU.
Zitter spoke to Kveller about the way Jewish values influence her practice, how she speaks about death and dying with her kids, and how the movements to change childbirth practices are connected to these emerging approaches toward death.
A lot of your book is about un-learning some of the things you assumed about your calling as a doctor.
I went into medicine believing that the point of what I was doing was to use fantastic and exciting technologies to save peoples’ lives. I also believed that working in the ICU, like surgery, was somehow more valuable than the more “soft-science” things like geriatric medicine.
You talk about the role of Jewish philosophy in your decision to become a doctor. Does it animate your life now?
I’ve always been very Jewishly identified, and my work in palliative care has brought me much closer to my Jewish values. I went into medicine for the reason many young Jewish people do: it’s a big part of our liturgy — life is so precious, saving a life is so important.
What I learned from listening to patients is that machines and technology have a place — but in moments of acute decision making, 95% of our efforts should be about taking care of the human being, not about taking care of the organ. We prioritize technology and the stretching out of every nanosecond of life. But if you look at the Bible, we’re taught we should not interfere with death or dying. The story of Jacob shows us the value of preparing and being in control of your final days. We learn from Exodus the importance of autonomy, of not being a slave.
I feel my Judaism is able to flourish now because I’m prioritizing patients’ autonomy — as well as values like community support and not treating people like strangers.
In your book, you mention that for a brief period you considered becoming a rabbi!
I did. I think part of why I didn’t do it was because I wanted a clearer path forward to help. Medicine felt, at first, like a simpler approach. The irony is that as a palliative care doctor, my main job is to be a rabbi-like figure: to listen, to support, to see what’s most helpful.
There’s something of a backlash going on against the over-medicalization of childbirth. Do you see parallels between the way we think about death? Can a palliative care team function like doulas and midwives?
I think there’s absolutely a parallel. I think it’s really encouraging, too — for so many years people had this magical vision of the doctor as this Norman Rockwell figure who was going to take care of us and had our best interests at heart. But now, whether it’s unnecessary cesareans or the end-of-life conveyor belt, there’s a similar shift. People are waking up and saying, “I think I need to take control. “
What do you mean by the “end-of-life conveyor belt?”
It’s the automatic, unquestioning application of increasingly powerful tools and technologies that take over for the patient’s organs as they begin to fail when they’re dying. If patients and their surrogates are fully aware and making truly informed decisions, that’s different. It’s only the end-of-life conveyor belt if it’s going on without the patient understanding.
In your book, you talk about speaking to your teenagers about death. What are parents’ responsibilities here?
The first and foremost is for the parent to do their own work first. You can’t really have a conversation with a kid about death and dying if you haven’t processed your own feelings.
In my house, we talk about it a lot. In fact, my kids sometimes say: “Mom, can we have one Shabbat dinner where we don’t talk about death?” But they know about death, they know it’s going to happen, and when it does, they’re going to be able to process it because they’ve had those tracks laid down.
What’s your favorite Jewish custom or tradition?
Shabbat. On Friday night we always have friends over, with lots of singing and banging on the table. My husband makes us go around the room, and everyone, big and small, talks about their week. I’m grateful for something nice to come home to every Friday.
What’s the last thing you do before bed?
I probably check the news — not a good habit.
What TV shows have you binge-watched?
I’ve watched The Office and The Americans.
Do you have a favorite Yiddish word?
This post is part of a series supported by MJHS Health System and UJA-Federation of New York to
raise awareness and facilitate conversations about end of life care in a Jewish context.
To learn more about the role of hospice and its value to patients and families click here.