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Nurse Anesthetist
Mrs. Lisa Horowitz is a 35 year-old Orthodox Jewish woman, who is married for 10 years, and has six (6) children all under 15 years-of-age. Today, she seeks care from her OB/GYN for abnormal uterine bleeding. After a thorough evaluation, diagnostics and imaging, her results confirm a uterine mass. Further evaluation suggests cancer. The team recommends that Mrs. Horowitz should undergo a total hysterectomy.
What are the views of Jewish clients related to the gender of medical providers?
You are the male Nurse Anesthetist in the case. Knowing Mrs. Horowitz's religious belief, what are your responsibilities to the client?
What procedures are recommended/required when providing care for a female Orthodox Jew?
Sample Answer
Jewish views on medical care are guided by the principle of Pikuach Nefesh (saving a life), which overrides nearly all other religious laws. However, when life is not immediately threatened, laws of modesty, or Tzniut, must be respected, which affects provider gender preference and required care procedures.
Views on Gender of Medical Providers
For Orthodox Jewish women, modesty (Tzniut) is paramount. This principle generally dictates the following views regarding the gender of medical providers, especially during intimate or potentially immodest exams and procedures:
Preference for Female Providers: Orthodox women generally prefer a female physician and/or nurse for any examination or procedure involving exposure of the intimate areas of the body, including the breasts, pelvis, and genitalia.
The Overriding Principle (Pikuach Nefesh): If a female provider is unavailable, and delaying care would result in any risk to life or severe health damage (as in a cancer diagnosis and urgent surgery like a hysterectomy), the principle of Pikuach Nefesh overrides the modesty concern. In such cases, a male provider is permitted and required to proceed with necessary care.
Male Provider Protocol: When a male provider must examine or treat a woman, modesty requirements are fulfilled by having a female chaperone present. This is a non-negotiable step for Orthodox Jewish patients when possible.
Responsibilities of the Male Nurse Anesthetist
As the male Nurse Anesthetist (CRNA) for Mrs. Horowitz's total hysterectomy, your primary responsibilities are to provide safe, effective anesthesia while respecting her religious beliefs.
Responsibility
Action Required (in the context of this case)
Maintain Modesty (Tzniut)
You must ensure that Mrs. Horowitz's body is covered at all times, exposing only the necessary area for the procedure (surgical site and IV insertion sites).
Provide a Chaperone
A female chaperone (e.g., a female circulating nurse or tech) must be present whenever you are required to be alone with Mrs. Horowitz for pre-operative assessment or during any intimate physical touch, such as positioning or placing monitoring equipment.
Communication and Consent
Explain all procedures and required physical touch before you perform them. Communicate clearly with the surgeon and the operating room staff regarding her needs.
Addressing Family/Children
Given her large family, be mindful of their emotional distress. If Mrs. Horowitz has an Orthodox male family member (e.g., her husband) present, all communication regarding prognosis and technical details is ideally addressed to him in her presence, although she retains the ultimate decision-making authority.
Respect for Life/Fertility
Acknowledge that a hysterectomy is particularly significant, as it ends the ability to fulfill the Jewish commandment of having children. Your role is primarily medical, but being sensitive to the emotional and religious weight of the procedure is important.
Recommended Procedures for Female Orthodox Jews
When providing care to a female Orthodox Jewish patient, several specific procedures and accommodations are required to uphold modesty and respect religious laws:
Chaperone Policy: A female chaperone (or female staff member) must be present during any physical exam, procedure, or care where a male provider must expose or touch her body. This is the most crucial procedural step.
Gowns and Draping: Utilize double gowns and/or sheets and blankets for maximum coverage during transportation, exams, and while in the operating room preparation area. Only the precise area needed for access (e.g., for an IV or the surgical site) should be uncovered.
Blood Products and Organ Donation: While not immediately relevant to the anesthesia, general care should note that blood transfusions are permitted and encouraged under Pikuach Nefesh. In Judaism, organ donation is generally permitted after brain death, as it fulfills the commandment to save a life.
Sabbath and Holidays: If care extends past sundown on Friday or involves a Jewish holiday, special accommodations may be needed, such as:
Avoiding written documentation or answering the phone (can be delegated to non-Jewish staff).
No turning lights on or off (automatic systems are preferred).
Dietary Laws (Kashrut): Only kosher food should be offered.
Handling of Body Parts (Post-Hysterectomy): Although a hysterectomy is life-saving, in some ultra-Orthodox traditions, the uterus, as a body part, may need to be treated with respect, similar to the protocols for amputation, which involves a specific way of disposing of body tissue. The surgical team should consult with the patient or family regarding specific practices.
Hair Covering: Mrs. Horowitz, as a married Orthodox woman, will likely wear a head covering (e.g., a wig, scarf, or hat). This should be respected and only removed if absolutely medically necessary (e.g., for intubation or airway management).