Walking in God’s Ways: Restoring Dignity to Aging

For over one thousand years, Jewish communities have repeated a powerful plea in our prayers leading up to and throughout Yom Kippur: Hear our voices, Shema koleinu… Do not cast us away in our old age; when our strength fails, do not forsake us.

אַל תַּשְׁלִיכֵֽנוּ לְעֵת זִקְנָה כִּכְלוֹת כֹּחֵֽנוּ אַל תַּעַזְבֵֽנוּ:

The fear of abandonment is a primal, human concern picked up by our liturgy hundreds of years ago, but our Western, educated, wealthy culture – which prizes individuality and productivity above all else – has made it all the more acute. I work as a geriatrician in Toronto, Canada, caring for frail and vulnerable older adults. I hear this fear of abandonment when they speak of the future and more tragically, I see the reality of this abandonment in the gap between what they need and what they can access in the present: personal care, meaningful and accessible activities, a society that values their presence. We have created a society in which the aged, the frail, the confused are abandoned. To demonstrate this in the most concrete way: a wheelchair-bound adult who cannot afford private care can, at best, hope to receive four hours of personal care a day in Ontario (https://www.ontario.ca/laws/regulation/990386). That means being assisted out of bed, bathed and placed in a chair in the morning, then left there for the remainder of the day until someone returns in the evening to reverse the process. The amount of direct care provided in nursing homes is only minimally better (https://www.cbc.ca/news/canada/toronto/ontario-long-term-care-residents-care-target-1.7607561). This represents a mass societal abandonment and, in my opinion, a major driver of the use of physician assisted euthanasia in Canada and perhaps throughout the Western world.

One in twenty adults now die using physician assisted euthanasia (referred to as Medical Assistance in Dying, or MAID) in Canada. Adults are eligible if they report intractable and intolerable suffering due to a terminal disease, and the source of their suffering is tracked in a national database. Intractable pain is not the main driver of people’s suffering. Rather, our reports show that the loss of the ability to engage in meaningful activities, and the loss of independence and dignity are the most significant sources of their suffering (https://www.canada.ca/en/health-canada/services/publications/health-system-services/annual-report-medical-assistance-dying-2024.html#a3.4). And we should not be surprised. No amount of palliative care or pain medication can alleviate the fear of and the reality of the abandonment I’ve described.

A recent public debate in the Toronto Jewish community centered on whether rabbis should officiate at funerals for those who have died by MAID. While there is an important debate to be had about what Jewish law has to say about physician assisted death, the conversation so far has missed the mark on where we should be directing our attention. Our leaders – and every individual in our community – have obligations to those still living, to ensure they can live with dignity.

Jewish tradition teaches us to walk in God’s compassionate ways. It follows then that just as we beseech God not to forsake the needs of the elderly, neither should we. The words we utter during the High Holiday season should light a fire under each of us to ask ourselves and our leaders: “What can we do to prevent members of our community from becoming forsaken?”

To begin, there are three things we must do:

1. We must make meaningful participation possible even as physical and cognitive abilities change. I co-led the research into the needs of Toronto’s aging Jewish community on behalf of UJA Federation of Greater Toronto in 2025-2026 and we heard repeatedly how inadequate transportation, costly activity fees and difficulty finding information when it was only available online were major barriers to participation.
2. We must value and sustain the caregivers: professional caregivers deserve a living wage and working conditions that reflect the sanctity and importance of the work they do. Family and informal caregivers need more than gratitude: they need practical help, financial assistance and a community that recognizes caregiving as a shared responsibility rather than a private burden.
3. We must lead a cultural revolution that restores honour to aging: in our over-emphasis on independence, we’ve forgotten that we’re all truly interdependent. Jewish wisdom has taught this for generations: Kol Yisrael areivim zeh bazeh (all of Israel are inter-connected). We must raise up the value of bikur cholim (visiting the sick) and remember that sickness, frailty and death are not failures to hide, but rather part of the natural cycle of human life.

This year, as we sit and reflect during the long hours of Yom Kippur, let us consider the kind of community we want to be a part of and take steps to bring it to fruition. Put together a list of volunteer drivers for your synagogue. Offer to spend an hour or two with your neighbour who has dementia so their primary caregiver can take an hour to themselves. Ask your rabbi to give a class on bikur cholim (visiting the sick), or the values and limits of kiddud av v’em (honouring one’s parents). Look for the person who is becoming easy to overlook and refuse to look away.

Make this the year when we begin to shift the tide away from isolation and abandonment toward care and compassion. In these days as we ask God not to forsake us in our old age, may we, through our daily actions as individuals and as a community, bring this plea to life.