Honoring thy parents: applying the spiritual domain in palliative care decision making

Palliative care is an interdisciplinary approach to caring for individuals and families who are suffering with serious illness. Medical and psycho-social-spiritual symptoms and needs are assessed and addressed. Much of palliative care is about working with patients and families to bring their context to light, that is, to understand not only their medical situation but also their wishes, values, cultural background, previous experiences, and quality of life. As palliative care clinicians, we have seen how popular understanding and misunderstanding about what it means to “honor thy mother and father” can influence medical decision making. Whether or not adult children of patients have familiarity with the honor commandment, the biblical text “honor thy father and mother,” or whether they identify with a particular religious tradition, this theme plays a central—and often unaddressed—role as adult children strive to make decisions with and for a seriously ill parent. In this article we examine the commandment to honor one’s father and mother by exploring its religious, spiritual, textual, and cultural origins, as well as subsequent Jewish commentary. We also contextualize the honor commandment in the palliative care setting through clinical case studies that illustrate the concerns of adult children who wish to honor their parents but are perplexed or conflicted about what this mandate means in the face of difficult medical and psycho-social-spiritual circumstances.