Between us, my wife and I have buried three of our parents. This is the way of the world. Everyone should be blessed to bury their parents, as the alternative is tragic.  The circumstances surrounding each of their passing were unique, but shared many similarities.  The common thread was that each parent arrived at a point in time where treatment of their illness ended and palliative care began.  They were no longer ill, they were dying.

I have no words to express how grateful we were in each case to our friends, extended family, community and clergy for their practical and emotional support and advice. Yet somehow we felt abandoned when we went to synagogue and entered a space of prayer, of religious wishes.

In shul and even in conversation there is a striking gap in our liturgy and vocabulary in addressing this stage of life. There are powerful and meaningful prayers and rituals for illness, death and mourning, but not for those who are dying. (Viduy is a prayer by the dying, not a prayer for the dying). The absence is striking and at times painful. Caring for a dying loved one has unique challenges and is a roller coaster ride of emotions and uncertainty. We need liturgy and vocabulary to match each stage in a person’s life. Wishing a refuah shlemah (complete healing) to a dying person and his or her family, no matter how well intentioned, is awkward.

The Misheberach L’choleh (Prayer for the Sick) excludes the dying, with the word refuah (healing) being repeated six times and the central thesis of restoring health “to all 248 organs and 365 sinews.”  This exclusion is best summed up by those who introduce the prayer in English as “a prayer for those who are not yet well.”

There remains a tremendous resistance in yiddishkeit to engaging with the terminally ill. This gap is not an accident or oversight. Our traditions value life, thus we are culturally conditioned to resist any formal acknowledgement of the dying.  Open contemplation of death is seen as either a “slippery slope”, a lack of faith in Hashem or ayin hara (evil eye).

To be fair, these practices made sense throughout most of history. However, the process of dying has changed radically in the past century.  The power of modern medicine to routinely heal once fatal illnesses has in many ways bolstered our resistance to allowing acknowledgement that a life is coming to an end.  By the same token advances in palliative care often extend a person’s life in a meaningful way, while offering no hope of healing or recovery. Diseases that in the past killed in days or weeks from secondary effects often take months or longer to run their course as doctors learn to treat the symptoms. Thus, the new reality is that dying is a stage of life that can extend for weeks, months or even years.

What can each of us do to support our friends and neighbors as they care for the terminally ill?  Our instincts and actions are correct. We visit, make phone calls and send texts and emails of support.  We assist with shopping, cooking and errands.  Using words that match our hearts and deeds can only make us more effective in supporting the dying and their caregivers.   Perhaps next time instead of saying refuah shlema, or an English equivalent, simply say sheyeheyeh b’vracha (that it should occur with a blessing).  A blessing may be Divine intervention in the form of a miraculous recovery, or it may be Divine intervention in the form of an easy transition to the next world.  Reserving words focused on healing for those who have hope of recovery will not only bring better comfort to the dying and their caregivers, it will enhance the force of such blessings when offered to those for whom they are appropriate.

One of the classic debates about prayer is whether it requires kavannah (intent) to be effective, or if just saying the words suffices.  Rabbis on both sides of the debate agree that prayer is better with kavannah.   Some rabbis have suggested that the existing misheberach l’cholim either already includes the terminally ill or can be edited to be more inclusive.  However, under the principle that kavannah makes our prayers more effective, I am both reluctant to change a beautiful prayer for healing or to rely on a forced interpretation to express the very different prayers we have for the terminally ill.

Whether we are supporting the terminally ill or their caregivers, the words we use have a powerful impact.  Whether it is in a private interaction with a friend or family member or during a public synagogue prayer it helps to say what we mean and mean what we say.

Richard Langer, executive director of the Hebrew Institute of Riverdale – the Bayit, lives in Teaneck, NJ.