In the US, a legal doctrine known as Patient Autonomy affirms a patient’s right to make their own decisions regarding their health care. Patient Autonomy empowers the patient to decide the proper course of medical action for themselves. Patients can authorize doctors to speak freely with their rabbi. Patients can also object to a test or procedure against the advice of their doctor.
But what if the patient can’t talk?
If the patient is unable to express informed consent, their next-of-kin is empowered to make medical decisions for them. However, the patient’s next-of-kin may not be the person they would have chosen to make those decisions; they may have preferred decisions be made by someone else. Lack of clarity about who the patient wants to make medical decisions on their behalf can lead to heated disputes — and, sometimes, long-lasting enmity — between family members.
Moreover, the next-of-kin does not necessarily have the same rights as the patient. They may not be able to authorize doctors to speak with a rabbi, or to object to a test or procedure against the advice of the doctor.
How can patients maintain their right to direct their medical care if they are unable to speak for themselves? By enacting a living will.
With a living will, the only person with the authority to make decisions on the patient’s behalf — with the same degree of authority as the patient — is the person or persons the patient has appointed.

Living will is the general term for a legally-binding, written statement detailing a person’s wishes regarding their medical treatment in a situation where they are not able to express their own informed consent.
A living will that states what type of medical care a person desires is called an advance directive or an advance healthcare directive.
A living will that names a healthcare proxy is called a durable power of attorney or healthcare power of attorney.
These are often combined in one document, as they are in a halachic living will.

According to Jewish law, all medical decisions must be based on the specifics of that particular case. Since it is not possible to create a comprehensive list of every conceivable medical case, with all their possible details, a standard advance directive is impossible to fill out in advance.
MOLST (Medical Orders for Life-Sustaining Treatment) and POLST (Physician Orders for Life-Sustaining Treatment) forms, which also direct medical care, are also impossible to complete in advance in accordance with halachah.
The only way to ensure the patient’s wishes are followed in a way that conforms to halachah is to execute a halachic living will. A halachic living will ensures that the patient’s wishes are followed in all possible cases, without needing to know the circumstances in advance.
A halachic living will simply states that all medical decisions must be made in accordance with halachah. In addition to allowing you to appoint a healthcare proxy, a person designated to make medical decisions if you are unable to do so for yourself, a halachic living will allows you to designate a specific rabbi to answer all questions regarding Jewish law.
In different states, the proxy may be called by different names. Instead of proxy, they might be called an “advocate,” an “agent” or a “surrogate.” All these terms are synonymous. The person filling out the halachic living will chooses both the healthcare proxy and the rabbi.

A halachic living will ensures both that one’s wishes will be carried out in accordance with Jewish law, and that the people of your choice are the ones empowered to make medical decisions on your behalf in a situation in which you are unable to speak for yourself.
Without a living will, medical decisions may, according to state law, be decided by a doctor or by a Hospital Ethics Committee.
Furthermore, the halachic living will gives your agent and rabbi the authority to define death according to halachic guidelines, not the hospitals guidelines. It also empowers your agent and rabbi to make all post-mortem decisions, including whether an autopsy will be performed, and the timing and type of funeral. By contrast, theauthority of a standard healthcare proxy ends when the patient dies.

Agudath Israel of America has created a version of a halachic living will, which they call a Halachic Medical Directive (HMD). The Rabbinical Council of America has also created a version of a halachic living will, which they call a Halachic Health Care Proxy (HHCP). The HMD comes in different versions, depending on the state. The HHCP comes in two versions: with and without a notary.
In addition to combining an advance directive and a durable power of attorney in a halachically acceptable way, both the HMD and the HHCP state that the named rabbi should determine the definition of death, whether or not postmortem procedures may be undertaken, and the handling and disposition of the body.
We recommend that the rabbi of each shul choose the halachic living will he is most comfortable with, and use that version in the halachic living will event. The various versions of the HMD and the HHCP can be viewed and downloaded HERE.
Each state has its own laws regarding how the signature on the living will must be authenticated. To view the specific requirements for each state, click HERE.

In order for a halachic living will to be useful, it must be easy to locate and access in case of emergency. The National Association of Chevra Kadisha (NASCK) developed the EMES card in order to ensure that a person’s wishes are immediately available to first responders. The EMES card contains a brief summary of the halachic living will, as well as the name and contact information for the healthcare proxy and rabbi. The EMES card is attached to a driver’s license or ID, in a specially created sleeve, so it can be easily found and accessed.

We at NASCK have developed two types of events: a Workshop, and an Open House. We will briefly describe and compare the two events. Once you decide which event you want to host, click on the toolkit for that event.

This event involves a live presentation in which the presenter guides the participants, paragraph by paragraph, through the version of the living will that was chosen by the rabbi. This can usually be accomplished in less than half an hour, depending on questions.

1. Having someone go through the document with the attendees gives them a sense of calm. We have found that the thought of executing a living will makes many people feel anxious. Having someone guide them through the document makes the process more manageable for them.
2. A presenter who is not a lawyer — and makes it clear that they are not giving legal advice — but is nonetheless able to answer participants’ questions helps people realize that many of their questions are simply a matter of their own personal preference. This is very liberating for participants, and makes it more likely that they will be able to finalize their decisions and execute the document.
3. There are some issues that are confusing the first time one reads the forms. Having a presenter who is familiar with the form can help clarify that confusion.
4. This event does not require tremendous effort from volunteers. If you are not using a notary, and the witnessing will be done hataras nedarim style, the only volunteer you need is the presenter. Even if you have a notary and witnesses, you can execute almost one hundred forms with a few witnesses and a notary in approximately one hour.

1. Having someone go through the document with the attendees gives them a sense of calm. We have found that the thought of executing a living will makes many people feel anxious. Having someone guide them through the document makes the process more manageable for them.
2. A presenter who is not a lawyer — and makes it clear that they are not giving legal advice — but is nonetheless able to answer participants’ questions helps people realize that many of their questions are simply a matter of their own personal preference. This is very liberating for participants, and makes it more likely that they will be able to finalize their decisions and execute the document.
3. There are some issues that are confusing the first time one reads the forms. Having a presenter who is familiar with the form can help clarify that confusion.
4. This event does not require tremendous effort from volunteers. If you are not using a notary, and the witnessing will be done hataras nedarim style, the only volunteer you need is the presenter. Even if you have a notary and witnesses, you can execute almost one hundred forms with a few witnesses and a notary in approximately one hour.

This event encourages people to fill out their forms ahead of time. When they come to the event, all they will do is have their documents properly witnessed (and possibly scanned). The Open House event is not really an event, but rather an organized way to ensure that people actually execute their documents. All the work occurs before the event, and is directed through the rav’s drashah, shul announcements, and informational emails.

1. People can come in and out in very little time. They can even switch with their spouse and not need to worry about child care.
2. There is no need for anyone to have any expertise regarding the documents.
3. This event is extremely easy to plan and execute. Every shul in the US has the resources necessary to hold this event successfully.

1. You will need to recruit several volunteers to serve as witnesses. The more people you expect at the Open House, the more witnesses you will need. Depending on which state you live in, you may also need to recruit at least one notary. The witnesses will not need much training, but there should be a meeting before the event to make sure they are familiar enough with the documents that they can spot obvious errors.
2. If people have questions, there is no one to talk to. You can mitigate this by having the rav present, which is highly recommended in any case. It is also wise to ask a few people to familiarize themselves with the form, and be available to answer questions. It is often easier to find people who are willing to answer questions informally than to find someone who is willing to speak from a podium. Viewing the following video, which explains the details of the form in just 20 minutes, is enough training for most people. (Please note that the video reviews the RCA version of the halachic living will, but the Agudah version, which varies from state to state, is very similar.)
Your volunteers are always welcome to reach out to NASCK for support. It will only take a few minutes for our veteran presenters to train any well-spoken individual in your congregation.
3. If the only activity taking place at the Open House is the witnessing of the document, people might opt to skip the event, believing they will find their own witnesses at a convenient time. Our experience is that these people seldom actually execute the document. Holding a Workshop event, rather than an Open House event, gives people more incentive to attend, since they will be receiving information and instruction regarding the documents.

To reiterate: we have seen tremendous success with both of these models, and we are here to support you with either one.