HLW Background

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). 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.
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.