When a person faces illness, one of the most important documents to have in place is an advance medical directive. Unfortunately, like many important documents, the medical directive is not understood or utilized widely enough.
A medical directive typically has two main goals: setting out a person’s wishes and naming an individual to speak on that person’s behalf if they themselves can no longer do so.
Setting Out Our Wishes
The first goal of filling out a medical directive is to clearly state how we would like to be cared for in the case of serious illness. In it, a person can provide details about, for example, when they would or would not like to be intubated, whether there is a point at which they would like aggressive treatments to be stopped, and whether they would like artificial nutrition or hydration to continue. In the absence of a directive, medical staff may have to follow their own protocols, which might result in treatment that is more or less aggressive than a patient would want. By setting down our wishes with the force of legal authority, we provide instructions and guidance to our caregivers as to how they should proceed.
For Jews who follow halacha (Jewish law), a medical directive also serves the critical purpose of asserting that all care should be done in keeping with halachic requirements. Typically, this is accomplished by adding a clause requiring that no major treatments may be started or stopped without first consulting a rabbi. The directive should name the rabbi who should be consulted and include his contact information. A halachic medical directive is a document that incorporates this and other elements into the standard form. Both Agudath Israel of Maryland and Rabbi Moshe Hauer have produced halachic medical directives that are adapted for the state of Maryland. These are available online.
It should also be said that a medical directive is not only for the benefit of the person who fills it out; it is also deeply helpful for his or her family. Having seen these situations often, I can attest that there are few experiences more stressful than when a family has disagreement, or simply uncertainty, about how a loved one would want to be treated. Setting out our wishes clearly gives our family the peace of mind of knowing how to proceed.
Appointing an Agent
The second goal of the medical directive is to authorize a person to make medical decisions on behalf of the patient if the patient is no longer able to articulate his or her wishes. Even if we express our health care wishes clearly, there will often be decisions that fall in a gray area where a balance will have to be struck. In practice, therefore, the word of the health care agent is likely to be taken even more seriously than the wishes expressed in the directive. This makes choosing the right person very important.
Naturally, people tend to ask a spouse or child to be their health care agent, but this is not always the best choice. The health care agent needs to be someone who will be able to make analytical decisions under pressure and in situations where they are already under a great deal of stress. The agent must also be someone we can trust to carry out our wishes as best as he or she can; if we want the agent to consult with a certain rabbi first, we must be confident that they will do so. It may be the case that someone more removed from the situation — like a less immediate relative or a friend — will fulfill their responsibilities more effectively.
Whomever we choose, it is also important to let that person know that he or she will be our health care agent. Talk with him or her as best as you can about what you would or would not want to be done. The agent should also have a copy of the written medical directive.
Keep It Updated
Finally, each person should revisit and, if necessary, update the medical directive from time to time. As we grow older, our wishes about our care can shift. With the right preparation, the medical directive can be the critically useful tool it was designed to be.
By Rabbi Daniel Rose
Rabbi Daniel Rose is the rabbi for Jewish Hospice Services for Seasons Hospice and Palliative Care. He is also the assistant rabbi at Bnai Jacob Shaarei Zion Congregation in Baltimore.