Chapter 20 | Recommendations for Filling out Medical Power of Attorney forms and Living Wills

Rabbi Yuval Cherlow, Rabbi Uriel Ganzel, Rabbi Shaul Baruchi

Chapter 20 from the booklet The Halakhot of Treating a Terminally Ill Patient and a Patient Suffering From Dementia

As stated in the previous chapter, one option is to sign a continuing power of attorney in the presence o a lawyer. We will not address that option here. Our focus here is on the provision of a living will and the appointment of a proxy under the Dying Patient Act, by means of the Ministry of Health forms. There are various types of living wills available, and it is not necessary to use the form provided by the Ministry of Health, but the instructions must be formulated in accordance with halakha. There is a detailed version of a power of attorney form, alongside an abbreviated and easier-to-use version, but this can be signed only before one is legally defined as a “terminally ill patient.” Both versions are relevant only to the treatment of someone who is defined by the law as a “terminally ill patient”1.

Recommendations for filling out a power of attorney form

1. We recommend appointing a proxy in advance, before one is defined by law as a “terminally ill patient,” and certainly before he becomes incapacitated. At this stage, one can sign a shortened version of a power of attorney form without the involvement of a doctor.

2. When signing the full version of the power of attorney form, on page 4 of the form, regarding the authority of the attorney, it is recommended to choose the first option, which authorizes the proxy to make any decision regarding treatment or non-treatment. If one chooses this option, there is no need to specify in the form which treatments can be withheld.

In both options of sections 1(in the short version, or option (a) in the full version), it is recommended to add to the power of attorney a cover letter, in which the patient requests that a rabbi be consulted, as detailed in the last section below (“Cover Letter – Consultation with a Rabbi”).

3. If one chooses option (c), which authorizes the proxy with regard to specific treatments, we propose to add in section C4 of the form (“Personal Instructions Not Listed Above”) instructions to the proxy that are identical to what we detail below in the recommendations for the living will (including the clause requesting consultation with a rabbi). It is important to keep in mind distinctions between different stages of illness.

Recommendations for Filling out a Living Will

1. In our opinion, from a halakhic and medical perspective it is advisable and appropriate to choose the option of avoiding medical treatment in certain situations (section A in the form, pp. 3–6), andnotthe option of receiving life-prolonging treatment even if the medical staff advises against it (section B in the form, p. 7).

2. On page 6, section A5, “Personal Instructions Not Listed Above,” it is recommended to add the following instructions:

a. If I become a “terminally ill patient,” I instruct that artificial nutrition should not be withheld, except in situations where the medical staff has determined that feeding is causing harm or severe pain for an extended amount of time2.

b. If I become an “end-stage patient,” I instruct that artificial feeding should be halted and replaced by the administration of liquid solutions containing salts and glucose, if the medical staff determine that feeding will provide no benefit, and certainly if it will cause harm or severe pain, and withholding nutrition will not cause suffering3.

c. If I become an “end-stage patient,” if I am in severe pain, I instruct that I should be given morphine or any other medication that will prevent suffering, even if there is a risk involved4.

d. If I become an “end-stage patient,” if I am suffering from particularly extreme pain, I instruct that I should not be directly disconnected from a respirator. However, I permit stopping medication that supports artificial respiration, as well as lowering the percentage of oxygen to its level in the air, after consultation with a halakhic authority5.

3. In addition to these guidelines, it is advisable to add a clause mandating consultation with a halakhic authority.

Cover Letter – Consultation with a Rabbi

Both in the living will and power of attorney form, one should add the requirement for consultation with a rabbi, as detailed below. On the power of attorney form, (for both options A and B), it will be attached as a cover letter. For option C and in a living will, a passage can be added under the subheading “Personal Instructions Not Listed Above”:

When you need to make a medical decision involving my case, if I am a terminally ill patient or an end-stage patient, provided that time constraints allow for it, I request a consultation with Rabbi _____________, or alternatively, a rabbi whom, in the opinion of my family members/proxy, issues similar rulings to the rabbi I chose, and his recommendation should be considered a reflection of my wishes. I request that my family members/proxy make a reasonable effort to consult with me. If this is not possible, it should not adversely affect the powers of my family members/proxy.

הערת שוליים

  1. For other types of forms, see footnote 155, above; see also footnote 151, on the legal status of our recommendations. We recommend seeking the assistance of the rabbis from the Tzohar Ad 120 initiative.
  2. See chapter X, above.
  3. See chapter X, above
  4. See chapter XII, above.
  5. See chapter IX, above.

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