In Parshat Vayechi, the Torah speaks for the first time of someone becoming sick before they die. The elderly Yaakov falls ill, prompting Yosef to bring his sons to receive blessings. According to the Talmud, until that point there was no illness leading up to death; rather, one would die suddenly. Yaakov came and prayed for mercy, and illness was brought to the world, allowing one to prepare for his death (Bava Metzia 87a). Soon after, Yaakov commands Yosef regarding his burial wishes and leaves further blessings to all of his children. The story of Yaakov’s last days teaches that the opportunity to prepare for one’s own passing is a great opportunity and gift from G-d.
Our great sages taught us throughout the centuries that it is appropriate to plan ahead for illness and death. Halacha permits and even encourages people to purchase burial plots (Kol Bo, Avelut, vol. 1, p. 174), tombstones, and burial shrouds (Aruch HaShulchan, YD 339:5) in advance. In fact, Rabbi Yosef Karo even allowed people to dig their own graves, provided that they were not in such a mental state that thinking about death could harm them physically or emotionally (Beit Yosef, YD 339). Similarly, both Rabbi Chaim Falagi and the Chafetz Chaim urged people to sign a financial will and testament while they are healthy, in the spirit of the famous dictum of the Sages, “If I am not for myself, who will be for me?” There’s no reason to leave these decisions to others. These sources make clear that advanced directives are the most prudent way to receive one’s desired wishes while also avoiding unnecessary family strife.
Today, it is critically important for people to sign an advance healthcare proxy and directive. Many choices must be made as people age or approach the end of life. People may no longer be able to speak for themselves, and sometimes decisions must be made quickly. These can be cases of terminal illness, like an aggressive form of cancer, or a progressive or degenerative disease, like Alzheimer’s or ALS. People may suffer sudden and drastic changes to their health, such as a heart attack or car accident. Or as so frequently happens, they must cope with aging and increasing frailty, with many nagging ailments.
In any circumstance, healthcare providers need to know what decisions you’d like to be made on your behalf within the framework of Jewish law. The default decision of what someone else might deem to be in “your best interest” may not coincide with Jewish values. Your family members need to know who should be making these decisions on your behalf. They also need to know which rabbi to consult with if there are halachic questions regarding certain interventions. Various organizations, including the Rabbinical Council of America (RCA) and Agudath Israel, have created these forms in the past.
Ematai recently undertook the task of creating a document that can provide you with decision-making clarity along your healthcare journey. The document was created by myself and Rabbi Dr. Jason Weiner of Cedars-Sinai Medical Center (Los Angeles) with the input of many doctors, social workers, rabbis, and lawyers. It has received the endorsement of Rabbi Hershel Schachter and Rabbi Mordechai Willig, among others, and was recently adopted by the RCA as their official halachic healthcare proxy. Ematai runs workshops across the country to complete these forms, with sessions in New York, New Jersey, Florida, and California this coming week alone.
The document, which can be found online (ematai.org/netivot), has two sections: The first part is an advance healthcare directive that designates your powers of attorney, recommends the rabbi they should consult with, and declares that you want decisions made in accordance with Jewish law. It is a user-friendly document that can be easily filled out online or in print. Once it is signed, this is a formal legal document that will be respected by healthcare providers and hospitals.
The second document is a conversation guide to talk about your healthcare goals and values. It gives people the opportunity to express their general decision-making preferences. These aren’t easy conversations to have, but they are critical to help your proxy and rabbi better understand your goals and preferences so they can better apply them to each unique situation. It is also a gift to your loved ones, as it will help prevent family tensions and guilt caused by uncertainty and speculation about your values and preferences. Meaningful conversations about life and death can bring families together.
We need to follow the model of Yaakov Avinu and take the initiative today. Im lo achshav, ematai? If not now, when?
