The term Advance Directive refers to any of a variety of forms that detail what medical care we would want if we were unable to speak on our own behalf.

And quite the variety there is, a veritable alphabet soup of choices: POLSTs, MOLSTs, MOSTs, POSTs, the less mellifluous TPOPPs. The list goes on and on.

Which should you choose? It’s easy: None of them.

A Jew can’t choose any of these documents precisely because they detail our choices regarding resuscitation, dialysis, tube feeding, intubation (an intervention unfortunately common during Covid), as well as other procedures that might be necessary to maintain life.

These decisions involve the most complex and nuanced areas of halachah, and must be made in conjunction with a qualified rav. Moreover, such choices must consider the specifics of the medical situation at the time the decision will take effect, something that can’t be known in advance.

For a Jew, the only type of Advance Directive to sign is one that names the people (called proxies or agents) they trust to speak for them in that situation, as well as the rabbi who will guide those decisions. This form is often referred to as a Halachic Medical Directive or a Halachic Healthcare Proxy, but we prefer to call it by the simple term, Halachic Living Will.

Both the Rabbinical Council of America and Agudath Israel have produced halachic living wills, which you can access by clicking the button at the bottom. Either version will function perfectly.

 AT WHAT AGE DOES SOMEONE NEED A HALACHIC LIVING WILL?

65, right? When Medicare kicks in. Or maybe 40, when you start noticing that you’re getting older. 

Actually, the right age is 18.

HIPAA regulations consider an 18-year-old to be an adult, and prevent medical personnel from discussing their condition with anyone other than a designated health care proxy. That’s not usually a problem. 

Until it is.

The Wall Street Journal tells a harrowing tale about a family who dropped off their 18-year-old daughter at college for her freshman year and didn’t hear from her for days. She didn’t return their phone calls or emails. The school suggested the parents call the local hospital, but the information they received over the phone was severely limited by privacy rules. They drove frantically to the hospital and discovered that their daughter has been bitten by a spider and had been in a coma for three days. 

Thankfully, the girl recovered, but, bottom line: everyone over the age of 18 needs a halachic living will. It should be a rite of passage for every newly minted “adult.”

 I SIGNED IT. I’M GOOD, RIGHT?

Almost!

Now that you have this essential document, you need to make sure it will be found in case of emergency. This is no theoretical concern. See the letter written to Dear Abby by a “grieving husband,” below.

The first thing to do after creating a halachic living will is to give it to anyone who might possibly need it. 

Don’t just send it to your lawyer to keep with your other legal documents, and don’t just file it away in a drawer somewhere. Give copies to anyone who might need to have it, including your emergency contacts, health care proxies, doctor, social worker, and the admissions department of any hospital or care facility you enter.

(While you’re at it, you can also send it to your lawyer. And instead of putting it in a drawer, post it on your refrigerator. EMTs are trained to look there for important information.)

There are also two ways to keep your information on your person when you are out and about: the high-tech way and the low-tech way.

The high-tech way: there’s an app for that! Smartphone users can download the ICE Medical Standard app (Android, iOS). (ICE does not refer to what you should put on your sprained ankle, by the way. It stands for In Case of Emergency.) This highly reviewed, free app allows you to show important information, including your emergency contacts, medications, drug allergies, and a shortened version of your halachic living will, right on your locked phone screen.

If you have a smartphone, but find an app too complicated, you can create a message to display on your locked screen.

The low-tech way: the EMES (Emergency Medical Education Sign-up) Card. NASCK’s EMES card contains a shortened version of a halachic living will and attaches to your driver’s license or any other standard-size ID card. NASCK will send you a free EMES card if you fill out a Halachic Living Will.