A new look at Advanced Medical Directives |

I have written about living wills (aka Medical Directives) for a long time. (Here’s but one .) And, I warned many of you who had the (same, incorrect) impression that I did how many states and localities are making the decision that we are dead- and then extract organs for donation.

In my case, I am a traditional Jew. For us- until the mid-1980s- it was not acceptable to donate organs to the living. Our bodies were considered sacred- no autopsies, no organ donations.

The first crack came from my side of Judaism- the Sfardi Chief Rabbi, Rav Ovadya Yosef, who decreed in 1986 that pikuach nefesh- the saving of a life- and kavod hamet (honoring the dead) were not in conflict. In particular, Rav Ovadya Yosef ruled that it was the ultimate honor for the dead to offer life-saving organs to those in peril. (This turned some 5000+ years of Jewish tradition upside down!) [Note: It was 5 years later when my classmate, Rabbi Shmuel Goldin (the then head of the Rabbinical Council of America; the Orthodox Jewish rabbi’s organization) issued a similar ruling for the Ashkenazi and American Orthodox Jews.)

And, with that decree, I went the very next day to the Department of Motor Vehicles to register as an organ donor. Which I maintained for 15 years.

Why did I change? Because by 2011, many places decided that there was no need to determine if one were brain dead to extract organs. And, to this moment, that is the only definition that applies to us Jews. It’s not if our heart stops, it’s not if we aren’t breathing [by that definition, I’ve died WAY too many times]- it’s simply the loss of our cerebral function. And, that meant I am no longer what you would call an organ donor.

Except my children have been informed both verbally and via my Advanced Medical Directive- that when and if I am dead- brain dead, that is- they are welcome to authorize medical staff to extract whatever organs can benefit the living. But, only then. And, only by decision of my children. NOT the medical staff.

That’s where things stood for about a decade.

Except on the 11^th of January, the National Association of Chevra Kadisha [this is a committee that honors the dead, performing ritual activities for the body that has died], was involved in a national (OK- a series of local events all happening the same day) program on the Sanctity and Quality of Life.

For those of you who know Jewish philosophy, it won’t be surprising that assisted suicide is not considered appropriate for Jewish folks. (Sorry, Charlie. I’m not sure I will so opt- but I am not ruling it out.) There are 10 jurisdictions across the USA where assisted suicide is legal. (DC, California, and New Jersey are among them- and they have sizeable Jewish populations.) The Jewish position is that every moment of life is an opportunity to praise Hashem [The Supreme Being] and help effect tikkun olam- the reparation of our world to help it achieve perfection.

So, the new program set up an Halachic Living Will or Advanced Medical Directive. This not only involves the person making the choice, his/her proxies, legal counsel- but a rabbi of his/her choosing to help aid in those decisions.

But, it’s more than that. The goal was to involve discussing our wishes with family and friends. Because many of those folks may not be familiar with the exigencies of the Jewish traditions. To explain to them that a dead body is ‘guarded’ (a “shomer”) by one who recites tehilim (psalms) until the body is put in the ground. The body undergoes t’hara (ritual purification, the cleansing of the body), attiring the body in ritual garments (a ‘kittel’-a white robe. or perhaps a ritual shawl-a tallit), the use of a plain pine box as a casket (or even just a tallit), no cremation, etc.

Or, discussing with your elderly parents (hey, kids, that means me) about kivud av v’em (honoring one’s mother and father), how to address needs of care and living.

And, then, we get to the halachic living will. By and large, the biggest difference between the Halachic Living Will for the Commonwealth of Virginia and the Advanced Medical Directive is the designation of an appropriate religious advisor (rabbi) who will be part of the decision team- along with your trustee(s) and medical staff. (I do note that in the event of a difference of opinion, there is no clear cut decision. So, I have elected to have my children override the decision that may or may not be recommended by my rabbi- should he disagree with their considerations.) The other major difference- the elimination of an autopsy examination. (Please note- if one has been murdered, the need for an autopsy, a state-required action, generally overrides Jewish religious practice.)

I have attached both the Virginia Advanced Medical Directive and the Virginia Halachic Living Will. You may want to consider inserting clauses involving your religious traditions in your forms. (I actually am in the process of incorporating those sections in yellow from the Halachic Will into my Virginia Advanced Medical Directive [VAMD]. The VAMD seems more complete and inclusive.)