September 26, 2018

A New Jewish Health Care Directive

The first Jewish advance health care directive made its appearance in Genesis, when Jacob, nearing the end of his life, implored Joseph to bury him with his forefathers.

“Do me this favor. … Please do not bury me in Egypt,” Jacob declared. “When I lie down with my fathers, take me up from Egypt and bury me in their burial place.”

The way we care for those who are seriously ill has advanced since Jacob spoke with Joseph about 4,000 years ago. Our practices have changed a great deal, as well, in the decades since contemporary Jewish advance directives first were drafted in the early 1990s. These modern efforts, building on the foundations of our biblical ancestors, under-score how the need remains more crucial than ever.

Because of this need, my colleagues and I have developed an innovative new version — the Cedars-Sinai Jewish Ad-vance Healthcare Directive. We hope the document will be embraced by our Jewish patients and by diverse Jewish communities around the world.

To understand the nuances of this new advance directive, it is helpful to appreciate why a document like this is so essential.

Medical technology grows more sophisticated with each day, and with that comes the ability to intervene, cure dis-ease, mend bodies and prolong life. These interventions, however, are not always in a patient’s best interests.

Advance directives enable us to convey to our families and health care providers how we feel about our medical care if we are unable to actively participate in decision-making. They enable us to sort out what matters to us, including important end-of-life issues such as whether we desire extraordinary measures to prolong our lives — and if so, which ones we’re willing to accept. A legally binding personalized guide assures that our wishes will be followed even if we’re unable to articulate them.

So why a Jewish advance health care directive? The more the document can be formulated in a culturally and religiously sensitive manner, the better chance it has of actually being utilized and of accurately expressing patients’ goals, values and preferences. In 1991, the Rabbinical Council of America (RCA) developed an advance directive that reflected some of the Modern Orthodox community’s approach to mat-ters of health care and Jewish law. That document was followed a couple of years later by a version drafted by the Conser-vative movement. In 2003, Agudath Israel, an Orthodox organization, took a different approach by drafting a Jewish health care proxy form, which the RCA then emulated in revising its own document.

Each of these documents has value. Our new advance health care directive takes an entirely different approach. Instead of simply listing which medical interventions one does or does not want, it aims to capture the totality of a person’s values and preferences to be applied in various unforeseen circumstances.

Our aim has been to craft language in a way that is sensitive to the religious views of the patient. Because the Cedars-Sinai Medical Center version gives patients an opportunity to describe their values, it tells us about who our patients are, what is important to them, and what is not important to them.

The Cedars-Sinai Jewish Advance Directive provides a range of options. For example, individuals can appoint their own rabbi or a Jewish institution to assist with decision-making; patients also can indicate whether they want to donate their organs. The document is drawn up in a manner that is acceptable by the strictest interpretations of Jewish law while, at the same time, not obligating patients to follow Jewish law if that is not their wish.

My hope is that the user-friendly ad-vance directive will resonate with any Jewish patient who needs it, regardless of affiliation or persuasion.

This work is the start to a larger undertaking. Because Cedars-Sinai serves a broad and diverse community, it is our goal to produce more culturally sensitive and religiously appropriate directives for other groups so that all patients can ex-press their values as they work through some of the most profound decisions in their lives.

You can access the Cedars-Sinai Jewish Advance Healthcare Directive and a step-by-step guide by visiting the Spiritual Care Department at Cedars-Sinai (hard copies of the document are available to patients at Cedars-Sinai). The website also provides links to other traditions’ advance health care directives.

Rabbi Jason Weiner is senior rabbi and director of the Spiritual Care Department at Cedars-Sinai Medical Center.