Section 1
ADVANCE PLANNING
(Note that in this and the following sections “you” refers to the individual involved in advance planning.)
Habonim encourages advance planning for end-of-life matters. Planning is a process of learning, discussion, and documentation. It enables you to identify those you trust to make decisions about medical treatment and, when a death occurs, about a funeral and burial. Resources in this guide address Conservative Jewish practice. They also can be useful in facilitating discussions with your designated agent and your family about your preferences, easing their burden in carrying out your wishes.
A few important resources should be mentioned. The Rabbinical Assembly’s (RA’s) Committee on Jewish Law and Standards has addressed and offers detailed guidance on issues of organ donation, health care decision-making, and end-of-life treatment. The RA discussion and rulings on these subjects may be found at these links on Medical Directives / Living Wills and Organ Donations. You will want to check the website for any recent revisions to or updating of this guidance.
An experienced attorney can explain the state’s legal requirements and, though not essential, may prepare the various legal documents described below. The attorney can help avoid inconsistencies and may address such concerns as provisions for surviving relatives, distribution of assets, recent changes in legal requirements or restrictions, options for charitable giving, and, when family configurations change, advise whether you may need to update documents.
The New York State government, New York State Bar Association, and American Bar Association also have online resources for planning. (See the Appendix at the end of this guide.)
A. HEALTH CARE ADVANCE PLANNING
The documents described in this section include (1) the Health Care Proxy or Durable Power of Attorney for Health Care, (2) Medical Directives or Living Wills, and (3) Organ Donations. The discussion outlines the planning options available to any member of the community as well as the authority that is given to a designated agent. Hospitals and other medical providers will ask for any advance directives or health care proxies that have been executed. A Rabbinical Assembly document offers health care proxies and living wills while other RA materials discuss organ donations.
The Health Care Proxy or Durable Power of Attorney for Health Care.
With advance planning, you can appoint your “Health Care Proxy.” This is the person to make decisions about your medical treatment when you lack the capacity to make decisions for yourself.
A document naming a Health Care Proxy will designate a health care agent to make decisions about your medical treatment when your doctor determines that you lack the capacity to make decisions for yourself. You may appoint a family member, a close friend, or anyone you choose. Your agent can interpret your wishes as medical circumstances change and make decisions you could not have known would have to be made. The health care proxy document may also include your wishes or instructions regarding organ and/or tissue donation.
New York State has a form for appointing a single health care agent and an alternate, should the designated agent become unavailable. If a patient did not appoint a health care agent, New York’s Family Health Care Decision Act, effective 2010, establishes the order of priority to be the patient’s legal guardian, spouse (if not legally separated) or domestic partner, adult child, parent, brother or sister 18 years or older, or close friend.
Note: A Health Care Proxy does not give a surrogate the authority to make financial decisions. These are addressed through a Power of Attorney (discussed in Section IB)
Medical Directive or Living Will
Medical Directives or Living Wills express your wishes regarding end-of-life care. Discussion of these choices is an important step to ensure the trusted decision-maker understands these wishes. The RA’s guidance presents perspectives from a Conservative Jewish tradition on many of the sometimes difficult emotional decisions your agent may face. The document becomes effective when you are unable to make your own decisions.
The Living Will may include statements addressing:
- Life-prolonging procedures and other aspects of end-of-life care.
- A desire to be buried according to Conservative Jewish Custom and Law.
- Wishes regarding organ donation.
Note that you cannot use a Medical Directive or Living Will to designate a Health Care Proxy. You must use a Health Care Proxy form. However, instructions and preferences for treatment and end-of-life care may be incorporated into the Health Care Proxy.
Organ Donation
Jewish tradition and New York law both encourage organ donation through education and by making donation easily possible. The RA’s information sheet and organ donor card are available here. When death is imminent, the medical team will want to know whether the patient has expressed or documented any intentions regarding anatomical gifts. The guiding principle the Rabbinical Assembly has affirmed is that “organ donation is a new means to fulfill an ancient, eternal religious duty: a mitzvah of the highest order.”
The RA’s information sheet includes this quotation from Rabbi Joseph H. Prouser’s synopsis of the RA’s teshuva on organ donation: “The Committee on Jewish Law and Standards has affirmed this principle in unambiguous terms ….The preservation of human life is obligatory, not optional. Since all conflicting halakhic duties are suspended and human lives are at stake… consent must be granted for post-mortem organ donation when requested by doctors and hospitals for use in life-saving transplantation procedures…. This applies to the individual in anticipation of his or her own death, as well as to health care proxies or next of kin whenever they are legally empowered to make such decisions on behalf of the deceased…. By so doing, he or she renders only profound and genuine honor to the deceased.”
There are several ways you can authorize organ donation.
1. The New York State Donate Life Registry, available online, is a database of people who have signed up to donate their organs, eyes, and/or tissues after their death. This database is kept confidential. Note that taking any of the other actions listed below will not automatically enroll you in this registry. It is a separate step.
2. You can fill out the Organ/Tissue Donor Form provided by the Rabbinical Assembly (see above).
3. You can specify your wishes in your Health Care Proxy or Living will.
4. You can enroll with the New York State Department of Motor Vehicles when applying for or renewing a learner permit, driver’s license, or non-driver ID. There is a specific box to check on the application form. The DMV will default to some preferences that may not be yours. You can change these by visiting the DMV’s website after you receive confirmation by email. When you enroll at the DMV, a heart and the words “Organ Donor” appear on these documents.
A failure to specify your wishes, however, does not necessarily imply a wish not to donate. Under New York law your agent is authorized to consent to organ/tissue donation unless he or she has notice of opposition or reason to believe that the donation is contrary to your religious or moral beliefs.
Other Health Care Documents.
The DNR (Do Not Resuscitate) and MOLST (Medical Order for Life-Sustaining Treatment) are medical orders, signed by a physician, useful for documenting your wishes related to cardiopulmonary resuscitation and other life-saving emergency procedures.
More information about Advance Directives and other health care materials may be found in documents prepared by the office of the Attorney General of the State of New York and the New York State Department of Health.
SEE THE APPENDIX FOR ADDITIONAL READINGS AND RESOURCES
