Authority in the realm of halacha and medicine

1. Halachic authority is determined by the knowledge, experience, dedication to the halachic process, seniority, and public acceptance, similar to the way medical authority is determined. However, significant differences of opinion between authorities are common in the halachic realm, so that it is not possible to define a single Halachic Authority. For this reason, it is important that a person develop a relationship with a halachic authority who can serve as his personal mentor and guide.

2. In Israel, recognized authorities with particular expertise in medical halacha include: Rav S.Z. Auerbach and Rav E.Y. Waldenberg zt"l of the previous generation. Current authorities include: Rav Y.Y. Neuwirth, Rav Y. Zilberstyn, and Rav A. Weiss. Machon Schlesinger is dedicated to the field of medical ethics, and includes noted medical and halachic figures such as: Rav Dr. A.S. Abraham, author of Lev Avraham and Nishmat Avraham (available also in English); Prof. A. Steinberg, author of Encyclopedia of Jewish Medical Ethics; and others.

3. There are situations that a DNR order can be applied within the context of Orthodox Jewish Law. The circumstances are variable, though, so that it is important to consult a halachic authority in each specific case.

4. While not universally accepted, there is strong halachic basis for the Halachic Living Will. It is best to contact the Interlink Foundation directly regarding the halachic and legal implications in the UK.

5. The mentally competent decision for the HLW is most significant halachically, whereas the actual signature is of less significance. (Legal implications must be verified in UK.) Mental capacity must be determined on a case-by-case basis, in reference to the laws of shoteh, mental incompetence.

There is now a wealth of material available in English on Jewish Medical Ethics, including the Journal, Assia, published by Machon Schlesinger. For further English reading on the above topics, see:

a. "The Halachic Basis of the Proposed "The Dying Patient Law," by A. Steinberg

b. "The Dying Patient Law, 2005," translated by V. Ravitsky and M. Prawer

c. "End of Life Issues in Halacha: DNR, Feeding Tubes and Palliative Care," by D.I. Kaye and S. Glick

d. "The Use of Percutaneous Endoscopic Gastrostomy (PEG) in Demented Patients: A Halachic View," by A. Steinberg.

In addition, see: "Halachic Guidelines to Assist Patients and their Families in Making “End-of-Life” Medical Decisions," by the Rabbinical Council of America.

Best Wishes,

Meir Orlian