End-of-life is a complex tangle of spiritual, emotional, and legal concerns. In the final chapters of Genesis, Jacob approaches his own death with intention and clarity. His story prompts us to reflect on our own intentions for our end-of-life experiences and on the tools available to help us express our wishes. These are the choices that matter in spiritual and legal ways. While we can articulate our values and directions, we can never fully guarantee that family members or caregivers will carry them out exactly as we hope.
The weekly Torah portion “Vayechi” opens with the words, “Jacob lived,” and then immediately continues, “as the time approached for Jacob to die.” As death draws near, Jacob summons Joseph to give instructions about his burial. He also uses his final hours to offer warning, blessing, and wisdom to each of his sons. The narrative invites us to consider not only death itself, but the quality of the days, months, or even years that may precede it.
Blessed with long lives, many of us will experience a period of awareness that death is approaching, long before death actually arrives. During that time, we face choices—about how we live, how we are treated when we are ill, and how medical decisions are made on our behalf. This is where my legal perspective enters the conversation.
Understanding MOLST, DNR, and Living Wills
Concerns about appropriate medical care shape many healthcare decisions for older adults. Several documents help guide families and health care professionals through these decisions, including MOLST forms, DNR orders, and Living Wills. These documents are designed to guide care in serious or life-threatening situations. They are not intended to block routine medical treatment for common, treatable illnesses such as the flu or mild pneumonia.
When used well, these documents help everyone stay calm, communicate clearly, and remain aligned with the person’s values, while still providing medical care that is likely to improve health and comfort. Those values may reflect the Jewish tradition’s deep regard for the preciousness of this one life we are given.
A MOLST, or Medical Orders for Life-Sustaining Treatment, is a medical order that directs clinicians about which life-sustaining treatments to use or avoid. It can address CPR, intubation, feeding tubes, hospitalization, and intensive care. Through a MOLST, a person may accept or refuse specific treatments based on their goals and values.
A DNR, or Do Not Resuscitate order, is far narrower. It means only that if a person’s heart or breathing stops, CPR should not be attempted. A DNR does not mean “do not treat.” It does not prohibit antibiotics, oxygen, fluids, or comfort-focused care.
A health care professional must complete DNR and MOLST forms. These documents memorialize the choices that matter most to medical personnel caring for the elderly.
A Living Will is a legal document that explains what types of medical treatment a person would or would not want in limited circumstances, usually involving terminal illness or permanent unconsciousness. Unlike a MOLST, it is not a real-time medical order. Instead, it provides guidance to clinicians and loved ones when difficult decisions arise.
Illness in the Elderly Is Not the Same as Dying
When an illness is not immediately life-threatening, the standard medical approach is to treat it. This typically includes antibiotics, fluids, oxygen, and medications to ease discomfort. In these situations, MOLST forms and Living Wills should guide the level of care if the person’s condition worsens—not serve as reasons to withhold reasonable, low-burden treatment.
If a person is still able to make decisions, clinicians should confirm that existing documents reflect that person’s current goals. These forms are not frozen in time; they can and should be revised as health, circumstances, or priorities change. Serious illness can clarify what matters most. For some, it reinforces a desire to avoid repeated hospitalizations and focus on comfort and time at home. For others, it strengthens the resolve to pursue every reasonable option to extend life.
When properly understood and applied, MOLST, DNR, and Living Will documents protect older adults from unwanted, extreme interventions while preserving access to compassionate and appropriate care for everyday illnesses. Problems usually arise not from the documents themselves, but from misunderstandings about their purpose.
Just as Jacob shared his wisdom with his family, each person has the opportunity to offer thoughtful guidance about their own care in later life. Documents alone are not enough. They must be accompanied by conversation, clarity of purpose, and the sharing of values. Ultimately, our wishes depend on the understanding and care of those who love us and those entrusted to care for us.
Rabbi Evan J. Krame
If this reflection resonates with you, consider sharing it on social media—or simply take a moment to reflect on how you can create a better community.
