The end-of-life decision-making process in Israel: Bioethics, law, and the practice of doctors

INTRODUCTION Making decisions for patients at the end of life is a delicate process that involves moral values, bioethical principles, personal beliefs, and legal rules. This is particularly true for Israeli society, which comprises various communities with different cultural backgrounds. This heterogenic aspect of Israeli society is reflected in different approaches to life-prolonging treatments that have yielded an ongoing public debate on the subject. A seminal point in this debate was the enactment of the Dying Patient Act (2005) by the Israeli Parliament (The Dying Patient Act 2005). Despite the ongoing debate on this issue in academic and public discourse and the time that has passed since the enactment of the Act, the impact the Act has on medical practice has scarcely been examined. In light of this background, and in view of the scope of this book, the purpose of this chapter is to examine how the legal framework set in Israeli law influences the practice of doctors who face – together with dying patients and their relatives – decisions about life-prolonging treatments. To fulfill this purpose, findings from an empirical study conducted among Israeli doctors are presented and analyzed vis-à-vis the relevant legal rules and ethical principles. The structure of this chapter is as follows. To appreciate the differences and similarities between the law and doctors’ practice, we first provide a short review of the current position of Israeli law. We then provide a description of the study, including its findings. This is followed by a discussion about the findings’ legal and bioethical implications. We conclude by asking whether Israeli legal and bioethical position in this area tells a unique story. THE LEGAL FRAMEWORK Background Prior to the Act, there were several attempts to regulate end-of-life decision-making through specific legislation, but none of them was successful. In the absence of a specific piece of legislation, this area was regulated by general legal rules that still apply today. For example, hastening the death of a dying patient or assisting her to die are prohibited by the penal code (The Penal Code 1977, Articles 302, 309(4)).Furthermore, a patient has, to a considerable extent, a right to refuse treatment (The Patient Rights Act 1996, Article 15(2)).