In Israel, the assumption according to The Terminally Ill Patient Law is that a terminally ill patient wishes to live unless proven otherwise.
- The right to die with dignity in Israel is regulated according to the provisions of the law, which establishes that in certain situations, someone defined as a terminally ill patient is entitled to request a cessation of medical treatment, and the medical staff is obligated to comply with the patient's wishes, according to certain limitations defined in the law.
- Additionally, everyone is entitled to provide a living will while they are healthy, regarding the treatment they wish to receive or not receive if and when they are considered to be a terminally ill patient; they are also entitled to appoint a power of attorney to make decisions in their stead.
Who is Eligible?
- Everyone is entitled, both when they are healthy (by providing a living will in advance), and if and when they are defined as a terminally ill patient according to the law.
How to Claim It?
- In order for treatment to be stopped, it must be proven that the patient does not wish to live; as such, patients are either defined as legally competent or legally incompetent.
Legally Competent Patients
- Those who are over the age of 17, capable of expressing their wishes, have not been declared legally incompetent, and are cognitively, mentally and emotionally capable of making educated and rational decisions of their own free will regarding medical care are considered to be legally competent.
- A legally competent patient must explicitly express a desire to stop the medical treatment and/or adjunct treatment (medical treatment that is not directly connected to the incurable medical condition such as provision of food and liquids). As such, the patient must sign a form indicating the desire to not continue living.
- Patients who for some reason are unable to express their will in writing, may declare their wishes verbally in front of two witnesses, and the declaration will be documented in writing as shortly thereafter as possible.
Legally Incompetent Patients
- For those over the age of 17 who are legally incompetent, the right to die with dignity is granted in the following cases:
- The patient provided a written living will.
- The patient appointed a power of attorney who will give instructions in the patient's stead.
- The patient provided prior medical instructions and appointed a power of attorney.
- An institutional committee or national committee has provided a decision in cases where it is relevant according to the law.
- If there are no prior instructions, power of attorney, or committee decision, the declarations of those close to the patient may be consulted. Those close to the patient may declare that the patient does not wish to continue living. Those who are considered to be close to a patient are those who have a close familial or emotional connection to the patient, have had a close and continuous relationship for at least two years prior to the decision and know a significant amount of personal information about the patient.
- In rare cases, a guardian who has been appointed for the patient may be used if the guardian is close to the patient and has indicated that the patient does not wish to continue living.
- If it has been proven that a terminally ill patient does not wish to continue living, provision of treatment connected to the incurable medical condition must be stopped; however, it is forbidden to refrain from provision of adjunct treatment.
- It is only permitted to refrain from provision of adjunct treatment if the terminally ill patient is considered to be final stage, and is experiencing significant suffering.
Forbidden and Permitted Actions
Legally Forbidden Actions
- Prohibition of Active euthanasia (by injection, for example) - The performance of any action even if it is a form of medical treatment, that is intended to euthanize, or which will almost certainly result in death. Such an action is forbidden even if the act was requested by the patient and is for the purpose of decreasing the patient's suffering. The performance of such an action is considered a criminal offense.
- Prohibition of Assisted suicide - The performance of any action even if it is a form of medical treatment, which assists someone to commit suicide. The performance of such an action is considered a criminal offense.
- Prohibition of stopping continuous treatment - The stopping of treatment which is most effectively provided in a continuous manner and the cessation of which is liable to cause the death of the patient (for example, disconnecting a ventilator).
Legally Permitted Actions and Withheld Treatment
- It is permitted to refrain (according to the will of the patient as established in the law) from medical treatment of an incurable medical condition in a terminally ill patient, this includes examinations; surgeries; resuscitation; connecting (only) to a ventilator; chemotherapy, radiation or dialysis treatments, etc.
- Regarding treatments which have already been provided to the patient before a decision was made, the law distinguishes between two type of treatments:
- It is permitted not to renew cyclical medical treatment, which is medical treatment provided in cycles with breaks, and which the period between the end of one cycle and the beginning of the next can be clearly distinguished in practice.
- It is permitted not to renew continuous medical treatment, which was stopped unintentionally or by another legal means, and it is also permitted to use technological means by which continuous medical treatment is provided as cyclical medical treatment, even if it is most effectively and usually performed continuously, without breaks.
Care Providers' Professional and Ethical Reservations
- The law does not require a care provider to give a terminally ill patient a specific medical treatment or refrain from providing a specific medical treatment which is in opposition to that care provider's values, conscience, or professional medical opinion.
- Nonetheless, a care provider who refuses to act in accordance with the law due to any or all of the reasons indicated above must transfer care of the patient to another care provider, according to predetermined arrangements with the medical facility's adminsitration.
Laws and Regulations
- The Terminally Ill Patient Law, 5766 (2005)
- The Terminally Ill Patient Regulations (Committees, Documents, Database and Reporting), 5768 - 2007
- Ministry of Health Director Memo 7/2008 from 17.03.2008 - Guidelines for implementation of The Terminally Ill Patient Law
- The Ministry of Health website: The Terminally Ill Patient Law
- English translation and maintenance by The Shira Pransky Project.