Jewish Law in Our Times

by Simon M. Jackson, Adv., Legal Advisor to Torah MiTzion

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3 - The Israeli Terminally Ill Patients Law, 5766-2005 (Part II)

The Terminally Ill Patients Law, 5766-2005 contains a number of examples of balancing between the value of the sanctity of life and the value of an individual’s right to decide his own destiny.

Where a terminally ill patient is interested in prolonging his life, then even if he requests medical treatment which the attending doctor considers is without justification, he must be given the requested treatment within the boundaries set by the law and the policies determined by the Ministry of Health. This is a case, in which the value of the sanctity of life and the value of autonomy coincide.

Balancing of Values: Sanctity of Life v. Autonomy of the Individual

In the converse case, that of a compos mentis terminally ill patient who requests that his life not be prolonged and that treatment not be administered, the value of the autonomy of the individual takes precedence over the value of the sanctity of life. Yet even in this case, the personnel attending to a terminally ill patient “must make reasonable efforts to convince him to accept oxygen, as well as food and fluids, even via artificial means, and also to accept standard treatment which is required to treat simultaneous or prior illnesses and palliative care.” This represents a practical attempt to give more fitting expression to the value of the sanctity of life, but falling short of forcing it on the patient who has made an informed choice as to his destiny.

Treatment is not to be administered to a terminally ill patient who is not compos mentis, who suffers a significant degree of painand who has made it clear through one of the ways recognized by the law that he does not wish to prolong his life - e.g. through a ‘living will’ (‘advance care plan’ or ‘health directive,’ both of which are now recognized as binding by Israeli law) - including examinations, surgery, resuscitation, connection to a life-support machine, chemotherapy treatments, radiation and dialysis.

On the other hand, “ancillary treatment” must still be given, even to a person who has previously expressed his wish against further treatment. Ancillary treatment is medical treatment of a terminally ill patient which is unconnected to his incurable medical problem, and includes standard treatment required to deal with simultaneous or prior illnesses and palliative care, and similarly the provision of food and fluids, even by artificial means.

In such a situation, therefore, where, in real time, the patient is not compos mentis, but has made it clear in the past the way in which he would like to be treated in the event of becoming terminally ill, a different balance is created between the sanctity of life and the patient’s wishes - partial precedence being given to the former. However, the balance is tilted in the opposite direction, in the case of a terminally ill patient with less than 2 weeks to live. In such case, his wishes should be honored and even palliative care should be withheld, save for fluids which must continue to be given, save where the presiding doctor determines that the grant of fluids causes suffering or harm to the patient.

Active v. Passive Euthanasia

Practically speaking, it emerges from the above that it is forbidden to perform any direct activity which is intended to kill the patient, whether by way of active euthanasia or by way of assisted suicide. However, the law permits a doctor to refrain from administering treatment to an incurably ill patient at the patient’s request, provided he is suffering severe pain.

The law thus distinguishes between two types of treatment: “continuous medical treatment” - which is given constantly and without interruptions (essentially, connection to a life-support machine) - and “periodic medical treatment” which is given on a cyclical basis, there being a clear distinction between the end of one cycle and the beginning of the next. Periodic treatment is extremely common treatment at the end of a person’s life and includes: chemotherapy, radiation, dialysis or other drugs. The new law permits a doctor to refrain from administering treatment to an incurably ill patient whether at the start of treatment or whether by failing to continue periodic treatment already initiated by the doctor. By contrast, the law forbids the cessation of continuous treatment because to disconnect a life-support machine would be a direct act to cause the patient to die.

Prior to the entry into force of the new law, this issue was disputed throughout the world, due to the concerns of doctors and patients on the permissibility of disconnecting a terminally ill patient from a life-support machine, should the patient request this on account of his suffering. In this regard, the new law proposes an innovative possibility: to connect the life-support machine for a time interval which would transform the artificial respiration from continuous treatment to cyclical treatment.

A delayed-response ‘Shabbat timer’ built into a patient’s respirator will now be the main solution to the problem of how to let the terminally ill end their lives with dignity. The timer operates for 24 hours at a time and sets off a red light or alarm after 12 hours as a reminder to reset it. The patient or his representative could at any time request an extension, but if the dying person insists he does not want his life extended, the timer would turn off the respirator at the end of the cycle.

The withholding of nutrition and active euthanasia would not be permitted because they violate Halacha, but the legislation now allows the halting of ongoing support using the timer device. No longerwill families have to appeal to a court for specific permission to halt artificial means for keeping terminal patients alive against their will.

Steinberg has noted that since the idea of the timer became known abroad, many non-Jewish doctors abroad have expressed interest in it, because medical teams of all views and backgrounds feel uncomfortable turning off a dying patient’s respirator and causing his death.


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Jewish Law in our Times > Terminally Ill Patients and the Right to Die - in Dignity

Entered By:

moshe, 3/13/2008