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Timer to turn off patient ventilators in hospitals being tested but not ready for use
By JUDY SIEGEL-ITZKOVICH
10/12/2013
Only about 3,000 Israelis have registered a living will with the Health Ministry.
 
Over a decade after it was first conceived and discussed formulated by a public commission and eight years following its passage by the Knesset, the Dying Patient Law still has hardly been implemented due to technical and administrative problems and doctors’ ignorance of it. Though it is supposed to be supervised by the Health Ministry, only about 3,000 Israelis have registered a living will with the ministry; just 26 percent of doctors sampled knew they had responsibility for presenting its provisions to patients; and 28% of them were aware that it could be activated for patients who had less than six months to live.

The Jerusalem Post learned on Monday that Health Ministry director-general Prof. Ronni Gamzu has just allocated NIS 50,000 to purchase each of 10 specially invented timers for government hospitals where the devices would turn off ventilators at the end of a pre-set cycle. It is believed that the price will eventually drop to NIS 10,000 each. It could lead to the passive death of the patient, who might also survive the turning off of the timer.

An article on the failure to implement the law was just published in the American Journal of Clinical Oncology by oncology Prof. Ben Corn, director of the radiology institute at Tel Aviv Sourasky Medical Center and Prof. Isaiah Wexler, who specializes at Hadassah in pediatric metabolism and feeding disorders. Corn is also co-founder with his wife Dvora Corn of Tishkofet (Life’s Door), a voluntary organization established to help people with serious and terminal diseases and their families to cope illness and with the eventuality of death.

The survey also found that 88% of the 100 hospital doctors who constituted a representative sample said they did not present the law to patients due to “a lack of time.” No comment was received on the survey from the Health Ministry. As a way of fighting this ignorance among doctors, a piece of interactive software has been developed to teach doctors about the law.

The piece of legislation, which was approved by leading rabbinical arbiters and was not held back by Orthodox or haredi rabbis, expands the dying patient’s right in advance to refuse or agree to treatment if and when he becomes terminally ill. Israelis of all ages are encouraged to fill out living wills to state exactly what they want to be done to prolong or not to extend their lives. Living wills, renewable every five years, can be stored by patients on a special national database on the Internet and accessible to senior hospital physicians. “We expect that most people, especially the elderly and the chronically ill, will want to prepare a living will for any eventuality,” said Prof. Abraham Steinberg, who chaired the commission that drew up the recommendations in an interview some years ago.

The law also stipulates that every terminal patient has the right to palliative care to minimize his pain, but this is not implemented fully because of the lack of qualified experts and awareness. It is thus the first law in the world to set down the right to such humane treatment.

It does not involve active euthanasia for terminal patients, but it does make possible the use of the timer, based on the idea of the Sabbath clock used in religious Jewish homes to turn electrical devices on and off on Saturday. The timer would operate for 24 hours at a time and set off a red light or alarm after 12. The patient or their representative could at any time request an extension. But if the dying person were determined not to have their life extended, the timer would turn off the ventilator at the end of the cycle.

Corn said: “I think that this is an enlightened and advanced law that should be implemented in the health system, but in factual fact, it is not enforced at all. There is need for an educational campaign in the medical establishment to explain the advantages of discussing the end of life with the patient that in many cases enables a process for the dying to part in peace and serenity from their family and the world.”

The Post learned that Prof. Charles Sprung, the director of the critical care medicine unit in the anesthesiology and critical care medicine department at Hadassah University Medical Center and a former member of the Steinberg Commission recently volunteered to test the timer on mannequins and patients (without it actually being used to turn off the ventilator for possible passive euthanasia to ensure that it works properly.

The tests received first-stage approval from the ministry’s Supreme Helsinki Committee on Human Medical Experimentation. “We have to make sure that timer doesn’t interfere with the regular functioning of the respirator. We don’t want it to be set and automatically have it shut down,” Sprung said. “Then we need separate Helsinki approval to show the timer disconnects the ventilator.

After final approval is obtained, it could eventually be used at the request of patients or their surrogates. But Sprung said the timers, developed at Sheba Medical Center’s engineering department, have been plagued by technical problems and that he couldn’t predict when they would become available.

The device is for the dying patient who doesn’t want to be placed on a respirator or his surrogates. The timer is meant to turn off the ventilator intermittently; some dying patients may continue to live with the ventilator turned off. Sprung told the Post that he received a training grant to teach physicians to work with terminal patients.

“I am very disappointed that the law has not been implemented,” continued Sprung, who some eight years ago treated the comatose Ariel Sharon after the prime minister was felled by strokes and treated at Hadassah. Eventually, he believes the timer would be used by terminal patients with amyotrophic lateral sclerosis (Lou Gehrig’s disease) and others who don’t want to prolong their unbearable lives. “The law is a fantastic thing; most people have no idea what their dying loved ones want. The living will change this,” he said.
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