Death with dignity to be allowed from next month

Health Ministry will accept living wills but active euthanasia forbidden.

By
November 12, 2006 21:55
3 minute read.
Death with dignity to be allowed from next month

hospital bed 88. (photo credit: )

 
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On December 15 - after eight years of preparation and a year after it was approved by the Knesset - the law relating to dying patients will take effect, enabling people of all ages to submit forms to the Health Ministry declaring how they would like to be treated if they became terminally ill. The provisions of the law were approved by leading clergymen representing all major religions before it was approved. The application forms will be available on the Health Ministry's Web site (www.health.gov.il) in Hebrew only; other languages will be gradually added. The forms must be filled out by hand and submitted to the ministry's data center, whose staff will enter them into an electronic database not yet established that will be accessible by all hospitals and health funds. The law, initiated by the government on the basis of the recommendations of the Steinberg Committee - which met for six years on the sensitive subject - was passed on December 1, 2005. The recommendations were prepared by the 59-member public committee comprising physicians, scientists, medical ethicists, social workers, philosophers, nurses, lawyers, judges and clergymen representing the main religions in Israel. It was headed by Prof. Avraham Steinberg, an Orthodox rabbi, pediatric neurologist and medical ethicist. The legislation was described by then-health minister Dan Naveh as "on the human level, one of the most complicated and most important ever legislated by the Knesset. It is a great moral achievement for the dying and their families." Active euthanasia will continue to be forbidden. However, individuals will be able to set down in advance that they do not want to be attached to a respirator when they are dying or that, if a respirator is attached, it would include a delayed-response timer that can turn itself off automatically at a pre-set time. The timer would operate for 24 hours at a time and set 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 to have his life extended, the timer would turn off the respirator at the end of the cycle. Individuals could restate their end-of-life decisions every five years. Dr. Mordechai Halperin, the ministry's chief medical ethics officer who was charged with preparing for the law's implementation, told The Jerusalem Post that a ministry steering committee has been meeting for 10 months. "We are ready and have started the running-in phase, but some of the elements still have to be done. We will start the system even if some of the less-urgent elements have not been completed." Some NIS 300,000 and two positions - for a computer expert and an administrative worker to run the database - have already been approved, but NIS 2 million more is in the process of being allocated to train the country's doctors and to set up the computer network, he said. Halperin said he thought only a few terminally-ill patients would ask for a timer that could turn off their respirator, and the number of cases in which such a device would be used would probably be small. But, he said, it must be an option. A computerized teaching program for government-employed physicians and others interested in studying the requirements and options under the law is being prepared, said Halperin, adding that physicians in health fund facilities, voluntary hospitals and private institutions will not be obligated to use the teaching program. Doctors who complete the short course will be tested and receive certificates if they pass. There are already candidates for a national ethics committee to rule on special cases in place of a court, and individual hospitals will have to appoint their own committees as well. Some regulations related to the law still have to be approved by the Knesset Labor, Social Affairs and Health Committee. Halperin said it was vital that the public learn about the provisions, which will ensure transparency instead of the current situation, in which physicians can make these decisions for patients. At present, even if the family is consulted, doctors leave themselves open to lawsuits for carrying out their wishes, and this problem will be eliminated by the new law. Until now, desperate patients and their families sometimes had to appeal to the courts cases to allow the physician to cease life-maintaining treatment.

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