Treating patients at the end of their lives raises serious ethical dilemmas related to the tension between the ability of advanced technologies to prolong life and the suffering and pain that this may entail. Countries vary in how they balance the patient's autonomy and wish to control the treatment received at the end of life with other values, such as the sanctity of life and quality of life. This subject is a matter of great interest for professionals and policymakers throughout the world.
The Dying Patient Act was passed in Israel in 2005. The law prohibits active euthanasia but allows patients to give directives not to provide treatment at the end of their lives. The law also requires the health system to offer palliative care to dying patients. However, multiple difficulties have been encountered in implementation of the law.
The current study examined the perceptions of key informants about the contributions of the law, the barriers to implementing the law and possible ways to overcome them. In addition, the study proposes ways to enable individuals to exercise their basic right to decide what should be done with their bodies as they approach the end of life. The study was based on some 40 in-depth interviews with managers and professionals from the Ministry of Health, the health plans, hospitals and institutions for the elderly, and on the analysis of written procedures, observation of a workshop for professionals, and the convening of two focus groups, one of 10 nurses and one of 10 social workers.
The study provides a broad basis for discussion of how best to enhance the implementation of the law and can contribute to other countries that are also grappling with barriers to the implementation of similar legislation.
The study was funded with the assistance of a grant from the Israel National Institute for Health Policy Research.