Israeli Bioethics Panel: Terminal Patients Do Have Right to Reject Treatment

Statement comes in response to euthanasia tragedy over weekend; some professionals blame failure to implement Health Ministry directive mandating palliative care units be established in all Israeli hospitals.

Dan Even
Dan Even
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Dan Even
Dan Even

The state must provide palliative care to terminally ill patients, a governmental advisory panel on bioethics said on Monday.

The National Bioethics Council issued its statement in response to the tragic incident over the weekend in which Dr. Mordechai Shtalrid, head of the hematology department at Kaplan Hospital in Rehovot, committed suicide after euthanizing his daughter Keren, who had an incurable form of cancer.

The council, an independent advisory committee funded by the health and science ministries, issued a statement urging terminally ill patients to seek palliative care, and reiterating their right to reject treatments that could prolong their life and suffering.

"The medical system must honor [the patient's] request," it said. "Refraining from life-extending treatment significantly shortens the period in which there is a possibility of the terminal patient suffering."

As for palliative care, it continued, Israeli experts in the field "know how to prevent most pain in a very effective manner and ease the psychological suffering and emotional distress of the patient and their family," and it is the state's obligation to ensure that such treatment is made available.

Some medical professionals blame the Shtalrid tragedy on delays in implementing a Health Ministry directive from July 2009 that mandated the establishment of palliative care units in every hospital in the country within four years, meaning by July 2013. In fact, most hospitals still don't have palliative care units.

The directive also required all hospitals to open hospice units for terminally ill patients. But in reality, only four hospitals have such units, containing 87 beds in all - exactly the same number as in 2009. In part, this is because the ministry has yet to provide funding for this purpose.

Shtalrid's actions also prompted a debate about euthanasia. But when people talk about euthanasia, "they forget all the solutions along the way," said Prof. Ephrat Levy-Lahad, who co-chairs the bioethics council along with Prof. Avraham Steinberg. "We're reminding people that these are terrible situations, but it's possible to take certain actions, like refraining from pointless treatments and obtaining palliative care to ease the pain. It's the state's obligation to provide these services."

At the same time, the council reiterated that euthanasia is absolutely illegal. "We're aware that there are countries that permit euthanasia, but very few," said Levy-Lahad. "Our position [against euthanasia] is shared by most of the countries of the world."

The council has no plans to discuss the issue now, she added, as a thorough discussion by a panel of experts preceded the original decision to ban euthanasia.

Dr. Itay Gur-Aryeh, director of the palliative care unit at Sheba Medical Center in Tel Hashomer, noted that the law permits administering painkillers to terminally ill patients "even in high doses that endanger their lives, as long as the goal is to ease their pain. The law indeed forbids euthanasia, but it's a very advanced and liberal law that provides an answer for terminal patients."

The Health Ministry said it will ensure that all hospitals comply with the directive by the July 2013 deadline.

Patients at Haifa’s Rambam Hospital.Credit: Hagai Fried

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