Unprecedented: Israeli Court Okays Euthanasia for Patient Who Didn't Meet Criteria

After AG Weinstein weighed in, permission granted to diminish functioning of ALS patient's life-support systems, unprecedented since legislation of 2005 Dying Patient Act.

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A bed in an Israeli hospital.
A bed in an Israeli hospital. Credit: Reuven Castro

A gag order was lifted Tuesday on a recent, unprecedented decision by an Israeli court which allowed a patient suffering from a terminal disease to end his own life, though he did not meet the criteria of "dying patient" set into legislation in 2005.

Two weeks ago, the Tel Aviv District Court approved administering euthanasia to a patient suffering from amyotrophic lateral sclerosis, a neurodegenerative disorder also referred to as ALS and Lou Gehrig's disease. Last week the functioning of the life-support systems was diminished in the wake of the ruling, which was handed down after the attorney general expressed an exceptional and precedent-setting opinion authorizing the act.

The patient had suffered from ALS for over nine yeaA gag order was lifted Tuesday on a recent, unprecedented decision by an Israeli court which allowed termination of the life of a patient suffering from a terminal disease.

Two weeks ago, the Tel Aviv District Court approved administering euthanasia to a patient suffering from amyotrophic lateral sclerosis, a neurodegenerative disorder also referred to as ALS and Lou Gehrig’s disease. Last week the functioning of the life-support systems was diminished in the wake of the ruling, which was handed down after the attorney general expressed an exceptional and precedent-setting opinion authorizing the act.

The patient had suffered from ALS for over nine years. During the past seven years he had been totally paralyzed, except for being able to move his eyes. He was bedridden, unable to speak, and was fed and ventilated artificially. Recently his condition deteriorated and there was a concern that he would also lose his ability to communicate via eye movements.

Attorney General Yehuda Weinstein.Credit: Olivier Fitoussi

Attorneys Giora Erdinast and Avi Stav, from the firm of Erdinast, Ben Nathan & Co., who represented the patient pro bono, appealed to the court with the exceptional request.

In the petition to the court, the patient, whose name is still under gag order, wrote: “Despite my many disabilities, for quite a long time after being connected to the respirator, I was in a condition that enabled me to experience a reasonable quality of life. But for about two years now, in parallel to a significant deterioration in my condition which includes more pain, loss of sphincter control, a deterioration in the condition of my eyes and so on – I have decided to end my life.”

Attorney General Yehuda Weinstein held a special discussion on the issue and decided in an unprecedented move to support the request, although the person did not meet the definition of a “dying patient” as determined in legislation passed in 2005, since his life expectancy was thought to exceed the cap of six months stipulated there – as long as he was connected to life support.

The Dying Patient Act, which tries to create a balance between the sanctity of life and a person’s autonomy over his own life, creates a distinction between active and passive intervention in bringing about a person’s death. Passive intervention includes refraining from accepting medical treatment or in some way allowing a disease to overpower a patient and kill him. The law determines that an active intervention is forbidden whereas refraining from administering treatment is permitted under certain conditions.

In the case at hand, Weinstein declared that, “Even if it isn’t clear whether said petitioner is liable to lose movement in his eyeballs, his fear of such a possibility, even though it may be rare, is not groundless.” The attorney general referred to the fact that the patient’s request to be disconnected from the various life-prolonging devices was made when he was of sound mind and body, and aware of the significance of his request.

Accordingly, he ruled that in the unique circumstances of the case there was no legal hindrance to having the patient continue to be connected to the devices while a gradual reduction in the rate of ventilation and in the concentration of oxygen would be introduced. That meant that in effect, the patient would not be disconnected per se from life support, but nor would he be forced to receive unwanted medical treatment.

Tel Aviv Judge Rahamim Cohen authorized the agreements between the parties and approved the euthanasia.

Weinstein ruled that there was no legal hindrance to having the patient continue to be connected to the devices while a gradual reduction in the rate of ventilation and in the concentration of oxygen would be introduced. That meant the patient would not be disconnected from life support, but nor would he be forced to receive unwanted treatment.rs. During the past seven years he had been totally paralyzed, except for being able to move his eyes. He was bedridden, unable to speak, and was fed and ventilated artificially. Recently his condition deteriorated and there was a concern that he would also lose his ability to communicate via eye movements.

Attorneys Giora Erdinast and Avi Stav, from the firm of Erdinast, Ben Nathan & Co., who represented the patient pro bono, appealed to the court with the exceptional request.

In the petition to the court, the patient, whose name is still under gag order, wrote: “Despite my many disabilities, for quite a long time after being connected to the respirator, I was in a condition that enabled me to experience a reasonable quality of life. But for about two years now, in parallel to a significant deterioration in my condition which includes more pain, loss of sphincter control, a deterioration in the condition of my eyes and so on – I have decided to end my life.”

Attorney General Yehuda Weinstein held a special discussion on the issue and decided in an unprecedented move to support the request, although the person did not meet the definition of a “dying patient” as determined in legislation passed in 2005, since his life expectancy was thought to exceed the cap of six months stipulated there – as long as he was connected to life support.

The Dying Patient Act, which tries to create a balance between the sanctity of life and a person’s autonomy over his own life, creates a distinction between active and passive intervention in bringing about a person’s death. Passive intervention includes refraining from accepting medical treatment or in some way allowing a disease to overpower a patient and kill him. The law determines that an active intervention is forbidden whereas refraining from administering treatment is permitted under certain conditions.

In the case at hand, Weinstein declared that, “Even if it isn’t clear whether said petitioner is liable to lose movement in his eyeballs, his fear of such a possibility, even though it may be rare, is not groundless.” The attorney general referred to the fact that the patient’s request to be disconnected from the various life-prolonging devices was made when he was of sound mind and body, and aware of the significance of his request.

Accordingly, he ruled that in the unique circumstances of the case there was no legal hindrance to having the patient continue to be connected to the devices while a gradual reduction in the rate of ventilation and in the concentration of oxygen would be introduced. That meant that in effect, the patient would not be disconnected per se from life support, but nor would he be forced to receive unwanted medical treatment.

Tel Aviv Judge Rahamim Cohen authorized the agreements between the parties and approved the euthanasia.

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