A response delayed by a timer attached to a patient's ventilator will solve the Israeli government's wish to introduce passive euthanasia for terminally ill people and to allow them to die with dignity.
A government bill setting down the process of passive euthanasia and safeguards to prevent abuse has been passed for its final reading by the labour, social affairs, and health committee of the country's Knesset (parliament). The full parliament is expected to approve the bill soon.
The bill was six years in the making and is the culmination of two years of work by a public committee of 58 members, including doctors, nurses, scientists, medical ethicists, social workers, philosophers, lawyers, judges, and representatives of the main religions in Israel.
If a terminally ill patient older than 17 has requested in a living will that his life should not be extended by artificial means, a doctor will be allowed by law to carry out the patient's wish. An adult who has power of attorney may also make such a request on someone else's behalf. Being terminally ill is defined as having less than six months to live.
Active euthanasia and the withholding of nutrition will not be permitted under the new law because they violate Jewish law. But the legislation, expected to come into effect within a year, will allow the halting of ongoing support using a timer device. The family of a terminally ill patient will no longer have to go to court for permission to stop artificial life support if the patient has previously made it clear that that is his or her wish.
The timer, based on the idea of the Sabbath clock, used in religious Jewish homes to turn electrical devices on and off on Saturday, 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.
Living wills, renewable every five years, will be stored by patients on a special national database on the internet and will be accessible at all hospitals. “We expect that most people, especially the elderly and the chronically ill, will want to prepare a living will for any eventuality,” said Abraham Steinberg, who chaired the committee that drew up the recommendations.
Professor Steinberg, a paediatric neurologist, medical ethicist, and orthodox rabbi, said that although the law was entirely different in concept from that of the Netherlands' liberal law that permits active euthanasia, great interest in the timer idea has been expressed around the world. “Even those who favour active euthanasia admit that medical personnel don't like the idea of turning off a respirator themselves,” he explained.
Hospital ethics committees will become statutory committees, not voluntary ones without legal status, said Professor Steinberg, and palliative care to reduce pain will be an integral part of the process. A national ethics committee could hear appeals in special cases so that lower courts would not have to intervene at all. “I am very satisfied with the bill. It is very balanced and will offer answers in all situations,” he concluded.