On December 15, a technology-driven advance directive for dying patients will come into effect in Israel. People will be able to record their wishes on how to be treated if they are terminally ill on a computerised national register accessible by all health funds and hospitals. They will be able to specify that they do not want to placed on a respirator.

The novel feature of this system, which was approved by the Knesset last year, is a delayed-response timer which can turn the respirator off automatically at a pre-determined 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 were to insist, the timer would turn off the respirator at the end of the cycle.

This unique system was created by the 59-member Steinberg Committee, which had studied the issue for six years. 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.”

The ethicist in charge of implementing the law, Dr Mordechai Halperin, says that only a few terminally-ill patients will ask for the timer, but that it had to be an option. He says that the new system will protect doctors who leave themselves open to lawsuits by relatives by following the final instructions of a patient.

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Michael Cook

Michael Cook edits BioEdge, a bioethics newsletter, and MercatorNet, an on-line magazine whose focus is human dignity. He writes from Sydney, Australia.

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