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Israel: Tel Aviv District Court Authorizes Avoidance of Treatment for ALS Patient

(Dec. 16, 2014) On November 23, 2014, the Tel Aviv district court issued a declaratory judgment authorizing the gradual decrease of the ventilation rate of an amyotrophic lateral sclerosis (ALS) patient to a minimum. The court required that the procedure be undertaken only upon the treating physician’s verification beyond any reasonable doubt that the patient wishes to go through with it. The ventilation rate decrease, according to the court, must be performed while providing the patient palliative sedation and while avoiding any monitoring of the patient’s blood oxygen saturation and level of gas and electrolytes in his blood. The judgment requires documentation of the procedure in accordance with medical guidelines. (Request 16813-11-14 Anonymous v. the Attorney General (decision rendered by Judge Rahamim Cohen) (Nov. 23, 2014), NEVO LEGAL DATABASE (by subscription) (in Hebrew).)

The case involved a terminally ill ALS patient who for several years had been completely incapacitated except for being able to communicate through eye movement. He requested to be disconnected from the ventilator and to be able “to end his life with dignity.” He argued that there had been a deterioration of his condition, that he had been subjected to an increased level of pain, and that there was a possibility that he would lose even the ability to move his eyes. (Id.)

Both parties agreed that the case was not subject to the application of the Dying Patient Law 5760-2005 (SEFER HAHUKIM [BOOK OF LAWS, Israel’s Official Gazette] No. 2039 p. 58). Under this Law, the perpetration of an action, even by provision of medical care, that is either designed to, or the result of which is likely to, cause death, and the providing of assistance to a dying person, even upon that person’s request, are prohibited. The Law permits, however, refraining from renewing a new cycle of treatment. (Id. § 21.) The Law defines a dying person as one whose life expectancy, even with medical care, has been determined by an authorized physician as not exceeding six months. (Id. §§ 3 & 8(a).)

Even though in the current case it could not be ascertained that the patient’s life expectancy as long as he was connected to the ventilator was six months or less, the Attorney General did not object to applying the principle recognized by the Law for dying patients, which would permit avoidance of treatment rather than a deliberate act resulting in the patient’s death. (Hen Maanit, Publication Release: An Israeli Court Authorized Mercy Killing, GLOBES (Dec. 9, 2014) (in Hebrew).)