Introduction

Is there a distinction between withholding and withdrawing medical treatment at the end of life? In the past two decades, courts and bioethicists in most Western countries have rejected this distinction.1 However, some doctors, patients, and families still find the distinction to have important ethical implications. A proposed Israeli law offers a unique approach that attempts to respect the cultural reluctance to withdraw treatment while finding a practical solution that respects the wishes of patients and families and allows patients to end their lives with dignity. The Israeli case offers important insights for other countries that want to combine their cultural identity and heritage with democratic and liberal values as well as for doctors in Western countries caring for patients and families that espouse different communal cultural traditions.

Objections to withdrawing treatment

The standard Western response to the reluctance of doctors and families to withdraw care is to dismiss it as an emotional reaction. The solution offered is to employ rational reasoning and not be misled by the apparent distinction.2 This approach is difficult for individuals or cultures who take the distinction seriously. Israel is a case in point. Although in many ways Israel is part of the Western medical world, it “Deviates considerably from Western norms in certain fundamental respects.”3 Israel defines itself as a “Jewish and democratic state” and attempts to integrate a liberal democracy with a Jewish communitarian approach.

Israel does not share the strong Western, especially Anglo-American, consensus regarding the over-riding ethical priority accorded to individual autonomy. Traditional values that Judaism shares with other religions are also at play. These place an enormous emphasis on the value of human life up …