פרופ' שטיינברג - גרסה מקוצרת

Summary

In this comprehensive lecture, Professor Abraham Steinberg, a pediatric neurologist and expert in medical ethics, discusses the complexities surrounding end-of-life care for terminally ill patients in Israel. He outlines the development of the 'Terminally Ill Patient' law, which followed a significant legal case involving a man with ALS, and explores the various ethical, medical, and legal challenges of end-of-life decisions. Steinberg emphasizes the balance between preserving life, patient autonomy, and quality of life, while highlighting the importance of legal frameworks in guiding these delicate decisions. The lecture provides an in-depth look at the multidisciplinary approach to addressing terminal illness and patient rights.

Takeaways

• 😀 Professor Abraham Steinberg, a pediatric neurologist and medical ethics expert, discusses the complex issue of terminally ill patients.
• 😀 In 1992, a proposed law on patient rights attempted to address end-of-life care, but was rejected due to strong opposition in the Knesset.
• 😀 The case of a patient named Itai Arad, who requested to be removed from a ventilator in 1998, led to the establishment of a committee to address the legal aspects of end-of-life care.
• 😀 The legal and ethical dilemma surrounding terminally ill patients is not strictly medical, but involves philosophical, legal, societal, and religious considerations.
• 😀 The law defines a 'terminally ill' patient as one whose life expectancy is six months or less, excluding cases like dementia or vegetative states.
• 😀 The committee that eventually drafted the law consisted of 59 members, divided into four subcommittees: medical, legal, philosophical/ethical, and religious.
• 😀 The law distinguishes between terminal patients who have six months to live and those who are in the final stages of life with only two weeks remaining.
• 😀 The committee's work was influenced by both the need to respect the sanctity of life and the importance of quality of life for terminally ill patients.
• 😀 The law recognizes that some patients may wish to end their suffering by choosing to hasten their death, while others may want to live at all costs.
• 😀 The ethical dilemma balances the autonomy of the patient to make decisions about their life with the paternalistic role of doctors and society in protecting life.
• 😀 The final law, approved in 2005, reflects a compromise between respecting life and acknowledging patient autonomy, and it went into effect in December 2006.

Q & A

What is the primary focus of Professor Abraham Steinberg's work?

Professor Abraham Steinberg is a pediatric neurologist who is heavily involved in medical ethics, particularly focusing on both general and Jewish halachic aspects of medical issues.

What led to the establishment of the committee that Professor Steinberg headed?

The committee was established by the Minister of Health to propose legislation regarding the care of terminally ill patients, following a series of legal and ethical challenges surrounding this issue.

What was the controversy surrounding Section 10 of the Patients' Rights Law introduced in 1992?

Section 10, which aimed to address the issue of terminally ill patients in a single legal provision, was not accepted by the Knesset due to widespread opposition. This led to the omission of any legal reference to terminally ill patients in the final law.

What was the significance of the case of pilot Itai Arad in relation to the law?

The case of Itai Arad, a patient with ALS who sought to have his life support disconnected, prompted public discussion and legal action, ultimately leading to the establishment of the committee that drafted the law for the terminally ill.

What was the primary ethical dilemma surrounding terminally ill patients?

The main ethical dilemma was not strictly medical but concerned broader issues including autonomy, the sanctity of life, and societal views on end-of-life care, as well as the roles of medical professionals in making life-ending decisions.

How does the law define a terminally ill patient?

The law defines a terminally ill patient as someone with a prognosis of six months or less to live, even if treatment is provided, excluding patients in earlier stages of illness or those with conditions like dementia or persistent vegetative states.

What is the difference between a 'terminally ill patient' and a 'patient at the end stage of life' according to the law?

A terminally ill patient is someone expected to live no more than six months, while a patient at the end stage of life is someone expected to live no more than two weeks, which has implications for the types of medical interventions required.

What role did the committee play in shaping the law on terminally ill patients?

The committee, consisting of a wide range of professionals, was responsible for discussing and drafting a comprehensive law that balanced medical, legal, ethical, and societal perspectives on how to handle patients who are nearing the end of life.

How did the committee address the values of life and autonomy in relation to terminally ill patients?

The committee found a middle ground, acknowledging the sanctity of life as an important value but also respecting patient autonomy, recognizing that there may be cases where extending life artificially is neither desirable nor humane.

What was the broader societal context that influenced the discussions on the terminally ill patient law?

The broader societal context included diverse religious, ethical, and philosophical views on life and death, as well as practical considerations about how society should care for those in the final stages of life, including patients unable to express their wishes.