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Editorial comment on Y M Barilan’s ‘Is the clock ticking for the terminally ill patients in Israel?’
  1. G T Laurie

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    The act/omission distinction is used throughout Western legal systems, and indeed elsewhere, to police the boundaries between acceptable medical practice and unacceptable interventions designed to bring about the death of patients. Without exception, it has proved impossible to maintain the distinction with any clarity. In the United Kingdom, for example, it is lawful both to withhold and to withdraw from a patient treatment that the medical profession deems to be futile, even if this results in the patient’s death. Only the former, however, is incontrovertibly an omission, although the House of Lords in Anthony Bland’s case treated both as omissions for legal purposes. By corollary, only death inducing interventions which have nothing whatsoever to do with a patient’s care are treated as prima facie unlawful. The law in the UK and elsewhere embodies the ethical doctrine of double effect whereby the primary intention of caring for the patient can relieve a medical professional of liability even if, as an unlooked for consequence, the patient ultimately dies as a result—for example, the palliative administration of morphine in increasing doses which eventually suppresses the patient’s respiratory system. In countries which have legalised euthanasia—often as a form of assisted suicide—rigorous procedures must be followed. Frequently these include the requirement that the patient be critically or terminally ill; that she or he be competent and make repeated requests to die; that there be suitable medical involvement in the process, and that there is a “cooling off” period between the final request to die and the act itself. Notable jurisdictions are the Netherlands, Belgium, Switzerland, and the American state of Oregon. The Israeli example, however, seems to be unique. While it purports to adhere to the act/omission distinction, it blurs that distinction beyond all recognition; demonstrating, perhaps, the fallacy of believing that clear lines can be drawn or maintained in the euthanasia debate from either an ethical or legal perspective. This is a fact that has been appreciated almost since time immemorial.1