The policy of non-decision: the case of the dying patient law and the vegetative state patients in Israel

Abstract

The issue of dealing with the end of life, in the context of death with dignity, has gained wide public significance in recent decades. Enacted in Israel in 2005, the dying patient law does not apply to vegetative state patients, leaving them with no decision regarding their fate. This article discusses the policy of non-decision using as a case study the treatment and the option of abstaining from treatment of patients who have been classified as ‘vegetative state’ (VS). This analysis was conducted while focusing on the various explanations for adopting a policy of non-decision, and suggests that it is the gap between the national level of policymaking, where a policy of non-decision is adopted, and the local level of policymaking, where concrete decisions are required, that harms those affected both directly and indirectly by the decisions made. With the aim of informing policymakers about their choice, the article will explain how a policy of non-decision leads to local medical positions that create a street-level policy, ignoring the shared medical needs of the VS patients as a group. The ramifications of this choice lead to a failure to exhaust all treatment options, or alternately, the impossibility of avoiding treatment of these patients.