Withdrawal of life-prolonging treatment in the face of severely limited resources: Ethical and legal analysis of the law in Israel

Abstract

The provision of lifesaving treatment subject to severely limited resources can lead to serious moral dilemmas and legal challenges on many levels. The issue becomes particularly acute in a crisis such as the current Covid-19 pandemic. In this context, legal questions arise regarding withdrawal of treatment, particularly withdrawal of ventilation. Israeli law prohibits withdrawal of ventilation, a situation that affects the prioritization criteria for patients who can benefit from ventilation. This issue is discussed in the context of the Covid-19 pandemic where the legal prohibition may lead to a situation in which patients will not have access to ventilators. In addition, a theoretical framework is proposed that includes not only beneficence, nonmaleficence, and distributive justice but also a relational approach to autonomy and justice. We also propose potential solutions under the current legal framework. Based on the legal analysis, it is proposed that Israeli law be amended so that more patients will have access to ventilation during a pandemic. It is argued that clinicians cannot act beneficently to prolong life if they ignore patients’ fundamental rights or the distributional effects of ethical policies. Autonomy and justice and their accompanying liberal and relational perspectives should remain relevant even during a pandemic, a time when resources are scarce.