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In an age where people meticulously plan nearly every aspect of their lives — from education and career paths to insurance policies and financial planning — many still avoid addressing one of the most critical decisions: how they wish to be treated at the end of life.
Despite widespread efforts to ensure control over personal choices, including the drafting of wills, powers of attorney and detailed instructions for managing assets, only about 4% of Israelis have submitted advance medical directives or appointed a medical power of attorney under the Dying Patient Act.
By comparison, about one-third of the U.S. population has done so. Experts attribute the low figures in Israel to a lack of public awareness and limited government outreach.
The legal framework
Passed in 2005, the Dying Patient Act provides a legal framework for the medical care of terminally ill patients in Israel. It seeks to balance the sanctity of life with a person's right to autonomy and dignity, particularly regarding the quality of life in its final stages.
The law introduces tools such as advance directives and medical powers of attorney, which enable individuals to communicate their medical preferences ahead of time.
Advance medical directives take effect only when a physician formally defines a patient as terminally ill — meaning the patient has an incurable disease, a life expectancy of less than six months and is suffering significantly. In emergencies such as accidents, medical teams are obligated to attempt all lifesaving measures.
Patients may use these directives to express preferences about receiving — or forgoing — certain treatments, including resuscitation, mechanical ventilation or other life-prolonging interventions while ensuring that pain relief is administered. Euthanasia remains illegal in Israel.
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Powers of attorney: Common misconceptions
Appointing a medical power of attorney — someone entrusted to make decisions when a patient is no longer able — is another critical option. However, many mistakenly believe that signing such a form gives the appointee full authority immediately. In reality, as long as the person remains competent, their own decisions override any previously delegated authority.
There’s also confusion about the scope of a “durable power of attorney.” While this tool allows a trusted person to manage financial, personal and medical matters in the event of incapacity, it does not apply once someone is officially defined as terminally ill. Without a valid advance medical directive, even those who have appointed a durable power of attorney may find themselves without representation at a crucial time.
Some avoid completing advance directives out of concern that declining life-prolonging treatments contradicts Jewish law. However, halachic interpretations increasingly support minimizing suffering when recovery is no longer possible. While preserving life is a fundamental value in Judaism, it is not at all costs, especially when it prolongs pain and suffering.
How to complete the forms
To file an advance medical directive, individuals must fill out an official form and sign it before two witnesses who are not family members or otherwise involved. If completing the extended version of the form, which includes specific medical procedures, the patient must do so with their physician and an additional medical witness to confirm full understanding and consent.
Once submitted to the Health Ministry’s registry, an official confirmation is issued. It's advisable to keep a copy and inform loved ones of its existence. Since the directive is valid for five years, individuals should update it periodically. The ministry typically sends a reminder when it's due for renewal.
Attorney Efrat Klipper-DugmaPhoto: Liron WeissmanA basic right
Preparing for the final stage of life is a fundamental right. Being clear about how we want to be treated ensures our wishes are respected and spares loved ones from making painful decisions on our behalf. Advance directives offer peace of mind to all involved, reducing uncertainty, emotional strain and potential family conflicts.
- Attorney Efrat Klipper-Dugma is the legal advisor for LILACH – The Israeli Society to Live and Die with Dignity, an NGO promoting awareness of the Dying Patient Act and assisting the public in completing advance directives.