Abstract

This article examines the current state of end-of-life care in internal medicine wards in Israel, through an analysis of medical practice and the existing legal framework. The authors demonstrate the processes that lead chronically ill, elderly patients to perceive death as an unexpected phenomenon that is to be avoided at all costs. This perception stems, among other things, from the lack of public debate on questions relating to the end of life and the dominant cultural expectation that physicians provide curative interventions. This results in a dearth of palliative care for the elderly along with a growing number of medical interventions that are of questionable value. The authors propose an alternative approach that highlights individual well-being and that demonstrates the potential areas of intervention by which death can be transformed into an expected and acceptable occurrence for the old and infirm. This approach allows patients to avoid unnecessary interventions and to reduce the burden of responsibility on family members and physicians, who are currently being called on to make end-of-life choices under exigent circumstances. We present these dilemmas by focusing on typical cases of incompetent elderly patients when there is no clear documentation of their wishes regarding treatment, and when their families do not have a coherent perception of what they may have wanted or of the care that would be most appropriate for them. We conclude with a call to action that highlights the need for greater awareness—through public discourse and private discussions—of end-of-life medical choices before the onset of ill-health and incompetence.