Abstract
National legislation, as well as arguments of experts, in Germany and Israel represent opposite regulatory approaches and positions in bioethical debates concerning end-of-life care. This study analyzes how these positions are mirrored in the attitudes of laypeople and influenced by the religious views and personal experiences of those affected. We qualitatively analyzed eight focus groups in Germany and Israel in which laypeople (religious, secular, affected, and non-affected) were asked to discuss similar scenarios involving the withholding or withdrawing of treatment, physician-assisted suicide, and euthanasia. In both countries, respect for patient autonomy and patients’ wishes to die with dignity found broad consent. Laypeople argued in favor of accepting such wishes when they were put down in an advance directive. Laypeople in non-religious groups in both countries argued on the basis of a respect for autonomy for the possibility of euthanasia in severe cases but, at the same time, cautioned against its possible misuse. National contrast was apparent in the moral reasoning of lay respondents concerning the distinction between withholding and withdrawing treatment. The modern religious laypeople in Israel, especially, argued strongly, on the basis of the halakhic tradition, against allowing the withdrawal of treatment in accord with a patient’s wish. We conclude by discussing the emergent notion of shared responsibility and views of professional responsibility, which we connect through relevant cultural themes such as religion and national culture.
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Notes
We differentiate between withholding of treatment (not administering it when indicated) and withdrawing treatment (stopping already started treatment; e.g. stopping artificial ventilation), which are summarized under the German term “passive Sterbehilfe” (passive euthanasia) as two ways of letting a patient die. Furthermore, we discuss physician-assisted suicide and euthanasia as two acts that aim at deliberately ending a person’s life. In the first case the act is done by the patient himself (e.g. applying a deadly dose of treatment); in the second case the application is administered by a physician.
We did not ask terminally ill patients themselves to participate since discussing end-of-life decisions might have been too tiring, stressful and disturbing for them.
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Acknowledgments
The authors would like to thank all the respondents who participated in this study. The study was made possible thanks to the support of the German-Israeli Foundation, GIF Grant No. 1023-317.4/2008, ‘Cross-Cultural Ethics of Health and Responsibility: Expert and lay perspectives regarding bioethical dilemmas in Germany and Israel’. The authors thank Greg Sax for the language revision.
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Inthorn, J., Schicktanz, S., Rimon-Zarfaty, N. et al. “What the patient wants…”: Lay attitudes towards end-of-life decisions in Germany and Israel. Med Health Care and Philos 18, 329–340 (2015). https://doi.org/10.1007/s11019-014-9606-5
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DOI: https://doi.org/10.1007/s11019-014-9606-5