How to join
Joining the therapeutic process in Hospice is done via the medical centers (at this moment, the Hospice of the Upper Galilee is connected with Clalit and Maccabi). The process commences in the patient’s clinic; when the family doctor is convinced there is a need for palliative care, they recommend that to the HMO. The clinic would then make an additional examination and would then refer the patient to the Hospice. Once the Hospice of the Upper Galilee receives the referral, they get into action.
Palliative Care
The care is done at the patient’s home. First visit will be a doctor and a nurse; this visit takes approximately two hours, during which all the information is gathered about the condition, the family and its way of coping with the changes. Then, a plan is provided, as well as a letter to the family doctor. In the second visit, a social worker will arrive as well. Based on the patient’s condition and the stage of the illness, other therapeutic aspects will be included, such as: psychology, art therapy, music therapy and more. (The Hospice team will continue to arrive weekly, but we are always available by phone 24/7). In cases of emergencies we would arrive at night or on weekends.
During the years, the Hospice has been recognized and awarded for its activity, such awards included: Yakir HaGalil award in 2012; Israel Cancer Association for excellence in special care for cancer patients; Macmillan Prize in England for teamwork in Palliative care; Knesset Chairman award for the Hospice founder, Dr. Nancy Caroline (RIP) who, after her passing, was awarded the Doctor Medal of Honor, by the Israel Association of Medicine and Law; same award was also given to the current Chief Medical Officer of the Hospice in 2015; this year, the Hospice was honored by the Ometz Association for contribution to the community.
The Dying Patient Law
In December 2005, was enacted the “Dying Patient Law” in the Knesset (Israeli Parliament). This law is about the right of those suffering from incurable illnesses to avoid medical treatment to prolong life; it is mandatory by the health system to accept the patient’s decision. The Dying Patient Law’s goal is to “This Law regulates the medical treatment of the terminally ill patient based on an appropriate balance between the value of the sanctity of life, the value of the individual’s autonomous will, and the importance of quality of life” (Section 1.a. In the law). The law includes the right to request medical treatment, avoid medical treatment and discontinue treatment if such has already begun. The Patient’s Rights Law determines that medical treatment should not be given unless the patient has given their consent.
The consent can be given only after the medical professional has given the patient all the information required to make a decision. With that, this law doesn’t include specific instruction regarding the validity of a refusal to a treatment, that might lead to a patient’s death, in cases where the patient cannot clearly express their opinion.
The Dying Patient Law expands on the right to refuse or accept a treatment, by allowing the patient express their preferences to treatment in advance, if and when it is determined that patient is dying. The doctors will rely on the instructions previously provided only if the patient can no longer decide, or express, their wishes. In other words, the law allows someone to provide instructions even when healthy; those would be used by the medical team in case the patient is unable to decide, or express, their own decisions regarding treatment.
By law, the dying patient has a right to refuse, or request medical treatment to prolong his life, even if the doctor doesn’t see justification either way; the doctor is still under obligation to accept the dying patient’s wishes, within legal restrictions, and after the patient’s wishes have been proven beyond reasonable doubt. However, the law doesn’t permit all actions and treatment avoidance, rather it has reservations. The law states that deciding on such matters would only be acceptable by the patient’s wishes, and not by their families or other considerations. The desire of the patient can be proven in different ways, with the best one being written instructions left by the patient. Another way acceptable by the law, is Power of Attorney; in these cases, the doctors must accept the POA instructions as if they were the patient’s own.
You can read about the Dying Patient Law here.
What is Power of Attorney?
Medical Power of Attorney is a person’s best way to ensure their wishes regarding their treatment is heard even if they cannot express them themselves. According the Dying Patient Law, every patient can assign a person that will be allowed to make all medical decisions for that patient. The agent (the one authorized to act on another’s behalf), acts as a sort of messenger, and is obligated to be loyal and truthful to the patient. The patient alone can decide who will receive Power of Attorney. The authorizing party must detail the circumstances and conditions in which the agent would be allowed to decide on treatment, examination, nursing or rehabilitation. It’s possible to authorize several people to be POA.
Signing such an agreement must be done in front of professionals who are able to identify both sides, such as: doctor, psychologist, social worker, nurse, lawyer etc. It’s recommended to have at least 5-6 original copies (an original must be used in every medical procedure); the patient can determine an end date to the POA agreement. Regardless, the agreement is not permanent and, unless used, will be invalid within 10 years, unless stated otherwise.
Click here to download a Medical Power of Attorney form.
Other links:
Israel Cancer Association
National Insurance Institute of Israel