Researchers: Nurit Guttman¹, Shai Lavi¹

Background: According to the Israeli Law (The Dying Patient Act) people have the right to decide on their medical treatment in end-of-life situations and to prepare advance directives [AD] for situations in which they cannot express their wishes. Yet, most of the public has not done so.

Objectives: To identify what might inhibit or encourage people to discuss or prepare AD, from the experience of professionals and members of the public who have prepared AD and views of members of the general public regarding suitable timing, communication channels and personnel providing consultation.

Method: Interviews (n=91) with professionals involved in AD and people who had prepared AD; online survey (n=1,412); national phone survey (n=550).

Findings: A large majority did not know about the right for AD, but after an explanation viewed them as important. A considerable number (even among religious participants) expressed willingness to do various AD-related activities. Differences were found according to gender, religiosity, education and age. Preferred professionals as a source and guidance for preparing AD were medical personnel, including family doctors, and also religious leaders among religious and Arab respondents. Appropriate timing was viewed mainly a serious illness and preparing a will, but also happy occasions were accepted. Arguments to encourage talking about/preparing AD assessed highly were respecting people's will about their body, the ability for people to know their relative's preference, and avoiding family conflicts.

Conclusions: Most respondents did not know about AD. Despite the difficulty of the issue people want to get AD information and guidance. Emphasis should be on talking about the issue with close family members and professionals.

Recommendations: Need to develop an infrastructure to disseminate information about AD palliative care; develop training programs for personnel, including family doctors; utilize events and life-stages unrelated to health to create a discussion; involve religious leaders and lawyers; develop content for different groups; distinguish between AD and euthanasia; update the Ministry of Health's form and its submission process; enable documentation of treatment preferences personal medical file.
Prof. Nurit Guttman and Prof. Shai Lavi, Tel Aviv University
Advance directives, palliative care, end of life situations, public opinion

Research end date: 12/2019