A patient with a progressive neuromuscular disease underwent what amounted to euthanasia at Sheba Medical Center after a court unusually approved his request in July.
“In view of what is stated in the petition, and noting that this is an incurable disease today, at an advanced stage causing Michael extreme and untreatable suffering, and given the explicit wish Michael expressed while of sound mind, I found that there is no legal obstacle to honoring his request,” Disctict Court Judge Amir Lukashinsky Gal wrote in his ruling. The patient’s organs were donated after his death last week.
The patient, 44-year-old Michael Podolsky, was diagnosed in 2019 with ALS, amyotrophic lateral sclerosis, a terminal progressive neuromuscular disease. His condition has since markedly deteriorated. The ruling said that “for about three years Michael has been intubated and on mechanical ventilation because of respiratory muscle failure. In addition, because of a severe swallowing disorder he is fed via a percutaneous endoscopic gastrostomy tube.”
The judgment noted that Podolsky was completely paralyzed and bedridden at home in a fully dependent state and unable to carry out basic tasks independently.
“In recent years Michael has lost the ability to speak and now communicates only with his eyes, and with their use and the aid of a computer he also types. The concern is that in the near future even this ability may be lost, and Michael will be trapped in his body — lucid but without any means of communication, including the ability to express his wishes, his pain and his most basic needs,” it said.
In early July, Podolsky, through attorney Amit Gurevich, filed an urgent petition for a declaratory order allowing his treating physician to gradually reduce the ventilator rate and the oxygen concentration supplied by the ventilator so that he could end his life. The request was approved in mid-July and carried out last week at Sheba Medical Center at Tel HaShomer.
Israel has an explicit ban on euthanasia and on assisting or encouraging a patient to die. To prepare for loss of capacity, Israel enacted the Dying Patient Law in 2005, which allows advance directives specifying acceptance or refusal of life-prolonging treatment.
In his ruling, Lukashinsky Gal said that Podolsky’s request did not involve an active act to cause death by disconnecting the ventilator, but rather reducing treatment to a minimum and not adding additional interventions normally required to sustain ventilation, thus preserving the principle of passivity. The judge also said the move complied with the Patients’ Rights Law because it did not force treatment on a patient who refused it. A similar case involving an ALS patient occurred in 2014.
In the affidavit submitted with his petition and verified by fingerprint, Podolsky described his condition and feelings. “In the last year and a half my condition has significantly deteriorated. I can no longer move any part of my body except my eyes. I cannot move to a shower chair because any small movement is painful, and I no longer have muscle mass in my buttocks and waist to sit. I am completely bedridden. I have not bathed in more than a year, only wiped with wipes. I feel like a bag of bones,” he wrote. He added: “I am terribly afraid of being left without the ability to communicate. I am helpless and in physical and mental distress.”
He stated his wish not to have his life prolonged: “My life now is hell and I want to end it. This is a personal decision and no one influenced it. I am fully of sound mind and my decision is firm.” He also noted that he was single, that his parents had died, and that he had only his brother, Yuri.
Podolsky’s petition was supported by three medical opinions, including from Dr. Ehud Hochner, an internal medicine and geriatrician who has cared for him since 2021 in a home care unit of the health fund. Hochner wrote that while treatments had been tried when there was still a glimmer of hope, they are no longer realistic and the only expectation is further deterioration. Additional opinions came from psychiatrist Dr. Iris Fadlon and internist Dr. Amit Shintel, who has worked for about eight years in palliative care aimed at relieving suffering in patients with terminal illnesses. Shintel said he was impressed by Podolsky’s consistent and clear wish to end his life without suffering.
As authorized by the court, oxygen was reduced for Podolsky in the intensive care unit on Thursday, following the procedures detailed in the ruling. The judge ordered that before beginning any reduction in ventilator rate the physician must ask Podolsky and confirm beyond reasonable doubt that he remained resolute. “Only if he answers affirmatively and clearly that this is his wish may the process continue,” the ruling said. The judgment also noted that Podolsky was given palliative sedation to prevent any sensation of suffocation and that the ventilator rate and oxygen concentration would be gradually reduced to 21%, the oxygen level in ambient air, in line with medical protocols.
Gurevitz, said: “The ruling expresses Michael’s freedom of choice and dignity, given his existential suffering and lack of future. The decision is not only humane but also conforms to the law since it is not an active killing but a reduction of oxygen to a patient who cannot perform this action himself. Before the ruling Michael was miserable; after it he returned to being a person like any other — someone who can take responsibility for his life and end it before his eyes grow tired and he loses all communication with the world and remains trapped in his body indefinitely.”