Meanings and Attitudes Toward End-of-Life Preferences in Israel

Abstract

Thirty-six elderly people in Israel were interviewed concerning their meanings and attitudes toward end-of-life preferences. The phenomenological analysis method resulted in the identification of six meaning themes and a continuum of favorable to unfavorable attitude positions for each meaning theme. The combination of meaning themes and attitude positions produced 4 patterns of perspectives toward euthanasia, as well as a more holistic and integrative cultural dimension that was labeled Israel ego integrity. The 6 meaning themes were (a) moral perspectives, (b) religious beliefs, (c) mental and physical suffering, (d) family and community implications, (e) gaining control by willingness to trust others, and (f) previous experiences with death. The 4 patterns of perspectives toward euthanasia emphasized consequences for others, religious perspectives, concerns for personal suffering, and concerns for moral choice. The extensive diversity in the meaning-attitude perspectives from a small sample of elderly people suggested challenges for Israeli policy in regard to legalizing the living will to respect patients' rights to make end-of-life decisions.

Meta-analysis of qualitative studies on older people’s attitudes toward death in a nursing facility

“…Some senior citizens look forward to gaining emotional respect (“Death is the end of life on earth, and I hope I can live forever in the memory of my older person companions in the nursing facility with whom we lived” 9 ). Others expect to die with dignity (“I am 74 years old, suffering from cancer, often crying out in pain, and losing all dignity 12 . Having lost my husband in World War II, I often consider whether it was painful for my husband to die in the war.…”

“…It is the effect of war on my thinking that I now see old people in nursing homes lying in bed at the mercy of others, waiting to die, and I don’t see that as respectful! Instead of living a purposeless life, it is better to accept the ‘baptism’ of death normally and die with dignity” 12 ). Another person reported, “I think it is important to give face to death when one cannot take care of oneself, when one is lying naked at the mercy of others, when one needs help in urinating and defecating, when one has no dignity at all” 13 .…”

“…Others expect to die with dignity ("I am 74 years old, suffering from cancer, often crying out in pain, and losing all dignity. 12 Having lost my husband in World War II, I often consider whether it was painful for my husband to die in the war. How do you give a soldier a respectful death?…”

“…(A look of helplessness). Maybe I can donate them to some medical school for students to learn anatomy, so that I can contribute my last remaining strength to the medical profession (with a smile of relief)" 12 ]. Category 2, Desire for dignity at death.…”

‘There is a Time to be Born and a Time to Die’ (Ecclesiastes 3:2a): Jewish Perspectives on Euthanasia

“…They point correctly to the importance of training of healthcare professionals “in communication skills and cross-cultural medicine” (Jotkowitz 2010b), a requirement which is indispensable given the multicultural and multireligious outlook of contemporary societies. Indeed, religion and world view have influence on the way people deal with illness and ethical dilemmas, for instance in health care (Gielen et al 2009; Coleman et al 2007; Wenger and Carmel 2004; DeKeyser Ganz and Musgrave 2006; Margalith et al 2003; Musgrave et al 2001; Ejaz 2000; Leichtentritt and Rettig 1999; Carmel and Mutran 1997). Consequently, hospitals’ need felt to deal with a culturally diverse patient population is high, which is clear from the steady inquiries to our center1 to provide training and clear guidelines in this regard.…”