Barriers in implementing the dying patient law: the Israeli experience - a qualitative study

BMC Med Ethics. 2020 Dec 11;21(1):126. doi: 10.1186/s12910-020-00564-5.


Background: Coping with end-of-life issues is a major challenge for governments and health systems. Despite progress in legislation, many barriers exist to its full implementation. This study is aimed at identifying these end-of-life barriers in relation to Israel.

Methods: Qualitative in-depth interviews using professionals and decision makers in the health-care and related systems (n = 37) were carried out, along with two focus groups based on brainstorming techniques consisting of nurses (n = 10) and social workers (n = 10). Data was managed and analyzed using Naralyzer software.

Results: Qualitative analysis showed identification of six primary barriers: 1) law, procedures, and forms; 2) clinical aspects; 3) human aspects; 4) knowledge and skills of medical teams; 5) communication; and 6) resource allocation. These were further divided into 44 sub area barriers.

Conclusions: This study highlights the role of the family doctor in end-of-life by training physicians in decision-making workshops and increasing their knowledge in the field of palliative medicine. Effectively channeling resources, knowledge, and support for medical teams, by accounting for the structure and response of the units for home treatment will improve patient's access to information on and support for end-of-life laws, as well as reduce legislative barriers in other countries that face the same issues.

Keywords: End-of-life; Law; Palliative care; Physician.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Focus Groups
  • Humans
  • Israel
  • Patients
  • Physicians*
  • Qualitative Research
  • Terminal Care*