Sunday, October 23, 2011

A Note From Israel

Below is a commentary that I have permission to pass on from Dr. Leibovich. It points out to me that the issue of forcing the dying patient into the hospital may be an international problem, especially in the more developed countries.

"Today I found your blog on End of Life issues. I spent several hours reading all your posts, and I wanted to thank you for writing.

I want to apologize for my basic English, but I hope you'll understand. I wish I could write like you do…

I am a family physician in a Kibbutz in Israel and I take care of almost all the people in the Kibbutz, from birth to death. I am faced with end of life issues quite often, and I feel that I have the exact same views on this like you. I am fortunate to be able to help many patients and families to avoid futile hospital care, and this is one of the things I am very proud of.

A few months ago I took care of my stepfather who lived in a fancy place for old people who can take care of themselves and live alone in a nice flat, but they have a restaurant, have cultural activities etc, in a big city. (I don't know what this kind of place is called in English – here it's called something like "sheltered living"). At the age of 89 he started getting weaker and needed more and more help with his daily activities, until finally he needed constant care. Cancer was diagnosed. We got someone to take care of him 24 hours a day. When he got to the stage where he needed a wheelchair the management of this place did whatever they could to get him to leave – to a nursing home (with four people in a hospital bed in a room), a hospital or whatever. He had already sold his previous home, and he expected to live in this place for the rest of his life. He was alert and understood they wanted to get rid of him, as this spoiled their nice place for "the young at heart". They referred me to the contract where it says that this is a place for independent people. I managed to take care of him in his flat and refused to take him to the hospital, as this was his explicit wish, and we all knew that there was nothing they could do better in the hospital than we could do in his own home and bed. In the last week of his life I was there most of the time, gave him medications against pain, and he passed away in his bed surrounded by those who loved him. I was very happy to have been able to do this for him. I was very sad that this had to be done fighting the management all the way. They threatened me that I was denying him adequate care in a hospital, where he should be in his situation. I ignored them as I knew his time was getting short, and I didn't believe they would try to evacuate him forcefully in his situation. He passed away a day before another meeting they set up to tell me I had to take him somewhere else.

So I am glad to read your stories that show me that I am not alone in the thought that if there is nothing more medicine can do the best place for a person to finish his life is in his own home, if this is what he wants.

All the best, Mira Leibovich, MD - Israel"


  1. Thank you, Dr. Leibovich, for advocating for your father until the end. I work as a hospice nurse and believe with all my heart that a peaceful death in accordance with a person's wishes is worth more than medical care at that time. You're a mensch.

  2. THank you for this post. I just "discovered" this blog today.
    In my part of the world (Negros Oriental, Philippines), end of life care/palliative care is such a new thing, that I feel most physicians here are not so open about... I may have finished a palliative care fellowship but the acceptance of this kind of care is so difficult and frustrating in our setting.
    I hope to follow Dr.Leibovich example, of making the effort to provide the appropriate end of life care even in small steps.