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<p>Palliative sedation (PS) is a morally complex end-of-life practice that sits at the intersection of medicine, law, religion, and culture. While often framed as a purely clinical intervention aimed at alleviating intractable suffering, this article argues that PS functions—particularly in pluralistic societies such as Israel—as a form of ethical mediation and cultural accommodation. Through a philosophical-theoretical inquiry, this paper explores PS not as a universally justified act, but as a <b>“cultural solution”</b>: a pragmatic ethical practice that enables care to proceed amid deep moral disagreement. Drawing on ethical theories—including utilitarianism, deontology, virtue ethics, and care ethics—as well as on the concept of relational autonomy, the article demonstrates the limitations of universalist frameworks in contexts where bioethical norms are fragmented. In Israel, where Orthodox Jewish, Muslim, Christian, and secular liberal worldviews coexist, PS is often deployed without explicit naming or ethical consensus. It emerges in the legal and clinical “grey zones” created by the Patient’s Rights Law (1996) and the Dying Patient Act (2005), and is shaped by religious taboos, institutional ambiguity, and family-centered negotiation. Rather than treating this ambiguity as a flaw, the article reframes it as a <b>moral achievement</b>—a space in which physicians act as ethical mediators, and sedation operates as a bridge across conflicting values. By presenting PS as a culturally constructed and philosophically meaningful practice, the article calls for a non-universalist, <b>context-sensitive ethics of end-of-life care</b>, and contributes to the development of an <b>intercultural philosophy of medicine</b> grounded in moral pluralism, practical wisdom, and compassionate realism. The analysis is contextualized within Israel’s updated legal and medical directives on palliative sedation, including the 2015 Ministry of Health circular.</p>

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Palliative sedation as a cultural solution in Israel: a philosophical-ethical inquiry into end-of-life practice in a multicultural society

  • 期刊论文

  • 发表日期：

    2026年1月19日

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  • Rotem Waitzman

摘要

Palliative sedation (PS) is a morally complex end-of-life practice that sits at the intersection of medicine, law, religion, and culture. While often framed as a purely clinical intervention aimed at alleviating intractable suffering, this article argues that PS functions—particularly in pluralistic societies such as Israel—as a form of ethical mediation and cultural accommodation. Through a philosophical-theoretical inquiry, this paper explores PS not as a universally justified act, but as a “cultural solution”: a pragmatic ethical practice that enables care to proceed amid deep moral disagreement. Drawing on ethical theories—including utilitarianism, deontology, virtue ethics, and care ethics—as well as on the concept of relational autonomy, the article demonstrates the limitations of universalist frameworks in contexts where bioethical norms are fragmented. In Israel, where Orthodox Jewish, Muslim, Christian, and secular liberal worldviews coexist, PS is often deployed without explicit naming or ethical consensus. It emerges in the legal and clinical “grey zones” created by the Patient’s Rights Law (1996) and the Dying Patient Act (2005), and is shaped by religious taboos, institutional ambiguity, and family-centered negotiation. Rather than treating this ambiguity as a flaw, the article reframes it as a moral achievement—a space in which physicians act as ethical mediators, and sedation operates as a bridge across conflicting values. By presenting PS as a culturally constructed and philosophically meaningful practice, the article calls for a non-universalist, context-sensitive ethics of end-of-life care, and contributes to the development of an intercultural philosophy of medicine grounded in moral pluralism, practical wisdom, and compassionate realism. The analysis is contextualized within Israel’s updated legal and medical directives on palliative sedation, including the 2015 Ministry of Health circular.