Quick Answer: An advance medical directive in Israel is a legally binding document that specifies your end-of-life medical wishes if you become a dying patient — defined under the Dying Patient Law 5766-2005 as having a terminal condition with a prognosis of death within six months. Any adult, including foreign nationals, can file one at no cost through the Ministry of Health's national registry. Israeli hospitals check this registry; they have no access to, and no legal obligation to follow, a foreign living will or advance decision.
Every year, Israeli hospitals treat thousands of patients who are unable to communicate their wishes about medical treatment. For Israeli residents, this is a known problem with a clear legal solution: the advance medical directive (*הנחיות מקדימות*, hanachot mukdamot) registered in the Ministry of Health's national database. For foreign nationals, the problem is more specific. Whatever document they carry from home does not exist in Israel's system. This applies to a diaspora parent spending winters in Tel Aviv, an expat who has lived here for years without completing the paperwork, and a tourist who falls seriously ill during a visit.
The Dying Patient Law 5766-2005 (*Chok HaChole HaNote Lamut*, loosely translated as "the Law of the Dying Patient") is the primary legislation governing this area. It sets out who counts as a dying patient, what kinds of treatment decisions can be specified in advance, how those decisions are recorded, and what authority they carry. Understanding the law is the starting point for any foreign national who wants their medical wishes honored if they are ever critically ill in Israel.
This guide explains the Israeli advance medical directive system from the ground up, with particular attention to what is different, and what is harder, for people without Israeli identity numbers or permanent residence.
1. What Is an Advance Medical Directive Under Israeli Law?
An advance medical directive under Israeli law is a written declaration, signed by a competent adult and registered in the Ministry of Health's national registry, that specifies what medical treatment the person does or does not want to receive if they later become incapable of making those decisions themselves.
The directive operates specifically within the framework of the Dying Patient Law 5766-2005. This is important because the law's scope is narrower than many people assume. It applies only when the patient has been formally classified as a dying patient: diagnosed with a condition that is terminal and irreversible, with a medical prognosis of death within six months. A directive registered under this law has no legal effect on routine medical decisions, emergency triage for reversible conditions, or treatment decisions for patients who are incapacitated but not terminally ill.
For non-terminal incapacity (a patient in a coma following an accident who is expected to recover, for instance), the relevant instrument is not the advance medical directive but the personal care component of an Enduring Power of Attorney under the Legal Capacity and Guardianship Law 1962 (as amended in 2016). The two instruments address different situations and complement each other; they are not substitutes.
Within its scope, however, the directive is powerful. Once a treating physician confirms that the conditions for activation are met, the registered document is legally binding on the entire medical team. A doctor who proceeds with a treatment explicitly refused in a valid directive acts unlawfully under Israeli law.
2. Who Can File an Advance Medical Directive?
Any adult who is mentally competent at the time of signing can file an advance medical directive in Israel. There is no Israeli citizenship or residency requirement. Foreign nationals, tourists, and diaspora visitors are all legally entitled to register a directive. What matters is capacity at the time of signing, not immigration status.
The person must be at least 17 and have full decision-making capacity at the time of signing. Minors cannot file independently. A directive signed during a period of cognitive impairment, whether from illness, medication, or mental incapacity, is invalid regardless of what it says. The law also requires that the directive reflect an informed understanding of the person's medical situation and the consequences of the choices being made. For foreign nationals who do not speak Hebrew, consulting an Israeli physician or attorney who can walk through the form in English satisfies this requirement.
The signature must be witnessed by two adults who are not beneficiaries of the signatory's estate. Israeli hospital social work departments routinely provide this service at no charge; a notary public or Israeli attorney can also serve as a witness.
There is no fee to file. The Ministry of Health operates the registration system and does not charge for registering or renewing a directive.
3. What the Directive Can and Cannot Say
The Dying Patient Law 5766-2005 draws a clear line between refusing life-prolonging treatment (permitted) and requesting acts that actively hasten death (not permitted). Israeli law does not recognize active euthanasia or assisted dying in any form. A directive that instructs a doctor to administer a lethal dose, or to take any affirmative step to end life, is void to the extent of that instruction.
Within the permitted scope, a directive can address the following:
- Refusal of specific life-prolonging interventions. The person can specify that they do not want ventilators, resuscitation (CPR), dialysis, artificial nutrition, or other life-sustaining measures applied once they have been classified as a dying patient.
- Palliative care preferences. The person can request that treatment focus on pain management and comfort rather than life extension.
- Specific procedural instructions. A person may consent to some interventions but not others, accepting pain medication but refusing mechanical ventilation, for example.
- Conditions under which the directive activates. The person can specify particular scenarios (being in a persistent vegetative state, for instance) where they want specific instructions to apply, as distinct from a general terminal prognosis.
- Healthcare proxy appointment. The person can name a memuneh refu'i (healthcare proxy) to make decisions within the directive's framework. This is covered in detail in Section 4.
What the directive cannot do: it cannot instruct physicians to take active steps to shorten life; it cannot override emergency treatment in situations where the terminal diagnosis has not yet been confirmed by the treating team; and it cannot alter the legal requirements for determining that the dying patient threshold has been reached.
In Practice: Under Section 16 of the Dying Patient Law 5766-2005, the treating physician must consult the national registry and verify the directive before any treatment decision affected by it is made. For patients hospitalized in Israeli hospitals, the single most common failure point is a directive that was filed years ago and expired without renewal. Section 26 of the same law sets a five-year validity period. A directive that is even one day past its renewal date carries no legal weight — the medical team is not required to honor it. A sensible precaution is to set a calendar reminder at the four-year mark so there is time to renew before expiry. Renewing costs nothing and takes under an hour.
4. Appointing a Healthcare Proxy (Memuneh Refu'i)
Section 23 of the Dying Patient Law 5766-2005 allows the person making the directive to appoint a healthcare proxy (*memuneh refu'i*), an individual authorized to make medical decisions on their behalf in situations the directive does not explicitly address.
The healthcare proxy is not a substitute decision-maker with unlimited authority. Their role is specifically to fill gaps in the directive and to represent the patient's known values to the medical team. They cannot override a specific, clearly stated instruction in the directive itself. If the directive says "no ventilator," the proxy cannot authorize one.
Where the proxy's role becomes important is in situations the directive did not anticipate. Medicine is specific; legal documents are general. A directive signed five years ago may not address a particular treatment that has since become available, or may be ambiguous about whether a specific clinical situation falls within its scope. The proxy bridges this gap.
A proxy must be named in the directive at the time of filing. They cannot be added or changed afterward without filing a new or amended directive. The proxy must be an adult, but there is no Israeli citizenship or residency requirement. Their authority is limited to what the directive and the Dying Patient Law permit. They cannot authorize active euthanasia any more than the directive itself can. If the proxy and the medical team disagree about whether a specific decision falls within the proxy's authority, the hospital ethics committee can be asked to rule.
For foreign nationals with Israeli connections, appointing a proxy who is physically present in Israel is considerably more practical than appointing someone who would need to fly in from another country during a medical crisis. An adult child living in Israel, a trusted Israeli friend, or a professional (attorney or social worker) authorized to act are all reasonable choices.
5. How to File an Advance Medical Directive: Step by Step
The filing process is straightforward, though it has several specific requirements that must all be met for the directive to be valid.
- Obtain the official Ministry of Health form. The Ministry of Health publishes a standard form for advance medical directives in Hebrew, with an English translation available. The form covers all the decisions available under the Dying Patient Law 5766-2005 and includes space for a healthcare proxy appointment. Using the official form is not legally mandatory (the law allows a directive in any written form), but the official form is already structured to include all required elements and is immediately recognized by hospital staff checking the registry.
- Complete the form. The person must complete the form personally, not have it completed on their behalf. If they cannot read Hebrew, an English version of the form is acceptable. For foreign nationals who want guidance, an Israeli attorney can explain each section without completing it for them.
- Sign in the presence of two witnesses. The two witnesses sign to confirm that the person appeared competent and acted freely. Hospital social workers routinely provide this service for free for inpatients. Alternatively, an Israeli notary or attorney can witness and certify the signatures. The witnesses must not be heirs to the person's estate.
- Submit to the Ministry of Health registry. Completed forms are submitted digitally through the Ministry of Health's online portal, or physically through a hospital social worker or health maintenance organization (in Hebrew, kupat holim). The four main HMOs (Clalit, Maccabi, Meuhedet, Leumit) all accept forms for transmission to the central registry. Submissions are typically processed within 24 to 48 hours.
- Confirm registration. The Ministry of Health sends a confirmation once the directive is registered. Keep this confirmation. Also notify your healthcare proxy (if one is appointed) and any close family members who might be involved in a medical emergency so they know the directive exists and how to reference it.
In Practice: Foreign nationals who arrive at an Israeli hospital already incapacitated — following an accident or acute illness — cannot file a directive at that point. The directive must be signed while the person has full legal capacity. Consider a family whose elderly parent is hospitalized with no directive on file: the hospital ethics committee process under Section 32 of the Dying Patient Law 5766-2005 can take between three and seven days to resolve, days during which the patient may be on interventions the family is certain they would have refused. The committee process costs nothing in fees but imposes enormous emotional strain and does not guarantee the outcome the family seeks. Filing the directive in advance costs nothing and takes 30 to 60 minutes. There is no situation where waiting makes sense.
6. Validity, Renewal, and Revocation
Section 26 of the Dying Patient Law 5766-2005 sets the validity period for an advance medical directive at five years from the date of registration. After five years, the directive expires automatically. The medical team at any Israeli hospital will check the registration date in the national registry; an expired directive is treated as if it does not exist.
Renewal is simple and free. Before the five-year period ends, the person submits a renewal declaration through the same Ministry of Health portal or through their HMO or hospital social worker. The renewal resets the five-year clock. No changes to the directive's content are required. If the person's wishes have not changed, renewal is a brief administrative step.
Revocation can be done at any time while the person has capacity. A person who changes their mind about the instructions in their directive can revoke it immediately by submitting a revocation declaration to the Ministry of Health. Revocations are processed within 24 to 48 hours. There is no waiting period and no requirement to give reasons. After revocation, the person can file a new directive with different instructions if they choose.
A directive is also automatically suspended (not revoked, but temporarily set aside) if the person regains capacity after a period of incapacity. If a patient who was classified as a dying patient unexpectedly stabilizes and recovers decision-making capacity, they resume control of their own medical decisions, and the directive is held in suspension until capacity is lost again.
7. Special Considerations for Foreign Nationals
Israeli hospitals check the Ministry of Health's national advance directive registry. They do not check foreign databases, do not consult foreign government records, and have no legal mechanism to verify or enforce a foreign living will, US healthcare directive, UK advance decision to refuse treatment, or similar document from another country. Whatever the document says, whatever legal force it has in the country where it was signed, it simply does not appear in the system the treating physician consults when a patient arrives incapacitated at an Israeli emergency department.
This matters for several categories of foreign nationals:
- Diaspora visitors and seasonal residents. An American or British parent who spends several months a year in Israel and has a living will at home should also have a registered Israeli directive. The two documents can be substantively identical — the point is that one of them must be in the Israeli national registry.
- Long-term expats who never completed the paperwork. Foreign nationals who have lived in Israel for years but never formally registered an Israeli advance directive because they assumed their home-country document would suffice are unprotected in Israeli hospitals.
- Investors and property owners who visit periodically. Anyone who spends time in Israel, even for short business trips or property inspections, is at risk of a medical emergency during those visits. A registered Israeli directive provides coverage for those periods.
One practical consideration for foreign nationals without an Israeli identity number (*teudat zehut*): the Ministry of Health's registry system accepts passport numbers for non-residents. When completing the form, use your passport number as the identifying document, and ensure the hospital has a copy of your passport on file if you are admitted.
The advance medical directive coordinates with, but does not replace, the personal care component of an Israeli Enduring Power of Attorney. The directive governs end-of-life decisions for dying patients specifically. The Enduring Power of Attorney covers all other incapacity situations: dementia, accident recovery, extended illness that is not terminal. Foreign nationals with Israeli assets and connections should ideally have both. See our detailed guide on Estate Planning in Israel for Foreign Nationals for a full overview of the available instruments.
In Practice: Under Section 26 of the Dying Patient Law 5766-2005, renewal must occur before the five-year expiry. For foreign nationals who are not in Israel regularly, the practical approach is to file the directive during a visit, keeping a record of the registration date, and arranging for an Israeli contact (a family member, trusted friend, or attorney) to send a renewal reminder at the four-year mark. The Ministry of Health does not send automatic expiry notices. An expired directive discovered at a patient's bedside cannot be renewed retroactively. On the proxy side: foreign nationals who name a proxy living abroad should also prepare a backup arrangement. If the designated proxy cannot reach Israel within 24 hours of a medical crisis, the appointment is functionally useless. Consider naming an Israeli-based contact as an alternate proxy, or giving an Israeli attorney written authority to act in that role.
Common Mistake: Families sometimes believe that because they hold a notarized power of attorney for their parent's Israeli bank accounts or property, they also have authority over medical decisions. They do not. A financial power of attorney, even a broad Israeli general power of attorney, has no legal effect on healthcare decisions. The instruments are entirely separate. Medical authority requires either a registered advance medical directive (for end-of-life decisions) or the personal care component of an Enduring Power of Attorney under the Legal Capacity and Guardianship Law 1962 (for all other incapacity decisions). An attorney holding a financial power of attorney who calls a hospital to direct medical care is acting outside the scope of their authority, and the hospital is correct to disregard them.
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