Israel journal of health policy research
From statutory mandate to institutional integration: lessons from the national survey of Israel's healthcare ethics committees
By Paz A, Peled-Raz M, Zuckerman S and 1 others.
Abstract
Background
Israel's Patients' Rights Act (IPRA, 1996) established a unique statutory model for ethics committees (ECs), with legally binding authority, differing from the advisory nature of ECs in most countries. Following the 2015 State Comptroller's report highlighting widespread under-implementation, the Ministry of Health (MOH) issued a directive in 2018 aimed at standardizing EC structure, procedures, and training. However, the extent of subsequent implementation and operational activity has remained unclear.
Methods
This secondary analysis of the 2022‑2023 MOH national survey examined EC structure, governance, training, and activity in 52 institutions (response rate: 71%), including general, geriatric/rehabilitation, and psychiatric hospitals, MOH district bureaus, health maintenance organizations (HMOs), and the Israel Defense Forces (IDF). Institutional characteristics were merged from MOH administrative databases and compared with available 2015 baseline data. Logistic regression and Generalized Estimating Equation (GEE) models were used to identify factors associated with low EC activity. Low EC activity was defined as a committee that reported both one or fewer (≤ 1) meetings AND one or fewer (≤ 1) applications per year. Conversely, committees reporting more than one meeting or more than one application annually were classified as having high activity for the purpose of the analysis.