By Prof. Adv. Maya Peled Raz

Too often, when courts face the question of forced medical treatment for individuals under guardianship, the conversation quickly narrows to clinical calculations of risk and benefit. As a legal expert and clinical ethics consultant working within the healthcare system, I have often felt that something vital is lost in the transition from the bedside to the courtroom: the patient’s personal story, their relational identity, and the very dimensions that define their personhood.

My motivation for exploring this issue grew from a unique “natural experiment” I witnessed firsthand. Within a short period, two nearly identical cases reached the same Family Court in Israel. Both involved patients with long-standing schizophrenia who were diagnosed with advanced throat cancer and refused life-saving treatment. While the clinical and legal foundations of the two cases were nearly identical, they differed procedurally in one key respect: one included a pre-court clinical ethics consultation, while the other did not.

In the case where no ethics consultation occurred, the judicial record reveals what scholars often call a “balance sheet” approach. The deliberation focused almost exclusively on the clinical frame: the psychiatric diagnosis, the necessity of surgery, and the medical risks of non-treatment. Strikingly, the lived consequences of the intervention, such as the permanent loss of speech and the profound impact on quality of life, remained unarticulated. The patient was seen as a subject of medical classification rather than an individual with a history.

In contrast, the case preceded by an ethics consultation followed a different trajectory. This consultation may have helped create “conditions of possibility” for a more nuanced inquiry. By the time the case reached the judge, a broader range of voices, including the patient, his family, and the clinical ethicist, were already prepared to speak. The court’s reasoning seemed to be influenced by these narrative threads, moving beyond technical data to consider the psychological trauma of coercion and what it truly means to live a dignified life.

This comparison suggests that early ethics involvement can potentially foster a deliberative space where the patient is recognized as a “narrative agent”. For those whose voices are structurally constrained by disability or legal status, their stories are often dependent on others to be told. Narrative ethics, in this context, serves not just as a theoretical framework, but as a practical tool for ‘keeping moral space open’ within rigid legal systems. By integrating these perspectives, we might ensure that judicial decisions are situated within the richness of human experience, rather than just the clinical facts of a case.

Paper title: Pre-Court clinical Ethics Consultations and Narrative Ethics: Broadening Judicial Deliberations on Treatment Refusal

Author: Maya Peled Raz, School of Public Health, Faculty of Welfare and Health Sciences, University of Haifa

Competing interests: None

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