Implementation of Advance Care Planning in Israel: A Convergence of Top-Down and Bottom-Up Processes.

Although public health has traditionally been concerned with primary, secondary, and tertiary prevention, more attention needs to be focused on patient-centered care at the end of life. Improved access to quality end-of-life care can be achieved by advance care planning (ACP). In this article, we present an example of the processes of change regarding ACP and preparing advance directives (ADs) that have begun to take place in Israel in recent years. We argue that these processes derive from the synergy between legislation on the one hand, and initiatives and action by health organizations on the other. In other words, top-down action such as legislation and directives issued by the Ministry of Health in the past decade, alongside bottom-up action in the health plans and other organizations, have led to change that could not have happened without either side. In the first part of the article, we present Israel's Dying Patient Act and its ensuing amendments and in the second part, we present examples of activities in the health services. In the third part of the article, we discuss the argument that it is only thanks to the combination of top-down and bottom-up action that a breakthrough has been achieved.