Euthanasia as a Serious Homicide: An Empirical Study of (Normative) Consensus in Israel

Abstract The present study tests the applicability of the consensus versus the conflict model of criminal law in the case of homicide, and euthanasia, in particular. Although most criminal statutes consider euthanasia to be a serious homicide, many studies have revealed increasing public support for it. A survey of a national sample of Israeli respondents, based on a factorial design methodology, was conducted to determine the extent to which the criminal law reflects general or particular public attitudes toward euthanasia. The findings revealed that although social groups varied in their views on the seriousness of euthanasia, the public at large perceived it as significantly less serious than any other type of homicide. These findings are compatible with calls for reassessment of the criminal law with regard to euthanasia.

A pivotal question in the sociology of law is the extent to which the criminal law reflects the values prevailing in society. Two opposing theoretical models are usually cited in this context. The first the consensus model postulates a close match between the attitudes of various social groups toward both the definition of deviant acts as criminal offenses and their relative seriousness and, in turn, between such attitudes and their expression in the criminal law. 1 The second the conflict model predicts wide disagreement among social groups on both issues (each of them with their own standards of right and wrong), while the criminal law reflects only the particular attitudes of dominant groups in society (e.g., Newman, 1976; Rossi & Berk, 1997; Thomas et al., 1976; Warr et al., 1982). Despite their diversity, crime seriousness studies, which typically require respondents to evaluate criminal acts based on their seriousness, have consistently shown wide support for the consensus model in the particular case of criminal homicides (Jacoby & Cullen, 1999; Newman, 1976; Rossi & Berk, 1997; Thomas et al., 1976; Warr et al., 1982): these acts are universally seen by respondents as extremely serious and harmful (OConnell & Whelan, 1996; Roberts, 1992; Rossi & Berk, 1997; Rossi et al., 1974; Sellin & Wolfgang, 1964; Wolfgang et al., 1985); thus they usually demand for murders the most serious criminal punishments (Applegate et al., 1993; Durham et al., 1996; Jacoby & Cullen, 1999; Mitchell, 1998). Both views are widely reflected in criminal codes. A noteworthy exception to this strong rule of consensus, even perhaps supporting the opposing conflict model seems to be provided by a very particular form of formal homicide - euthanasia. Unlike former research on attitudes toward euthanasia, this study attempted to determine whether, in contrast to the applicability of consensus principles to most criminal homicides, the principles of the conflict model are specifically applicable to the case of euthanasia.

The Seriousness of Euthanasia: The Formal View

Although euthanasia, or mercy killing of terminally ill and/or incapacitated persons, is not a new social issue, it has represented a serious challenge to the medical world in recent decades due to the apparent conflict that it poses between the physicians roles as alleviators of suffering and preservers of life (Finlay, 1985). On the one hand, the development of medical knowledge and technology has vastly increased the range of options for treatment, to such an extent that the life in the biological sense of many patients can be prolonged substantially beyond previously known limits. On the other hand, the technical prolongation of life sometimes means the prolongation of suffering of terminally ill persons with no hope of recovery (Griffiths et al., 1998; Monte, 1991). Euthanasia recognizes such options as a means of enhancing autonomous decisions regarding the quality of life versus extending its quantity at all costs (Scherer & Simon, 1999). With few notable exceptions (the Netherlands and Belgium), euthanasia is formally considered a serious criminal homicide in Western legal systems (for a review, see Scherer & Simon, 1999). The rationale for this stand is that the criminal law does not recognize motive, even if based on humanitarian considerations such as mercy, as a defense to a homicide charge. Accordingly, if the evidence presented in court establishes that a defendant typically a physician or close relative of the ill person has committed euthanasia deliberately and with intent, even if the act was motivated by mercy and/or committed at the request of the victim, the law stipulates that s/he will be charged with and convicted of serious homicide (e.g., McCall Smith, 1996; note that this description is general: it may change in different jurisdictions).

The Seriousness of Euthanasia: Conflictive Social Views

Although not uniformly, this serious criminal status of euthanasia has been consistently endorsed by official (elite) authorities in the political, judicial, religious, and professional (health) fields (Lee et al., 1996; Melton, 1991; Scherer & Simon, 1999; Yount, 2000).2 However, the most consistent finding in the euthanasia literature is that public opinion has moved steadily toward favoring it. To date, numerous public opinion surveys and empirical studies reveal that most of respondents support some forms of euthanasia, and about one third of them (sometimes more) even its complete decriminalization. Note that despite this general trend, this literature also reveals that the acceptance of euthanasia has been found to vary across social groups in society: younger people, males, whites, those who are more educated, and/or especially secular respondents generally view euthanasia much more favorably than their (especially religious) counterparts (Bachman et al., 1996; Benson, 1999; Blendon et al., 1992; Braun et al., 2001; Caddell & Newton, 1995; Finlay, 1985; Hamil-Luker & Smith, 1998; Ho & Penney, 1992; Lee et al., 1996; MacDonald, 1998; Mitchell, 1998; Monte, 1991; Ross & Kaplan, 1993; Scherer & Simon, 1999; Seidlitz et al., 1995; Yount, 2000). Both sets of findings seem to constitute evidence in support the principles of the conflict model: Differences exist among social groups regarding the perceived seriousness of euthanasia, and criminal statutes do not reflect the views of many of them.

The Present Study

As stated, many crime seriousness and euthanasia attitudes studies have shown respectively, that, on the one hand, both the public at large and the criminal law perceive consensually several forms of homicide as very serious offenses, and on the other, that conflict seems to exist between different groups of people and between them and the criminal law concerning the formal perception of euthanasia as a serious homicide. The aim of this study was to link between both findings and explain this linkage under a common theoretical frame, by assessing for the first time the applicability of the principles of the conflict model to the specific case of euthanasia. In the context of this consensus-conflict controversy we attempted (1) to ascertain whether the criminal law, by considering all forms of euthanasia serious homicides, reflects general or particular views in this regard, and (2) in the latter case, to identify the social group(s) whose severe views toward euthanasia are reflected in the law. To this end, and in the framework of seriousness studies, respondents from a large national sample were asked to evaluate the seriousness of a collection of concrete scenarios entailing several typical euthanasia practices, criminal homicides, and for control purposes, non-homicidal criminal offenses. Based on the previously mentioned findings, the first two hypotheses of the study were as follows: H1: Respondents will perceive scenarios representing typical criminal homicides as very serious, and euthanasia scenarios as significantly less serious (even than many non-homicidal criminal offenses). H2: Unlike (strong) consensual seriousness perceptions for most criminal homicide scenarios, respondents seriousness perceptions regarding euthanasia scenarios will be affected significantly by social variables.

The third hypothesis relates to the identification of a dominant social group, apparently imposing its serious view of euthanasia on the criminal law and, consequently, on other social groups. Based on the aforementioned sources, it is assumed in this study that the serious definition of euthanasia in formal criminal codes matches particular religious principles. Generally, monotheistic religions hold that because human life is God-given, it should be put above anything else, regardless of its quality. Thus, any taking of life, including acts of euthanasia, is regarded as rebellion against Gods will, and hence as murder (Caddell & Newton, 1995; Ross & Kaplan, 1993; Scherer & Simon, 1999). Note that despite the principle of separation between religion and state in most Western countries, a substantial body of literature details the rational efforts of religious groups (mainly by lobbying through religious organizations, by promoting religious candidates, or even by playing a major role in elections) to promote measures that they deem beneficial to their cultural and moral interests (Beyerlein & Chaves, 2003; Fowler & Hertzke, 1995). Because attitudes toward criminal offenses in general (e.g., Newman, 1976) and particularly toward euthanasia are strongly influenced by religious beliefs (such as, sanctity of life; Bachman et al., 1996; Caddell & Newton, 1995; Ho & Penney, 1992) or secular principles (such as, individual autonomy; Finlay, 1985; Schrerer & Simon, 1999; Yount, 2000), the third hypothesis of this study was that: H3: Substantial disagreement on the seriousness of euthanasia will be particularly evident between secular and religious respondents. On the one hand, the former will perceive the euthanasia scenarios as significantly less serious than scenarios representing typical criminal homicides, which will be considered very serious. On the other hand, the latter will perceive both euthanasia and other homicide scenarios as very serious (on similar findings, see Caddell & Newton, 1995).3

On the theoretical level, confirmation of these hypotheses will provide support for the conflict model in the case of euthanasia, and reduce the applicability of the consensus model for all criminal homicides.4 On the practical level, it has often been argued that differences between public attitudes and the position of the law may adversely affect public trust in the legal system, which, in turn, may undermine public willingness to comply with the law and to rely on the criminal justice system (Newman, 1976; Roberts, 1992). Moreover, the consensus model is based on the rationale that democracies are founded on the principle of elected representation and popular control of the law by the citizenry; hence, the law should reflect the majority's public views (Roberts, 1992; Thomas et al., 1976; Tyler, 1990; Warr et al., 1982). Based on it, public opinion concerning euthanasia should play a significant role in the formulation of public policy in issues, such as euthanasia. It should be added here that the linkage between crime seriousness and euthanasia attitudes studies and the use of the consensus-conflict theoretical frame do not constitute the sole contribution of this study. First, unlike almost all the aforementioned studies, respondents in this study formed part of a large, representative national sample. Second, instead of focusing on a simple form of euthanasia or homicide for evaluation, the present study took into account the complexity and heterogeneity of both acts; thus it was based on the subjective evaluation of multidimensional scenarios, constructed under the factorial-survey approach. Moreover, unlike all studies, additional non-homicide scenarios were added to the analyses for control purposes. These improvements should considerably increase both the generalization and the internal validity of the findings.

Method
Israel, the location of the present survey, is well suited for the analysis of seriousness perceptions toward criminal homicide, in general, and euthanasia, in particular. (1) Very few studies on these issues have been conducted outside the United States and Britain (for recent reviews, see Roberts, 1992; Rossi & Berk, 1997; Scherer & Simon, 1999). Generally, the findings of the few crime seriousness studies conducted in Israel are similar to those found in the literature, with criminal homicides considered the most serious criminal offense and with religiosity significantly affecting seriousness perceptions (Herzog, 2003; see also Newman, 1976). (2) Important religious groups, traditionally under-represented and even ignored in other samples of Western countries, are well represented in this population; for example, a Jewish majority (77 percent; CBS, 2003) and an Arab (mostly Muslim) minority. (3) Influenced by English common law, mercy killings in Israel, as in most Western countries, are formally categorized as serious homicides - murder -, committed with premeditation and intent. (4) Although not based on empirical findings, there seems to be growing support for euthanasia also in the Israeli secular public, as reflected by the establishment of various voluntary organizations and groups supporting both the right to die honorably and euthanasia legislation. (5) In line with the third hypothesis, the dominant religious ethos in Israel concerning issues of life and death stems from the Jewish tradition. Moreover, religious norms have already entered the formal Israeli law in many issues, particularly in matters of personal status, such as marriage, divorce, and various life-and-death issues, such as burial procedures.5 These legislative concessions are usually permitted to allow some Jewish content in an otherwise secular state, and also in exchange for support from religious representatives in government and municipal coalitions. This situation is often considered

by the secular majority to constitute religious coercion, lending support for the conflict model: Although living a secular life, most Israelis are subject to norms whose essential source is religious (Hazan, 1999; Neuberger, 1999). The research data were collected from a large, representative, random, national sample random sample of the adult Israeli population (n = 892). Accordingly, it should be added here that the linkage between crime seriousness and euthanasia attitudes studies and the use of the consensusconflict theoretical frame do not constitute the sole contribution of this study. First, unlike almost all the aforementioned studies, based on samples of students, of selected or clinical populations, or in the best of cases, of citizens in local places, respondents in this study formed part of a large, representative national sample, increasing considerably the generalization of the findings.6 The most recent Israeli telephone directories, covering all geographical regions, provided the sampling framework, and the application of a systematic random sampling method assured identical probability of inclusion of all households listed (no other technique, such as interview schedule was applied).7 The sample distributions showed a close fit with recent official national data on the Israeli population (CBS, 2003). Respondents seriousness perceptions of hypothetical scenarios representing different euthanasia, homicide and other offenses cases were collected by personal, anonymous questionnaires, administered by means of a telephone survey (response rate = 66 percent; interview length: about five to seven minutes). Data collection took place during January and February 2003. A content analysis of Israels major national newspapers revealed no coverage of irregular euthanasia or offenses committed around the time of the survey, which might have affected respondents attitudes. Each questionnaire was relatively short and included ten different randomly-chosen hypothetical crime scenarios for

evaluation, including homicidal (not only murder, but also manslaughter, negligent, and justified-homicide), euthanasia and non-homicidal criminal cases (for control purposes), constructed using the factorial-survey approach (detailed later, see some sample scenarios at the end of Appendix 1),8 and a number of questions about respondents demographical information. Each telephone interviews lasted between seven and ten minutes. The language of the questionnaire was kept as simple as possible and the students who served as surveyors were carefully trained by the researcher to minimize potential biases. These ultimately led to a high response rate of 68%.9

The Research Design

As noted, a growing body of research has dealt with public attitudes toward euthanasia. Although these studies have provided useful insights, many of them are flawed by methodological problems. Despite the high heterogeneity and complexity of euthanasia situations and attitudes toward it, many of the aforementioned studies in this area called for general, simplistic responses (no/yes; agree/disagree) to very complex questions stated in simple terms. Accordingly, the information that becomes available through such polls and studies is limited (Applegate et al., 1993; Denk et al., 1997; Durham et al., 1996; Jacoby & Cullen, 1999; Rossi & Berk, 1997).10 Social scientists, cognizant of these methodological limitations, introduced the scenario approach to provide respondents with a more complex rating task, one that more closely approximates the information available in real-life situations and leaves less room for interpretative variation. This approach has been used widely in assessing public perceptions of the seriousness of a variety of offenses (see Herzog, 2003; Rossi et al.,

10

1974; Sellin & Wolfgang, 1964; Wolfgang et al., 1985), including criminal homicide (Mitchell, 1998), and euthanasia (e.g., Thrush et al., 1985). However, one of the main weaknesses of this approach is that it does not allow for systematic examination of the effect of multiple factors surrounding the scenario that may influence public attitudes toward it (Applegate et al., 1993; Jacoby & Cullen, 1999; Roberts, 1992; Rossi & Berk, 1997). This problem was overcome in the present study by applying a factorial design methodology (Denk et al., 1997). The factorial design method uses multidimensional scenarios presented in a form that combines the benefits of controlled, randomized experimental designs and conventional surveys (Denk et al., 1997; Rossi & Anderson, 1982; Rossi & Berk, 1997). The scenarios are created by randomly selecting values (levels) from each of several variables (dimensions; one level per dimension per scenario) until each dimension is represented and a complete story is formed. Thus, all scenarios considered represent a random sample of all possible scenarios available from the universe of all levels across the chosen dimensions. Rossi and Anderson (1982) note that by permitting multiple dimensions of a crime scenario to vary randomly across scenarios and by controlling the personal characteristics of the respondents, this technique allows for exploration of the effects of several independent variables simultaneously, while permitting unbiased estimates of the contributions of each of them to the overall judgment of the respondent. Moreover, due to their complete randomization, scenario dimensions cannot covary either with respondent's characteristics or with themselves (Denk et al., 1997). Given these advantages, this method has been applied to examine various sociological and criminological issues (Applegate et al., 1993; Jacoby & Cullen, 1999; Rossi & Berk, 1997), including attitudes toward euthanasia (Denk et al., 1997).

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Research Variables
After the presentation of each scenario, respondents were asked to judge it subjectively on two levels: by evaluating its perceived seriousness (by choosing one value on a Likert scale ranging from 1 = Not serious at all, to 11 = Very serious), and by determining the most appropriate penal measure (henceforth, for convenience, punishment) for it (by choosing one option from life imprisonment, a certain number of years in prison, any other punishment, and Not to prosecute a non-criminal act). The seriousness and punishment scores assigned to the scenarios constituted the dependent variables of the research. The latter was introduced to allow for improved interpretation of the former (e.g., decriminalization) and to reinforce its validity: Research has consistently reported a high correspondence between subjective evaluations of seriousness and of appropriate sentence severity (Durham et al., 1996; Jacoby & Cullen, 1999; OConnell & Whelan, 1996). To increase the uniformity of the evaluative task, respondents were instructed to base their responses on their evaluation of the described scenario and not on their personal knowledge of the criminal law (Herzog, 2003; Rossi et al., 1974). Nevertheless, the possibility that the respondents' evaluations are affected by the prevailing law cannot be excluded (see Blumstein & Cohen, 1980). The 21 independent and control variables for this study were derived from two sources: 14 from randomly assigned factorial dimensions within the scenarios (see Appendix 1) and seven from respondent characteristics, obtained at the end of the questionnaire after the evaluation of the

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scenarios. As stated, these personal details, especially religiosity, were particularly useful in testing the second and third hypotheses of this study.11 Eight different scenarios, varying randomly on their dimensions, were presented to each respondent (n = 7,136 scenarios).12 These eight scenarios included random choices of two different situations of murder, two of manslaughter, one negligent homicide, one justified homicide, one example of a criminal offense other than homicide (for control purposes), and one euthanasia situation.13 Despite the use of the factorial approach, some variables were kept uniform across all of the scenarios. First, all of the acts were described in such a way that there could be no question as to the responsibility of the perpetrators and the consequences of their acts. Second, the scenarios involved a single offender, and when described, a single victim. Of the 14 scenario dimensions, seven were considered independent variables (A-G) and the remaining seven (H-N), control variables. The former can be divided into: 1. Euthanasia scenario variables: Despite its humanitarian basis, euthanasia is far from being a uniform practice (for typologies, MacDonald, 1998; Scherer & Simon, 1999; Yount, 2000). Due to this variability and the differential effect of euthanasias characteristics on public attitudes toward it (Bachman et al., 1996; Blendon et al., 1992), five dimensions (A-E) were chosen to be randomly included only in the euthanasia scenarios (Denk et al., 1997): type of euthanasia active vs. passive (A), the identity of the perpetrator physician vs. relative (B), a clear

13

request to die by the victim voluntary vs. involuntary (C), the diagnosis of a terminal illness (D), and severe suffering of the patient (E). To avoid influencing the respondents, the word euthanasia was not specifically mentioned in these scenarios. 2. Homicide scenario variables: As stated, the seriousness perceptions of euthanasia scenarios were compared to parallel seriousness perceptions of homicide scenarios. A salient characteristic of euthanasia as distinct from other homicides is its humanitarian motive: it is motivated by considerations of mercy, ending suffering, and relieving pain. Thus, an additional independent variable (F) homicides underlying motive was applied to all homicide scenarios, including euthanasia. 3. All scenario variables: As stated, for control purposes, the euthanasia scenarios were actually compared with a number of other nonhomicide criminal offenses. Accordingly, a third type of independent variable (G) typical criminal offense, including formal definitions of criminal homicides (such as murder, manslaughter, and negligent homicide), other violent, property, and victimless crimes was applied to all evaluated scenarios. Also for control purposes, justified (non-criminal) homicides, usually committed by police officers in the course of their duty, were included as values in this variable. In addition to the seven respondents personal variables, the seven remaining scenario dimensions served as control variables: Four were related to the perpetrators personal characteristics (gender, ethnicity, age, and criminal record; H-K), and three to the victims characteristics (gender, ethnicity, and age; L-N).

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Results
Table 1 presents the values of the perceived seriousness and appropriate punishment obtained for the scenarios representing homicidal acts (differentiated by their motive; dimension F), and non-homicidal criminal offenses (dimension G), for the whole sample of respondents. For ease of understanding, the values of the independent variables are ordered in descending level of seriousness. Table 1: Mean Rating of the Seriousness and Punishment of Scenarios. Values n Seriousness Mea SD n Punishment (row %) Life Som Othe No impr e r prose . impr c. . 59.4 39.0 0.0 1.6 32.2 61.8 48.4 23.1 42.8 23.2 41.4 4.8 61.0 31.2 47.3 74.4 53.3 71.0 52.5 79.8 5.1 4.5 2.0 2.1 2.4 2.4 3.2 7.3 1.7 2.5 2.3 0.4 1.5 3.4 2.8 8.1

Murder: Commission of a crime Rape Murder: Family honor Homicide: Political controversy Negligent homicide: saving money Homicide: Financial controversy Negligent homicide: High speed driving Homicide: Romantic infidelity Domestic violence

187 118 157 451 242 481 207 508 89

10.2 4 10.1 2 10.0 0 9.95 9.63 9.54 9.41 9.15 8.64

1.40 1.60 2.24 1.98 1.86 2.16 2.13 2.48 3.01

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Negligent homicide: Error in medical diagnosis Robbery Drug selling Burglary Negligent homicide: Error in professional discretion Bribery Homicide: Domestic abuse Violence between acquaintances Theft Justified homicide: Prevention of danger Justified homicide: Prevention of offenders escape Tax evasion Murder: Euthanasia

207 108 87 99 236 97 1,784 93 83 452 440 118 892

7.95 7.75 7.73 7.72 7.49 7.43 7.22 7.00 6.93 5.79 5.40 5.27 5.21

2.92 2.80 3.05 2.91 3.00 2.78 3.27 2.80 2.96 3.65 3.20 3.14 3.64

5.3 2.8 5.2 2.0 6.4 1.6 17.7 0.0 0.0 7.6 2.9 0.0 7.9

66.5 89.8 77.4 94.1 64.8 72.4 62.5 76.9 83.1 39.2 43.3 46.6 39.4

20.4 7.4 14.8 2.0 19.9 24.4 10.5 23.1 16.9 18.3 19.9 37.9 14.8

7.8 0.0 2.6 2.0 8.9 1.6 9.3 0.0 0.0 34.9 33.9 15.5 37.9

Table 1 shows that most of the homicide scenarios (and also some negligent homicide and non-homicide violent scenarios, such as rape) obtained the highest seriousness means (ranging between 9 and 10; maximum possible value = 11) and the smallest standard deviations; no significant differences in seriousness scores were found among them. However, note that respondents evaluated homicides committed due to prolonged domestic abuse inflicted by the victim on the killer as significantly less serious than the other serious scenarios, and particularly, scenarios representing varying situations of euthanasia as the least serious scenarios, receiving the significantly lowest seriousness mean (5.21) and the largest standard deviation (3.64), in comparison with all criminal homicides and almost all the other criminal offenses evaluated. The

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only exceptions were scenarios of justified homicides and tax evasion.14 The results concerning the appropriate punishments for these crimes generally confirm the findings for seriousness: Significantly higher percentages of life imprisonment and not to prosecute (a non-criminal act) were mostly provided to these significantly most and least serious scenarios, respectively. The influence of the scenario dimensions and the personal characteristics of the respondents (independent and control variables) on seriousness and punishment values (dependent variables) were also analyzed using two multivariate regression models (OLS and logistic, 1 = Not to prosecute, respectively). Table 2 presents the unstandardized regression coefficients and standard errors of these variables in the two models for the whole sample of respondents. Due to the different types of evaluated scenarios, Table 2 focuses on the specific multivariate analyses of all homicide scenarios, without euthanasia, and of euthanasia scenarios taken separately. Table 2: Unstandardized Regression Coefficients (and Standard Errors) for the Seriousness and Punishment of Scenarios, by Scenario Dimensions and Respondents Personal Details, for the Whole Sample of Respondents.1 Variables Values scenarios Kind of All scenarios (n = 7,136) Seriousnes s Punishment Homicide scenarios (n = 5,352) Seriousnes Punishment s Euthanasia scenarios (n = 892) Seriousnes Punishment s -.53 (.36) -.54* (.23) -.71 (.38) .09 (.41) -.78* (.37) -1.55** -.05 (.24) -.55* (.27) .47* (.21) .78** (.23)

A. Type of euthanasia act 2

Dependent v. Active - provision

Passive - disconnection Passive - avoidance B. Perpetrators identity 0 = Physician ; 1 = Relative C. Request by the victim 1 = Yes

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D. Terminal illness E. Suffering of the ill person F. Homicide motives 3

1 = Yes 1 = Yes Commission of a crime Family honor Political controversy Endangering clients to save money Financial controversy High speed driving Romantic infidelity Error in medical diagnosis Error in professional discretion Domestic abuse Prevention of danger Prevention of offender's escape

4.95** (.24) 4.64** (.26) 4.83** (.19) 4.41** (.21) 4.37** (.18) 4.06** (.23) 4.02** (.15) 2.95** (.23) 2.25** (.21) 2.10** (.13) .52** (.18) .26 (.16)

-8.63 (7.32) -3.50** (.72) -3.39** (.39) -4.91** (1.00) -3.68** (.42) -2.86** (.39) -3.15** (.25) -2.13** (.29) -1.90** (.24) -1.83** (.12) -.09 (.13) -.15 (.12)

4.67** (.24) 4.38** (.27) 4.60** (.20) 4.21** (.22) 4.08** (.19) 3.88** (.24) 3.72** (.17) 2.65** (.23) 2.03** (.22) 1.73** (.15) .36 (.19) -

-7.57 (4.45) -3.38** (.73) -3.57** (.42) -4.90** (1.01) -3.71** (.43) -2.88** (.41) -3.11** (.26) -1.96** (.29) -1.77** (.25) -1.62** (.14) .04 (.15) -

(.32) -1.17** (.29) .26 (.27) -

.80** (.20) -.23 (.17) -

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G. Criminal offenses 4

Rape Domestic violence Robbery Drug selling Burglary Bribery Violence between acquaintances Theft Tax evasion

4.71** (.30) 3.18** (.29) 2.61** (.30) 2.69** (.33) 2.49** (.43) 2.35** (.31) 1.99** (.42) 1.76** (.34) -.19 (.35) -.01 (.20) -.25 (.21) .10 (.10) -.16 (.10) .03 (.09) .16 (.09) .52* (.21)

-3.49** (.72) -1.75** (.34) -8.75 (9.75) -3.18** (.61) -8.76 (14.02) -3.68** (.72) -8.75 (13.73) -8.80 (11.09) -1.41** (.34) -.16 (.26) -.04 (.26) -.09 (.10) .03 (.11) -.07 (.10) -.06 (.11) -.49* (.20)

-.19 (.32) -.39 (.32) .20 (.12) -.06 (.12) -.14 (.11) .08 (.11) 1.43** (.12)

-.37 (.44) .40** (.44) -.30 (.14) -.14 (.14) -.05 (.14) -.00 (.14) -1.14** (.23)

-.94 (.81) -.86 (.81) -.12 (.31) .40 (.34) .39 (.29) -.30 (.33) -

.34 (.57) .44* (.57) .02 (.20) .13 (.22) .00 (.18) .20 (.22) -

H. Perpetrators gender
5

Male Female Jewish Arab 25 years old 50 years old 0 = not stated ; 1 = Yes

I. Perpetrators ethnicity 5 J. Perpetrators age

5

K. Perpetrators crim. rec.

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L. Victims gender 5 M. Victims ethnicity 5 N. Victims age 5 O. Respondents gender P. Respondents age Q. Respondents education R. Respondents income S. Respondents ethnicity T. Respondents religiosity 6

Male Female Jewish Arab 25 years old 50 years old 0 = Female ; 1 = Male Interval
Interval

-.12 (.19) .32 (.20) -.02 (.10) .01 (.10) .05 (.09) .00 (.09) -.24 (.07) -.00 (.00) -.01 (.00) .11 (.07) -.01 (.09) .37** (.09) .46** (.11) .03 (.08) 6,904 .26** 5.46** (.40) 42

-.11 (.19) -.22* (.19) .07 (.10) .10 (.11) .10 (.10) .03 (.10) .08 (.08) .00 (.00) .01 (.01) .04 (.08) -.05 (.10) -.31** (.10) -.27* (.13) .10 (.09) 6,904 6,352.52 -.55 (.52) 42

-.03 (.30) .90** (.30) -.15 (.12) -.15 (.12) -.10 (.09) -.09 (.09) -.41** (.08) .00 (.00) -.00 (.01) .15 (.08) -.18 (.10) .27** (.09) .20 (.13) -.06 (.09) 5,178 .24** 4.89** (.54) 32

-.28* (.29) -.58* (.31) .23 (.13) .25 (.14) .09 (.12) .07 (.12) .14 (.10) -.00 (.00) .01 (.01) .05 (.11) .18 (.13) -.21** (.13) -.13 (.17) .25* (.12) 5,178 5,091.92 .83 (.74) 32

-.30 (.50) -.50 (.49) -.34 (.33) .11 (.33) .18 (.33) -.28 (.31) -1.10** (.23) .05* (.00) -.10** (.03) -.16 (.25) 1.21** (.29) 1.58** (.31) 1.97** (.39) .75* (.29) 863 .18** 9.74** (1.14) 27

.16 (.32) .11 (.31) .34 (.21) .02 (.21) -.04 (.21) .34 (.21) .44* (.15) .00 (.00) .05* (.02) -.00 (.16) -.81** (.22) -.89** (.19) -.97** (.26) -.01 (.18) 863 856.11 -3.06** (.79) 27

0 = + than 5, 000 NIS ; 1 = Less 0 = Jewish ; 1 = not Jewish Traditional Religious

U. Resp.s status in country Model data

0 = Veteran ; 1 = New immigrant Valid n R 2 / Goodness of fitness Constant d.f.

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* p < 0.05 ** p < 0.01 1. Due to the skewed distribution of the seriousness variable, especially in Model 3, the same analysis was conducted using the natural logs of the variables scores. Moreover, due to possible within-respondent variability in both models, the regression analyses were also conducted by HLM procedures. Generally, these regression analyses produced very similar results to those presented. 2. Dummy variable, Active - injection of a lethal dose is the reference group. 3. Dummy variable, Euthanasia and prevention of offenders escape are the reference groups in Models 1 and 2, and 3 and 4, respectively. 4. Dummy variable, Euthanasia is the reference group. 5. Dummy variables, Not stated is the reference group. 6. Dummy variable, Secular is the reference group.

For the first two models (all scenarios), Table 2 shows that when both control scenario dimensions and respondents characteristics were controlled, almost all levels of homicide motive and criminal offense (dimensions F and G) showed significant coefficients, with positive signs in the seriousness model and negative signs in the punishment model: Compared with the euthanasia scenarios (common reference group), respondents were significantly more likely to provide higher seriousness scores and to opt for criminal punishment of the perpetrators in almost all of the homicide and non-homicide scenarios. These variables appeared to have the greatest impact on respondents judgments in both models. Again, as shown in Table 1, the only exceptions were the two values of justified homicides and tax evasion. Table 2 also shows that the findings in both homicide models (without the euthanasia scenarios) were quite similar to those previously presented. Homicide motive (dimension F) continued to constitute the most influential variable in respondents judgments of both seriousness

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and punishment, showing significant (positive and negative, respectively) coefficients, this time, in comparison to one of the (least serious) justified homicides. Although relatively weaker than the effect of this variable, note that some control variables also showed significant coefficients in these analyses homicides committed by and against women (dimensions H and L), and by murderers with a previous criminal record (dimension K); and two respondent personal characteristics (gender and religiosity; variables O and T). In the euthanasia models, some of the dimensions of the euthanasia scenarios significantly influenced respondents judgments of seriousness and punishments. Generally, euthanasia committed by relatives (dimension B), when an ill person explicitly asked for help to die (dimension C) and/or suffered from a terminal illness (dimension D) were considered significantly less serious than other situations. Similar findings were found for punishment: In the former situations, the odds of respondents choosing not to prosecute increased significantly. However, in contrast to the former models for homicide, in the euthanasia models, scenario dimensions that served as control variables were mostly non-significant, and a significant influence of respondents personal details was clearly evident: Generally, women, older people, less educated, non-Jewish, and especially traditional and religious respondents were significantly more likely to evaluate the euthanasia situations as serious and to opt for criminal punishment for those committing such acts. Due to the importance of religiosity in evaluations related to euthanasia (and in the third hypothesis), Table 3 focuses on the specific seriousness and punishment values provided by traditional and religious respondents to homicide and non-homicide scenarios. As in Table 1, the values were ordered by their perceived seriousness.

22

Table 3: Mean Rating of the Seriousness and Punishment of Scenarios among Traditional and Religious Respondents (n = 316). Values n Seriousness Mea SD n Punishment (row %) Life Som Othe No impr e r prose . impr c. . 32.4 56.8 10.8 0.0 51.4 42.2 30.7 50.7 17.7 43.4 6.1 37.4 8.7 13.3 1.8 21.5 5.4 0.0 0.0 2.4 45.1 54.7 66.7 35.6 81.3 53.8 87.9 56.1 69.6 64.0 80.4 61.1 91.9 95.0 96.0 70.7 2.1 0.0 0.0 8.2 1.0 0.0 6.1 3.1 15.9 14.7 10.7 9.3 2.7 5.0 4.0 24.4 1.4 3.1 2.7 5.5 0.0 2.8 0.0 3.4 5.8 8.0 7.1 8.1 0.0 0.0 0.0 2.4

Rape Homicide: Political controversy Homicide: Commission of a crime Negligent homicide: High speed driving Homicide: Family honor Negligent homicide: saving money Homicide: Financial controversy Drug selling Homicide: Romantic infidelity Negligent homicide: Error in medical diagnosis Negligent homicide: Error in professional discretion Domestic violence Homicide: Domestic abuse Robbery Burglary Theft Bribery

37 170 64 85 63 76 165 33 170 79 76 36 632 36 30 35 37

10.2 9 10.1 6 9.96 9.73 9.43 9.37 9.37 9.15 8.97 8.26 8.04 8.00 7.55 7.43 7.35 7.20 7.12

1.22 1.70 1.78 1.91 3.01 2.03 2.32 2.06 2.55 3.03 3.21 3.34 3.29 2.84 2.73 2.90 2.50

23

Homicide: Euthanasia Violence between acquaintances Justified homicide: Prevention of offender's escape Tax evasion Justified homicide: Prevention of danger

316 36 154 36 162

6.49 6.25 6.01 5.58 5.12

3.69 2.73 3.21 3.37 3.50

15.3 0.0 3.3 0.0 4.5

46.0 75.0 55.7 33.3 34.8

10.9 25.0 15.3 46.7 21.2

27.8 0.0 25.7 20.0 39.4

Table 3 shows that, similar to Table 1, almost all criminal homicides (and also rape, drug selling, and some crimes of negligence) were considered the most serious scenarios (highest seriousness means and lowest standard deviations) by the traditional and religious respondents in the sample; again, no significant differences were found between these scenarios. Although unlike Table 2, the euthanasia scenarios were not rated as the least serious scenarios, they were still considered relatively non-serious by both traditional and religious respondents: These scenarios are still located at the bottom end of the seriousness ranking, with significantly lower seriousness scores than all the criminal homicide scenarios. Moreover, they still show the largest standard deviation in the table. Like the findings presented in the previous tables, the punishment scores reinforce these findings: Euthanasia scenarios, together with one situation of justified homicide (prevention of offenders escape) and tax evasion, received significantly higher percentages for not to prosecute than almost all the homicide and non-homicide criminal acts presented for evaluation. The only exception was the least serious act considered: prevention of danger.

24

Discussion
As stated, numerous studies show that public acceptance of euthanasia has increased significantly in recent decades. However, formal criminal statutes in most Western countries consider this practice a serious homicide. The argument of this study was that in contrast to the strong consensus that exists with regard to the seriousness of most criminal homicides, in the case of euthanasia this formal definition reflects mainly the particular views of religious groups in society; thus supporting the principles of the conflict model. This argument was expressed operationally by three research hypotheses. The research findings partially support this argument and hypotheses. First, as expected by the first two hypotheses and as shown in many crime seriousness studies, the situation regarding most criminal homicides accurately reflects the theoretical principles of the consensus model: Both bivariate and regression analyses show that there exists wide agreement among different Israeli social groups concerning their extreme seriousness (Tables 1 and 2); this agreement is reflected in the Israeli criminal code the mandatory punishment for murder is life imprisonment. Second, contrary to expectation, the particular situation regarding euthanasia does not seem to reflect the arguments of the conflict model accurately. Although as expected dissensus does exist between Israeli major social groups (unlike homicides, the most influential variables on respondents evaluations were related to their personal characteristics; Table 2), the research findings still show some consensus (although substantially lower than for most homicides) between them concerning the seriousness of euthanasia: All groups, including the religious, consistently considered it an act of middle-order seriousness, and consensually they perceived it as significantly less serious than any other form

25

of criminal homicide (and of many non-homicidal offenses; Tables 2 and 3). Moreover, as in the case of justified homicide, a significant part of the sample (more than one third; more than a quarter among religious respondents) considered euthanasia cases to be non-criminal acts and, as such, suggested that they should not be prosecuted at all (Tables 1 and 3). These findings imply that the Israeli public, irrespective of social groups, simply experience a substantially lower level of disapproval against an act of mercy killing as it does for other forms of homicidal (and non-homicidal) acts.15 According to these findings, and contrary to expectation, it may be concluded that the current severe criminalization of euthanasia seems not to reflect any major social view in this regard, including the religious. Although it may be still argued that this formal situation of euthanasia is due to the political coercion of influencing, reduced elite groups (e.g., physician authorities), it may be better explained under the tenets of Ogburns theory of cultural lag (1950): Material culture - technological inventions, advancements, and tools - normally changes faster than adaptive culture - institutional life - which generally lags behind; thus the former outstrips the latters capacity to contend rationally with the formers social and cultural consequences. Applied to this study, it may be said that instead of religious coercion, the formal consideration of euthanasia a serious homicide seems to be simply old-fashioned. In view of the consistent finding in the euthanasia literature concerning increasing public support for euthanasia practices, it may be concluded that the traditionally severe position taken by criminal statutes against euthanasia may have reflected general or particular views on this issue in the past, but today this is no longer the case.16

26

Accordingly, from a consensusally theoretical perspective, if the criminal law is supposed to reflect public attitudes, these findings support social calls for a complete reassessment of euthanasia in criminal statutes. As stated by Newman (1976: 283): " each and every society evolves and changes, so that what the public thought was 'right' in the 16th century may no longer be considered as 'right' in the 20th century." In this context, the current situation in the Netherlands may be seen as a good model for imitation. There, although still illegal, euthanasia is located in a relatively non-serious category of homicide and can, under certain specific conditions, be considered by prosecutors or judges as legally justifiable. Unlike most Western countries, in the Netherlands, prosecutors and judges are permitted wide consideration of the humanitarian motive of the defendant performing an act of euthanasia or assisting a suicide, the explicit consent of the patient, and the terminal character of the illness, when reviewing euthanasia cases. If the defendant can demonstrate that s/he has carefully balanced his/her conflicting duties in the conviction that treatment was senseless or futile and would prolong suffering, and the aforementioned conditions can be proved objectively at trial, s/he will not be convicted, or even prosecuted (Griffiths et al., 1998). Interestingly, these specific conditions were also found to affect the seriousness perceptions and punishment choices in this study (Table 4). It is worth noting, however, that in practice, unlike the formal law, criminal justice systems have already found ways to apply this need for reassessment with regard to euthanasia. Observations at the trial level suggest the letter of the law is applied somewhat differently in euthanasia cases, as evidenced in a high incidence of failure to indict, acquittal, finding the defendant temporarily insane, suspended sentences, and reprieve (Scherer & Simon, 1999; Yount, 2000).17 Hence, it could be argued that the cultural lag between the expected and formal seriousness status of

27

euthanasia has already been reassessed de facto. Although this situation may be perceived as reflecting adaptability on the part of judicial systems, it is, nonetheless, a basically undesirable characteristic because it may make the criminal law appear hypocritical in the eyes of the public; as consistently shown, the weaker the legitimacy of the law, the lower the citizens willingness to obey it (e.g., Denk et al., 1997; Roberts, 1992; Tyler, 1990).18 This situation highlights the importance of academic research that assesses public attitudes toward euthanasia by sophisticated survey approaches.

28

Notes
1. Due to the dichotomous nature of these models, Rossi and Berk (1985) introduced a more sophisticated analysis of public consensus, which included nine different, continuous models. 2. Among the basic premises associated with opposition to euthanasia, we may cite: (1) the potential for abuse by physicians, family members of the dying patients, and health insurance companies. These concerns are generally termed the "slippery slope;" (2) pressure on patients; and (3) the history of Nazi eugenics (Scherer & Simon, 1999: vii). 3. Religious beliefs tend to be associated with political conservatism, which is also strongly associated with opposition toward euthanasia (e.g., Caddell & Newton, 1995; Ho & Penney, 1992; Monte, 1991; Ross & Kaplan, 1993). 4. Conflict theorists have rarely considered religiosity as a source of conflict, since they mostly adopted a Marxist view of society, dividing the society in social classes. In addition, acts such as euthanasia appears to be more susceptible to the campaining of interest groups and where persons's moral evaluations of them are strongly affected by the norms of particular societal groups (Newman, 1976). 5. Other examples are the lack of state recognition of non-religious marriage, military exemption for religious scholars and observant women, and the formal prohibition of public transportation, commerce, and entertainment on the Sabbath and holidays. Note that both Judaism and Christianity tend to reinforce much of the State's requirements for the control of behavior. This is not surprising when one considers that much of the ideology of criminal sanctioning has its origins in Judeochristian law (Newman, 1976: 23).

29

6. Especially findings from students' samples have been found not to generalize well to the population at large, and particularly around criminological issues (e.g., Sears 1986): students are relatively homogeneous in their personal characteristics, and due to them and their relatively greater idealism, education, and political liberalism, tend to provide particular seriousness values to many criminal offenses. 7. According to formal data of the Israeli Ministry of Communications (personal communication), 98 percent of households in Israel have telephones, and the percentage of people not listed in the directories is fairly low. 8. Note that instead of focusing on a simple form of euthanasia or homicide for evaluation, by applying the factorial-survey approach (explained later) the present study took into account the complexity and heterogeneity of both acts. Moreover, unlike all aforementioned studies, additional non-homicide scenarios were added to the analyses for control purposes. Note also that terrorist, military, and criminal acts directly related to the Israel-Palestine conflict were excluded from the study: it only detailed homicidal and non-homicidal acts typically committed both in Israel and abroad. These improvements should considerably increase both the generalization of our findings to other national contexts and their internal validity. 9. The questionnaire was written in Hebrew, but translated into Arabic and Russian for these minority groups. The response rate was calculated on the basis of valid household numbers, excluding businesses, fax connections, etc. To boost response rates, respondents who could not be initially reached were contacted again. A household was replaced after three unsuccesful attempts. Because the sample was representative of the adult Israeli population, it may be assumed that no important groups were under-represented in it. Because the household's owner, whose name

30

appears in the telephone directory was not necessarily the person who answers the survey, the questionnaire remains anonymous. The questionnaire was also pre-tested with a small number of respondents in order to obtain an initial test of the measures reliability and to test for any unexpected response patterns (none were found). 10. These studies may be used by political candidates or interest groups to create a climate of opinion; thus they become the instigators of opinion (Newman, 1976: 294). 11. To measure religiosity, respondents were requested to define themselves as secular, traditional, or religious, according to their personal observance of religious precepts (see Newman, 1976). Such a measure is the most common categorization in terms of religiosity in Israel (e.g. Herzog, 2003). 12. The decisions regarding the number of dimensions to include in each scenario and the number of scenarios to present to each respondent were pre-tested and guided by methodological considerations, such as the use of a telephone survey, interview length, and full understanding of the scenarios. 13. The construction of both the questionnaires and the scenarios deviated slightly from complete randomization: homicides committed due to prolonged domestic abuse appeared in each questionnaire because this topic was the focus of another related study; all passive euthanasia acts (dimension A) were committed only by physicians (dimension B); all homicides committed to defend family honor (dimension F) were committed by men (dimension H) against women (dimension L). These deviations resulted in low intercorrelations among the dimensions.

31

14. On the one hand, concerning the offense of tax evasion, note that due to Israel high defense/security related expenses, the level of taxes is very high (see Ringen, 1987). Thus, tax evasion in Israel has become part of the way of doing "normal" business. On the other hand, since the second Intifada (2000) Israel has applied a clear policy of elimination of "terrorists" in the Palestinian territories. Accordingly, it is not surprising that the seriousness of these offenses were rated significantly low (for similar findings in England concering tax evasion, see Walker, 1978). 15. It was assumed that the statistical significance of the respondents characteristics variables - gender and religiosity - was mainly obtained because of the relatively high number of cases considered (more than 5,000 scenarios; Table 2). See also the small standard deviations obtained for most homicide scenarios (Table 1). 16. According to Newman (1976: 290), this situation tends to appear in less developed countries. 17. Note that despite the clearly illegal status of euthanasia in Israeli formal codes, its practical situation in Israeli's courts is complex and unclear. On the one hand, Judge Elon from the Supreme Court supports the general tenets of Jewish law, holding that human life is inherently sacred (see the Scheffer case). On the other hand, Judge Goren accepted in 1990 an appeal for dying with dignity (the Eyal case), based on the view that Jewish law recognizes the need not to afflict dying people, taking into consideration human suffering and pain. In addition, Rabbi Lau (the former Ashkenazi Chief Rabbi in Israel) wrote in a letter concerning this case that the Jewish law does not require, and sometimes prohibited, the performance of exceptional treatment that only prolonged the patient's suffering without healing the cause of the pain (see CohenAlmagor, 1995).

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18. Note that legislators often employ the strategy of maintaing obsolete laws in criminal codes for avoiding the message that certain behaviors become acceptable. As stated, many systems resolve such problems by not enforcing the law.

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Appendix 1: Scenario variables, values and examples: A. Type of euthanasia act (only for euthanasia scenarios) 1. Active injection of a lethal dose / 2. Active provision of a lethal dose / 3. Passive disconnection from a respiration machine / 4. Passive avoidance of connection to a respiration machine. B. Offenders identity (only for euthanasia scenarios): 1. Physician / 2. Relative C. Victims request (only for euthanasia scenarios) D. Diagnosis of a terminal illness (only for euthanasia scenarios) E. Severe suffering of the ill person (only for euthanasia scenarios): 1. Yes / 2. (Not stated) F. Homicide motive (only for homicide scenarios, including euthanasia) 1. Euthanasia (murder) / 2. Romantic infidelity (murder or manslaughter) / 3. Financial controversy (murder or manslaughter) / 4. Political controversy (murder or manslaughter) / 5. Domestic abuse (murder or manslaughter) / 6. Commission of a crime robbery (murder) / 7. Family honor due to suspected infidelity of woman (murder) / 8. High speed driving (negligent homicide) / 9. Endangering clients to save money (negligent homicide) / 10. Error in medical diagnosis (negligent homicide) / 11. Error in professional (clerk) discretion (negligent homicide) / 12. Prevention of offenders escape (justified homicide) / 13. Prevention

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of danger (justified homicide) G. Criminal offense (for all scenarios): 1. (Intentional) murder / 2. (Heat of passion) manslaughter / 3. Negligent homicide / 4. Justifiable homicide / 5. Domestic violence / 6. Violence between acquaintances / 7. Rape / 8. Burglary / 9. Theft / 10. Robbery / 11. Tax evasion / 12. Drug selling / 13. Bribery H. Offenders gender and L. Victims gender: 1. Male / 2. Female / 3. (Not stated) I. Offenders ethnicity and M. Victims ethnicity: 1. Jewish / 2. Arab / 3. (Not stated) J. Offenders age and N. Victims age (in years): 1. 25 / 2. 50 / 3. (Not stated) K. Offenders criminal record: 1. Yes / 2. (Not stated)

Sample scenarios: 1. A Jewish woman is suffering from a terminal illness. Due to her clear request to die, a 25-year-old female physician disconnects the patient from the respiration machine, thereby killing her. In your opinion, how serious is this act? Not serious at all 1 2 3 4 5 6 7 8 9 Very serious 10 11

If you were the judge in this case, what would be your decision regarding the appropriate punishment for the physician? Sentence her to life imprisonment / to years of imprisonment / to other less serious punishment (probation, community service, fine) / not to prosecute her at all it was not a criminal act.

42

2. A 25-year-old Arab man suspects that his wife, a 25-year-old Arab woman, is cheating on him. He therefore decides to kill her. When they are alone, he kills her.

3. A dangerous offender, a 50-year-old, Jewish man, is escaping from police custody. Therefore, a 25-year-old Arab police officer shoots and kills him.

4. Two acquaintances enter into a furious political argument during which one of them, a 50-year-old man with a criminal record, kills the other, a 50-year-old, Jewish man.

5. A 25-year-old Jewish man with a criminal record breaks into the apartment of an Arab woman through a window and steals jewels and money worth NIS 10,000.