Netanyahu is undergoing surgery. Who takes over if something goes wrong?

Prime Minister Benjamin Netanyahu’s prostate removal surgery Sunday has revived concerns regarding the 75-year-old leader’s physical well-being, along with questions of what would happen should his health suddenly fail, leaving him unable to manage the affairs of state, or worse.

Twice in the last 30 years, Israel’s government has had to deal with the sudden loss of its prime minister: the 1995 assassination of Yitzhak Rabin and the incapacitation of Ariel Sharon after he suffered a series of strokes in early 2006.

Unlike Sharon, who had appointed a successor to take over in the interim should anything happen to him, Netanyahu has resisted naming any such figure, instead doing so on an ad hoc basis when the need arises.

A version of this article first ran following a previous prime ministerial surgery in March 2024.

A series of surgeries

The most recent episode in the ongoing saga of Netanyahu’s health came on Saturday when the Prime Minister’s Office announced that he would have his prostate removed in surgery on Sunday, and noting that doctors had discovered and treated an infection in his urinary tract resulting from a benign enlargement of the prostate.

The prime minister was to be put under full anesthetic for his operation, scheduled for Sunday evening, and will remain in the hospital for several days following the surgery, his defense lawyer told the Jerusalem District Court. A request to cancel Netanyahu’s scheduled testimony in his ongoing corruption trial this week was quickly accepted by the court.

While Netanyahu is incapacitated, Justice Minister Yariv Levin will fill in temporarily as acting premier and Defense Minister Israel Katz will be authorized to convene the security cabinet if needed.

This is only the latest in a series of procedures the prime minister has undergone over the last two years.

This March, as he underwent surgery for a hernia at Jerusalem’s Hadassah Ein Kerem hospital, Levin was, just as now, placed temporarily in charge of the country. That same month, Netanyahu missed several days of work after contracting the flu.

Sunday’s procedure came less than a year after Netanyahu was fitted with a pacemaker after suffering a “transient heart block.” A week before then, he had been hospitalized for what he said at the time was dehydration. Doctors subsequently revealed that the prime minister has had a heart conduction problem for years.

That episode led to considerable speculation among many in Israel as to the health of the prime minister and to what degree details had been hidden from the public.

A medical report released in January said Netanyahu was in a “completely normal state of health,” that his pacemaker was working correctly and that there was no evidence of heart arrhythmia or any other problematic conditions.

Despite protocols requiring prime ministers to release such health reports annually, Netanyahu did not release one between 2016 and late 2023. He could not be legally forced to share his health information as these protocols, developed by the PMO, are not enshrined in law.

The prime minister is dead, long live the prime minister

According to Amir Fuchs, a senior researcher at the Israel Democracy Institute, if a prime minister dies in office “it’s as if the government had resigned on the same day.”

Speaking with The Times of Israel in March, Fuchs explained that rather than leave the nation rudderless, the cabinet would quickly convene and hold a simple majority vote to appoint a Knesset member — likely one of their own rank — as acting prime minister until a new government can be formed.

Within 14 days the president must task a Knesset member with forming a government.

While the deputy prime minister, in this case Levin, might have a leg up on the competition, they would not be automatically appointed to fill the premier’s shoes.

“It’s just like after we have an election,” Fuchs said.

Should the prospective prime minister designated by the president fail to establish a workable coalition, the country would have to hold elections, he explained.

“There is no line of succession like in the United States,” Fuchs said. “It’s a different approach. It’s not like in the US, where you vote for the president and vice president, and if he dies, the vice president becomes the president, and everything is normal. The whole government dies with the prime minister, and we need to form a new government.”

This is what happened on November 4, 1995, when Rabin was assassinated by a Jewish far-right extremist. Within hours, the cabinet met and appointed foreign minister Shimon Peres as acting prime minister. Peres was later named the head of the Labor Party and subsequently tasked with forming a government by president Ezer Weizman.

Peres formed a government with little hassle, but months later called new elections, which also marked the first time Israelis ever voted for a prime minister directly (in a short-lived electoral reform experiment). On May 29, 1996, Peres was defeated by a young upstart politician named Benjamin Netanyahu.

A lesson from Sharon

Since his third return to power in December 2022, Netanyahu has declined to formally designate an acting prime minister to take over if he were to suddenly vacate his seat or be incapacitated.

But Israeli law requires an acting prime minister to step in during situations in which the leader is either abroad or temporarily unable to perform their duties, such as during a medical procedure involving loss of consciousness. In line with the law, Netanyahu has appointed a temporary acting prime minister each time it became necessary.

“It’s a different approach. It’s not like in the US when you vote for the president and vice president and if he dies the vice president becomes the president and everything is normal. The whole government dies with the prime minister and we need to form a new government.”

When a prime minister is incapacitated without a designated acting prime minister, the government chooses his temporary replacement — again by way of a simple majority in the cabinet.

According to the quasi-constitutional Basic Law: The Government, “should the Prime Minister be unable to perform his duties on a permanent basis, the Government is considered to have resigned on the 101st day on which a replacement served in his place.”

After the 101st day, legally it is as if the prime minister had died and the president is tasked with giving an MK the mandate to form a new government — and if that MK cannot do so, the country goes to the polls.

Speaking with The Times of Israel last year, sources in Netanyahu’s Likud party explained that his reluctance to designate an acting prime minister stemmed from worries that he would suffer the same fate as Sharon — not a stroke, but an unintended successor.

When Sharon went into a coma on January 4, 2006, from which he would not emerge until his 2014 death, acting prime minister Ehud Olmert automatically stepped in to run the government, becoming head of Sharon’s Kadima party.

A previously scheduled election held in late March gave Kadima 29 seats and Olmert formed a government weeks later.

But Sharon had never intended Olmert to lead Kadima or the government, the Likud sources said. Olmert’s title of acting prime minister was granted for reasons of political expedience, with Sharon apparently not seriously thinking the reins would ever actually fall into the hands of the former Jerusalem mayor.

There is no difference in the scope or authority of a regular prime minister versus one appointed as a temporary acting premier — except that the replacement has the slightly curtailed status of any prime minister during a transitional government.

“It’s the same, for example, with a regular prime minister when going to an election, since the government indeed fell,” explained Fuchs. “It’s not written anywhere but in many verdicts the court limited the transitional government,” saying it must not deal with issues “that aren’t urgent and necessary.”

Paralyzed

While the cabinet gets to choose a temporary replacement for an incapacitated prime minister, a more basic question, of who gets to decide whether or not the prime minister is incapacitated, has been a source of controversy.

Until recently, the attorney general has had the authority to do so, but that changed with the passing of the recusal law, an amendment to Basic Law: The Government, in March 2023.

The law — which restricts a declaration of incapacity to reasons of “physical or mental inability only” — states that there are only two ways for a prime minister to be removed from office: either by informing the Knesset that they are recusing themselves or through being suspended by way of a three-quarters vote of the cabinet which is then upheld by a 90-member supermajority in the Knesset.

Opponents of the recusal law have argued that it was designed, among other things, to shield Netanyahu from the consequences of possibly violating a conflict of interest agreement he signed in 2020 to allow him to serve as premier while on trial for corruption charges. Under that deal, Netanyahu committed not to involve himself in judicial matters that could affect his ongoing trial.

In a six to five ruling in January, the High Court of Justice ordered that the law not be implemented until the beginning of the next Knesset term, determining that it had been passed to personally benefit the premier.

Fuchs, who said the law was problematic and a new one should be passed, noted that the practical implications of the legislation are that Israel’s body politic could be left paralyzed.

“So if we have someone in a coma but the politicians don’t decide, that’s it, there’s no way to announce someone is incapacitated,” he said. “It’s illogical.”

Times of Israel staff, Carrie Keller-Lynn, Lazar Berman and Jeremy Sharon contributed to this report.