Letters Doctors and torture

The campaign about doctors and torture in Israel five years on

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g4386 (Published 09 July 2014) Cite this as: BMJ 2014;349:g4386

Re: The campaign about doctors and torture in Israel five years on

We write as the Health Advisory Council of Jewish Voice for Peace (1) in support of the rapid responses by Drs. Derek Summerfield and Chris Burns-Cox dated 15 September and 12 February 2016 (2,3) regarding Dr Michael Marmot and the World Medical Association (WMA). We wish to endorse the call for accountability by the WMA in the matter of medical complicity with the torture of Palestinian prisoners in Israel. The WMA has yet to satisfactorily address the evidence brought to its attention, notably in a letter sent to the WMA in 2009 (4), cosigned by 724 physicians (including two of us, A.M. and A.R.) and a second letter sent in January 2016, cosigned by 71 UK physicians (2,3).

We note that the WMA's Declaration of Tokyo (5) is unambiguous: "The physician shall not countenance, condone or participate in the practice of torture or other forms of cruel, inhuman or degrading procedures, whatever the offense of which the victim of such procedures is suspected, accused or guilty, and whatever the victim's beliefs or motives, and in all situations, including armed conflict and civil strife." Regarding confidentiality: "When providing medical assistance to detainees or prisoners who are, or who could later be, under interrogation, physicians should be particularly careful to ensure the confidentiality of all personal medical information. A breach of the Geneva Conventions shall in any case be reported by the physician to relevant authorities" but "as an exception to professional confidentiality, physicians have the ethical obligation to report abuses". Further, "the physician's fundamental role is to alleviate the distress of his or her fellow human beings, and no motive, whether personal, collective or political, shall prevail against this higher purpose."

Multiple reports from Amnesty International (AI)(6,7,8), Physicians for Human Rights-Israel (PHRI)(9,10) and the Public Committee Against Torture in Israel (PCATI) (8,11) provide credible evidence that Israeli physicians working for the Israel Prison Service have violated these principles. While then-president of the Israeli Medical Association (IMA) Dr Yoram Blachar stated (12) that "we [the IMA] have never been specifically informed of any particular physician who was present during an act of torture", this statement in effect redefines the act of physician collaboration with torture as his/her presence in the torture chamber, while the AI report makes clear that "a bureaucratic system has been developed in which doctors and paramedics—who preserve the health and sometimes the life of detainees under interrogation— form an indispensable part. Without the presence and the silence of doctors and paramedics this system might not survive." (6) The PCATI/PHRI report (8) notes:

"Our experience on this matter is unequivocal: medical professionals are indeed among those working for the authorities who interact with prisoners and take part in what goes on in the prison system and the interrogation rooms. Medical professionals abandon their duty by failing to document and report torture; by passing on medical information to interrogators; returning interrogees to the custody of their interrogators when in danger of being exposed to further torture or ill-treatment; and in extreme cases, by taking an active part in the interrogation. Because of their unique social status, the presence of medical professionals in facilities where torture or ill-treatment are carried out indicates the boundary between the permissible and the impermissible; it grants ISA interrogators a stamp of approval, whether explicit or tacit, that their conduct is acceptable."

The IMA has never addressed this institutionalization of the role of physicians in the torture enterprise, nor has the WMA held the IMA to account on this and other problematic aspects of the IMA's posture vis-à-vis torture in Israeli prisons. For example, the IMA's ethical code grants the physician the option to subsume the patient's interests to those of the State:

"4. The physician shall be entitled to aid security authorities, at their request, even if this may harm the rights of the patient, only in cases in which there is a high probability that if he does not do so harm will be caused to society by the said patient." (13)

As clinicians, we categorically reject any suggestion that the duty of the physician to his/her patient may ever be superseded by the interests of "security authorities, at their request". Such a doctrine is anathema to the most fundamental and universal principles of the practice of medicine and indeed is in direct contradiction to the WMA's Declaration of Tokyo as cited above. We condemn complicity of Israeli physicians and the IMA in torture or ill treatment of Palestinian detainees and prisoners in Israeli prisons and call upon the WMA to review its stance on this matter and to repudiate such practices.

1. Jewish Voice for Peace mission statement, https://jewishvoiceforpeace.org/mission/
2. Summerfield DA, Burns-Cox C. Sir Michael Marmot, the World Medical Association, and medical complicity with torture in Israel. BMJ rapid response, 15 September 2016
3. Summerfield DA, Burns-Cox C. Sir Michael Marmot, the World Medical Association, and medical complicity with torture in Israel. BMJ rapid response, 12 February 2016
4. Kmietowicz Z. Doctors call for head of World Medical Association to quit "as a matter of priority". BMJ 2009;338:b2556
5. WMA Declaration of Tokyo - Guidelines for Physicians Concerning Torture and other Cruel, Inhuman or Degrading Treatment or Punishment in Relation to Detention and Imprisonment. 1975, 2005, 2006, 2016. available at http://www.wma.net/en/30publications/10policies/c18/
6. Amnesty International, International Secretarial. Israel and the Occupied Territories: Oral Statement to the United Nations Commission on Human Rights on the Israeli Occupied Territories. 29 January 1991. available at https://www.amnesty.org/download/Documents/196000/mde150041991en.pdf
7. Amnesty International. “Under constant medical supervision”: Torture, ill-treatment and health professionals in Israel and the Occupied Territories. August 1996
8. Amnesty International. Israel and the Occupied Palestinian Territories (oPt): Briefing to the Committee Against Torture. September 2008
9. Physicians for Human Rights-Israel and the Public Committee Against Torture in Israel. Doctoring the Evidence, Abandoning the Victim: The Involvement of Medical Professionals in Torture and Ill Treatment in Israel. October 2011
10. Adalah, Al Mezan Center for Human Rights, Physicians for Human Rights-Israel. Joint NGO Report to UN CAT: Written information for the examination of Israel’s report by the Committee, 57th session, May 2016, submitted 28 March 2016
11. Public Committee Against Torture in Israel. Ticking Bombs: Testimonies of Torture Victims in Israel. May 2007
12. Blachar Y. Amnesty report on torture in Israel. Lancet 1996;348:1738
13. Reches A. The Ethics Board: Rules and Position Papers. Part D: The Medical Ethical Code. 2. Physician-society relations. i) Cooperation between the physician and law authorities. Israeli Medical Association, The Ethics Board, 2009, p 33. available at https://www.ima.org.il/ima/formstorage/type7/imaethicalcode2013.pdf

Competing interests: No competing interests

14 December 2016
Alan F Meyers
pediatrician (retired)
Maxine Fookson RN, MN; Alice Rothchild MD; Rachel Rubin MD,MPH; Peter Sporn MD, Ari Wohlfeiler
Boston University School of Medicine
84 Amory Street, Cambridge MA 02139 USA