New bill on force feeding prisoners poses medical dilemma for Israel’s doctorsBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h3304 (Published 16 June 2015) Cite this as: BMJ 2015;350:h3304
Israel’s doctors are finding themselves caught between their ethical obligations as doctors and a government bill likely to become law that would require them to force feed prisoners who go on hunger strikes that endanger their lives. Currently four Palestinian prisoners are refusing to eat solid food, and one has been admitted to hospital in a weak condition.
Prime Minister Benjamin Netanyahu’s right wing cabinet approved on Sunday 14 June the decision to revive the bill, which was dropped in the previous 19th Knesset (parliament) last year because of strong opposition by the Israel Medical Association. But the government has rushed it through so it can go through the legislative process’s official readings.
The association’s chairman, Leonid Eidelman, and the Physicians for Human Rights-Israel organisation strongly attacked the cabinet decision in a letter to the new internal security and justice ministers. The bill would make it possible for doctors to receive a court order to give medical treatment to hunger strikers or force feed them against their will and even their active opposition.
The next day the deputy health minister and ultra-Orthodox rabbi Ya’acov Litzman denounced Eidelman for directing the association’s members not to implement the requirements of the bill if it is passed. Speaking at a session of the Knesset’s health committee, Litzman demanded that Eidelman “take back what he said and apologise.” He added, “If he refuses, I will find ways to take action.”
The association objects because it places responsibility on doctors to carry out invasive treatment of prisoners in spite of their preferences and right to autonomy. The bill thus contravenes the Patients’ Rights Law, said Eidelman, as well as medical ethics codes accepted in Israel and abroad. Doctors are sworn to uphold the principle of “non-maleficence,” that is, the obligation of the physician not to inflict harm intentionally. Thus, doctors will face complex and difficult ethical dilemmas if the bill passes.
The association accepted the Tokyo Declaration in 1975 and the Malta Declaration in 1991, both formulated by the World Medical Association, which specifically preclude the force feeding of hunger strikers. The declarations ban not only the use of a tube in force feeding but also feeding prisoners intravenously, Eidelman said. The Israel Medical Association considers both methods to be unethical.1 In recent years Israeli doctors have amassed much experience in treating security prisoners and hunger strikers “and didn’t have to use such drastic measures and violate ethical rules,” he said.
In fact, the bill “is not realistic, and it will not solve any problem,” Eidelman said. “It creates the illusion that, with such a law, one can prevent harm to the health of hunger strikers—but it doesn’t actually do so. We will not agree to such a law that places physicians at the front where they don’t belong, both as a group and as individuals, in complete violation of their professional and ethical responsibilities.”
A large hunger strike that prisoners held last year ended without a single prisoner dying or experiencing chronic harm, Eidelman said. As part of the doctors’ struggle against the bill last time the association held a conference on how to treat prisoners and detainees who went on hunger strike. It was attended not only by doctors but also by senior officials from the health ministry, Israel prison service and Red Cross representatives, medical ethicists, and senior medical administrators. It concluded with a consensus prohibiting forced medical treatment, including feeding.
Cite this as: BMJ 2015;350:h3304