Medical ethics, the Israeli Medical Association, and the state of the World Medical AssociationBMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7414.561 (Published 04 September 2003) Cite this as: BMJ 2003;327:561
Open letter to the BMA
- Derek Summerfield, honorary senior lecturer ()
EDITOR—Persistent concerns have been raised about the role of the World Medical Association (WMA), the international watch-dog on medical ethics, in respect of their approach to the Israeli Medical Association (IMA) in particular.1 Matters have now come to a head with the news that Yoram Blachar, longstanding IMA president, has been elected as chairman of the WMA council.
The WMA must know the well founded criticism over many years of the medical ethical track record of the Israeli Medical Association (IMA). In 1996 Amnesty International concluded that Israeli doctors working with the security services “form part of a system in which detainees are tortured, ill treated, and humiliated in ways that place prison medical practice in conflict with medical ethics.”2 Other major human rights organisations, such as Physicians for Human Rights (USA) and Human Rights Watch, published similarly. The IMA did nothing, although when challenged tended to dismiss criticism as “political” and point to their membership of the WMA as evidence of their probity. Moreover Blachar is on record in the Lancet as defending “moderate physical pressure” during the interrogation of Palestinian detainees: it is not often that the president of a national medical association uses a medical journal to defend what the rest of the world, and the UN Committee Against Torture, regarded as torture.3 Thus the IMA have been in violation of the WMA's Declaration of Tokyo, which forbids the involvement or collusion of doctors with torture or other cruel, inhuman, and degrading procedures. The WMA has consistently chosen to ignore the mass of documentation pointing this way.
During an interview in 1999 with a delegation from the Medical Foundation for the Care of Victims of Torture, London, the then head of ethics of the IMA, E Dolev, stated openly that “a couple of broken fingers” during the interrogation of Palestinians was a price worth paying for information.4 This was sent to Delon Human, WMA secretary general, whose response was telling. He wrote back to say, “I must come to the defence of the IMA in affirming that they are co-signatories of the WMA Declaration of Tokyo. They have been active collaborators in the WMA's continued struggle to eradicate torture of any kind in prisons or other settings all over the world” (personal communication, 29 October 2001). He later added that he had spoken to Blachar, already a WMA council member. Blachar had reassured him that the IMA had done nothing wrong and had shown him “classified material,” presumably from military sources. It is preposterous that Human was satisfied by this.
The other major ethical issue is medical neutrality. The blatant and apparently systemic disregard shown by the Israeli defence force during its reoccupation of the West Bank early last year and subsequently, has been widely reported: Palestinian ambulances fired on (231 incidents to date) and their personnel killed, sometimes after the ambulances had been cleared for safe passage, the International Committee of the Red Cross and other aid agencies obliged to limit activities in the West Bank as a result of threats to staff and attacks on vehicles and officers, severely injured Palestinians dying of blood loss because their relatives were not permitted by Israeli soldiers to take them to hospital, the safe passage of emergency supplies of food and medicines blocked, wilful destruction of water supplies, electric power, and the public health and medical infrastructure. Blachar's response to an editorial in the Lancet last year on these events makes his and the IMA position clear.5 6 Bar a one sentence reference to the principle of medical neutrality, he emphatically attacked the editorial en bloc and unconditionally defended the behaviour of the Israeli army. He implies that the death of Palestinian civilians was not morally equivalent to the death of Israeli civilians: this dehumanisation is the enemy of any universal application of medical ethics and medical humanitarianism.
A recently published report by Physicians for Human Rights Israel (PHR, www.phr.org.il) states that “we believed that the IMA might be able to curb the appalling deterioration in the attitude of Israeli military forces towards Palestinian health and rescue services. Yet despite severe injury to medical personnel and to the ability of physicians to act in safety to advance their patients' interests, despite Israeli shells that have fallen on Palestinian hospitals, despite the killing of medical personnel on duty—IMA has chosen to remain silent.”7 The IMA has refused to answer any of PHR's detailed complaints. Hadas Ziv of PHR Israel charged in the Lancet recently that the IMA was merely an executive arm of the Israeli establishment, working to support political imperatives rather than serving universal medical ethics.8
It seems to many that it is PHR Israel not the IMA who are the upholders in Israel of what the WMA exists for. Thus I question the judgment and rigour of Human in his scarcely credible public defence of the IMA, and of Blachar, whose presence at the WMA affords him the opportunity to “explain” why the IMA should not be the subject of serious scrutiny. For Blachar to now take up the chairmanship of the WMA Council is to reduce things to a mockery of what was intended when the WMA was created in 1947.
Until now the BMA has relied on discreet methods but these have not worked. Once before the BMA took a robust approach—in relation to the Medical Association of South Africa (MASA) during the apartheid era—and for a time withdrew from the WMA in protest at their re-admittance of the MASA. The BMA surely needs to use its weight to confront the WMA leadership and the IMA. Things cannot go on like this: please act on our behalf. For a start, Blachar cannot remain as chairman.