Medical ethics, the Israeli Medical Association, and the state of the World Medical Association
BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7414.561 (Published 04 September 2003) Cite this as: BMJ 2003;327:561All rapid responses
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Dear Dr Smith,
Yes, well, we can all quote Milton.
He begins Paradise lost by saying:
‘ Fast by the Oracle of God, I thence invoke thy aid to my
adventurous song, That with no middle flight intends to soar above th’
Athonian mount, while it pursues things unattempted yet in prose or
rhyme’.
What follows is a story in verse that is still being read three
hundred years later.
Personally, I am not that interested in who said what to whom at the
World Medical Association. What matters is what is happening on the ground
in the Middle East. That is best described by a calm narrative on the
suffering of civilians on both sides.
Because, what is undeniable is that, like all civilians in all wars,
they have been betrayed by leaders who regard conflict as an acceptable
price to pay for authority.
Yours sincerely,
John Hopkins
Competing interests:
None declared
Competing interests: No competing interests
Editor - In response to Dr Summerfield’s letter written in the
September 6th edition of the British Medical Journal, I was shocked to
read his biased view with regard to the Israeli Medical Association. The
conflict in the Middle East is an extremely sensitive and difficult issue
where not only Palestinian, but also innocent Israeli lives are being
threatened which Dr Summerfield fails to mention. You cannot talk about
the IMA without putting the Israeli/Palestinian conflict into context,
something which Dr. Summerfield painfully disregards. The IMA is forced
to work in extreme circumstances where it is difficult to act as one would
during peace times. Israeli doctors and nurses have worked in a war zone
for over 2 years, treating victims of terrorist attacks on a daily basis.
They have treated patients and suicide bombers side by side in hospitals
and discriminate against no one in their struggle to save lives. Often
because of their greater injuries the Palestinian suicide bombers will be
treated ahead of their Israeli victims.
Dr Summerfield comments on how Palestinian ambulances have been fired
on by the IDF in the past, however there is no mention of that there have
been a number of terrorist incidents involving Palestinian Red Crescent
Workers over the past few years. Palestinian terrorists have abused
Palestinian ambulances, rescue vehicles and medical symbols, as an example
of this recently a Red Crescent ambulance has been used to transport a
gunman who then killed an Israeli soldier. The IDF have no wish to delay
the passage of Palestinian ambulances who are legitimately trying to treat
the sick or wounded. But like every other country in the world, Israel has
the right to defend itself against terrorism and currently the Palestinian
Authority’s failure to clamp down on terrorist infrastructures leaves the
IDF with little choice.
The IMA are responsible for groundbreaking discoveries in the field
of medical research and its experience and expertise are used throughout
the world for the treatment of sufferers. Its care not only provides for
all the residents of Israel irrespective of their race, colour or creed
but, has provided treatment for other nations in the wake of natural
disasters such as Turkey and Greece. Whatever your opinion of the Israeli
government, we should applaud the IMA for their great diligence and
professionalism under such appalling circumstances.
Lotte Newman
Competing interests:
None declared
Competing interests: No competing interests
After following the links provided by Zagzoug, which he provides
facts in this debate, I am still unclear as to why Dr Blachar should be
considered unprofessional or, as the title of Mr Zagzoug's response seems
to imply, inhuman.
None of the links seem to lead to any evidence of wrong doing by the
President of the IMA.
If Dr Blacher is to be held accountable for every action of his
government, then would the same hold true for other countries? For
example, the Amnesty site lists the torture of a Palestinian supporter by
the Egyptian Police.(1) Would this bar a Egyptian Doctor from the
Presidency of the WMA?
One would have thought that the medical profession would be a group
that could operate in a spirit of mutual respect and understanding,
whatever their politics. This might have useful practical benefits for
all concerned.
Instead, it seems that people wish to use Dr Blacher's appointment as
an opportunity to play at politics under the wafer-thin mantle of a
ethical debate.
1.
http://web.amnesty.org/library/Index/ENGPOL300052003?open&of=ENG-EGY
Competing interests:
None declared
Competing interests: No competing interests
1. BMJ readers may be interested in a different view on the
relationship between Zionism is and the Jewish religion (see below).
http://www.jewsnotzionists.org/
http://www.nkusa.org/
2. The Medical Protection Society may back libel action if a doctor's
reputation is likely to be damaged by an accusation. Correspondents may
wish to bear this in mind when trading claims of racism.
3. Despite claims of a larger popoulation, the population of Israel
is 6 million (including Israelis resident overseas). It is also decidedly
multi-ethnic.
The population includes 5 million Jewish Israelis (many of whom are
declaredly secular), 1 million Arab Israelis and al least 0.25 million
recent non-Jewish immigrant workers (Chinese, Malaysian, Ghananian,
Turkish etc). There are a further 3.5 million Arabs in the Occupied
Territories. Fertility rates in the Jewish population are just above the
replacement rate and emigration from Israel in recent years exceeds
immigration. Fertility rates in the Arab population are very high (6
children per woman).
In other words, taking the whole of Israel-Palestine there are today
5 million Jews and 4.5 million Arabs. In 20 years there will be 5.4
million Jews and 6.1 million Arabs. In another twenty, 6.2 million Jews
and 9.5 million Arabs.
This means that unless the a "greater Israel" that includes the
Occupied Territories will rapidly become a de facto Arab state. This is
why some of the current Israeli government's coalition partners (the
National Union - an alliance of three small parties: Moledet, Tekuma and
Yisrael Beitenu) advocate mass expulsion of Palestinians. (Ref. 2)
Ref. 1 Israel and Palestine. Why They Fight and Can They Stop?
Bernard Wasserstein Demy Paperback 2003
Ref. 2 http://www.moledet.org.il/english/moledet.html
Competing interests:
None declared
Competing interests: No competing interests
Once upon a time the BMJ supported a boycott of South Africa. The
justification was obvious. South Africa was an apartheid state and the
welfare of the oppressed was getting worse - not better. Israel is also
an apartheid state and the welfare of their oppressed is also getting
worse - not better. Nevertheless Nathanson argues that a boycott isn’t
appropriate because the situations aren’t equivalent. In this I agree –
there is no equivalence. The case for a boycott of Israel is twice that
against South Africa. After all Israel:
1. It is an apartheid state AND …
2. It is engaged in an unnecessary war of territorial expansion against
its defenseless neighbour. A war which it fights ignoring all known rules
of human decency and convention.
Let us not forget Burke’s words, ‘The only thing necessary for the
triumph of evil is for good men to do nothing.’ I agree. At least a
boycott – however pathetic - is doing something. I also suspect that
Burke, when debating genocide and ethnic cleansing, would regard the BMJ’s
program of “robust debates on ethical issues”, as doing nothing!
Competing interests:
None declared
Competing interests: No competing interests
It was sad to see the ranting of Derek Summerfield given such pride
of place in the letters section of the BMJ. This man is well known for his
anti-Israel agenda and this diatribe was no exception. The WMA has
democratically elected its chairman, no doubt despite a flurry of
malicious claims by the likes of Summerfield. What is patently
preposterous is Summerfield’s arrogant assumption that his flawed
superficial knowledge exceeds that of all member states of the WMA
involved in this election.
His other largely unsubstantiated claims not only reveal a man with a
deep seated hatred of Israel but are also insulting for those of us who
have worked as physicians there. He talks of the neglect shown to
Palestinians by Israelis but fails to mention the vast numbers of
Palestinians treated in Israeli teaching hospitals (often more than 50% of
the caseload in Jerusalem). This figure includes Palestinian terrorists
injured in botched suicide attacks. It is worth adding that these
terrorists are usually seriously injured and as such are triaged and
treated before their Israeli victims.
From the safety of Denmark Hill, Summerfield pours scorn on Israeli
doctors who struggle every few weeks to deal with victims from atrocities
on the scale of the Omagh bomb. He fails to acknowledge the deliberate
targeting of women and children by the Palestinian leadership and perhaps
worse of all, he fails to address the involvement of Palestinian doctors,
medics and ambulances in the ongoing terror campaign. (At least 5 doctors,
including Dr Rantisi, a paediatrician, are senior Hamas commanders and
countless Palestinian ambulances have been found smuggling weapons and
even the bombers themselves.)
Unfortunately the BMJ reply was hollow and weak. It makes no counter
to Summerfield’s baseless accusations and implies tacit acceptance of his
misleading comments. In a response that tries to sit on an increasingly
wobbly fence, the BMJ re-asserts that if someone sends in enough letters
repeating the same lies again and again, he will eventually gain
credibility. In particular, Ms Nathanson’s comment that Summerfield’s
belief in human rights ‘commands respect’ is remarkably naïve and
completely ignores his hidden agenda. It is quite clear that Summerfield’s
often mistaken beliefs on human rights are targeted against a single state
whilst the rest of the world appears to bypass his highly selective moral
microscope.
Competing interests:
None declared
Competing interests: No competing interests
Dear Sir,
The stimulating article written by Dr. Summerfield, and responses to it, makes it hard for the conscience reader to overlook the issue. It is part of our professional responsibility to take such topic seriously and to find out what's the truth behind what's said. We have facts that need to be verified, emotions have to be directed towards the right way and actions have to be taken based on them. The issue in hand simply is not the Arabian-Israeli conflict, or the recent dreadful bombing from the Israeli F-16 or the retaliatory attacks from the desperate Palestinian. It's better left to the politicians. We are as health professionals, holds the responsibility to have a strong unified stand in choosing a person as the advocate of ethics and principles in our profession worldwide.
Facts are easy to find:
http://shr.aaas.org/aaashran/country.php?c_id=15
http://web.amnesty.org/library/Index/ENGMDE150182002?open&of=ENG-ISR
http://www.jewishvoiceforpeace.org/involved/action.htm (An Israeli siteļ)
The evidence posed here, in addition to the references sited by the original article is more than enough to reach a conclusion about the issue in hand. Is this the right person to lead the world medical association and be an advocate for professional ethics? Well this is not the hard part. ļ
Emotions have to be justified:
As humans and responsible professionals cannot accept or tolerate that a criminal would be a role model and a devil is an ethics advocate. If we agree that this person based on the evidence is not suitable to that position, we have to regret, refuse and even protest to this appointment.
And actions are not easier than this:
I would suggest sending letters of our opinions to the following:
World Medical Association wma@wma.net
Standing Committee of European Doctors cpme@euronet.be
Amnesty International (AI) amnestyis@amnesty.org
Commonwealth Medical Association (CMA) com-med-assn@compuserve.com
We cannot take this issue lightly.
Hazem Zagzoug
Competing interests:
None declared
Competing interests: No competing interests
Thank you for your rapid response, and what has happened in Israel in the past
24
hours is clearly dreadful.
I understand why you want us to remove the rapid response you refer
to,
but we are always reluctant to take down rapid responses and to censor
debate. I believe strongly that free debate is ultimately a major
benefit, even though it means that people will sometimes be upset and
offended.
John Milton gave the best argument in know in favour of free speech.
"Give me," he wrote, "the liberty to know, to utter, and to argue freely
according to conscience, above all liberties. Truth was never put to the
worse in a free
and open encounter ... It is not impossible that she [truth] may have
more shapes than one ... If it come to prohibiting, there is not ought
more likely to be prohibited
than truth itself, whose first appearance to our eyes bleared and dimmed
with prejudice and custom is more unsightly and implausible than many
errors …Where
there is much desire to learn there of necessity will be much arguing,
much writing, many opinions; for opinion in good men is but knowledge in
the making."
There would also be practical difficulties in removing the rapid
response you object to. There have been others that have been similar
and should thus be logically removed. There have also been rapid
response that are strongly anti-Palestinian. How could we decide what to
remove without exacerbating this dreadful state of affairs?
Yours sincerely
Richard Smith
Editor, BMJ
Competing interests:
I am the editor of the BMJ and accountable for all that it contains.
Competing interests: No competing interests
Editor,
It is indicative of the confused times we live in that people feel it
necessary to attack the Israeli Medical Association in the BMJ.
This week saw another suicide bombing and with it the loss of a well
respected Doctor. Dr. David Appelbaum, the head of Emergency Medicine at
Shaare Zedek
Medical Center, and his 20 year old daughter, were murdered while having a
meal in a Cafe the night before her wedding. (1) Dr Appelbaum would
normally be the first to appear at the site of an attack to help
ambulances to evacuate the injured. Ironically, he had just returned from
the US after giving a lecture on dealing acts of mass terror.
Israel is the only democracy in the Middle East and is under attack
from a terrorist organisation whose own Covenant is clearly anti-semetic
and not compatible with the continued existence of Israel.(2)
To view this situation out of this context and without reference to
the war of terror being conducted against Israel is simplistic. The
people critical of the IMA should spend their time and energies more
appropriately by trying to convince the Palestinian authorities to curb
the activities of HAMAS.
Targetting the IMA President in this way is an appalling act of
double standards and has little to do with medical ethics.
1. Bombing kills hospital ER chief, daughter:
http://www.haaretz.com/hasen/spages/338755.html (accessed 10th of
September 2003)
2. The 1988 Hamas Covenant:
http://www.yale.edu/lawweb/avalon/mideast/hamas.htm (accessed 10th of
September 2003)
Competing interests:
None declared
Competing interests: No competing interests
open reply to Andrew Rouse
Dear Dr Rouse,
I read your recent posting with some disbelief. Don't get me wrong, I
am all for varied opinions but you must have some factual basis for that
opinion. Labelling Israel apartheid not only belittles the genuine
apartheid of old South Africa but it is a complete nonsense. Israel has
over a million Israeli Arabs as part of the state. They all have voting
rights and freedom to travel anywhere within Israel. There are Arab
generals in the the Israeli army, Arab judges, Arab policemen and Arab
politicians. This is not apartheid. If you want apartheid in the Middle
East then cast your eyes at Saudi Arabia. There are numerous restrictions
for non-Muslims and frequent signs which state "Muslims only".
The other part of your posting was equally inaccurate. The fact that
you accuse Israel of 'ignoring all known rules of human decency and
convention' is breathtaking. It is Palestinians who board buses and sit
next to women and children prior to blowing them up. This extremely
intimate act of barbarity does not seem to feature in your definition of
human decency.
I would also urge you to consult some history books on the region.
You would then gain perspective on how the West Bank and Gaza were part of
Jordan and Eygpt respectively and were never an independant Palestinian
State. It may also benefit you to know how the original British mandate of
Palestine was divided in the 1920's in order to create a brand new Arab
country called Jordan. Now you advocate dividing what's left into another
brand new country called Palestine?
Do some research Dr Rouse before you go for publication. As a doctor
I thought this would be obvious to you.
Regards
Dan Ellis
Competing interests:
None declared
Competing interests: No competing interests