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-a (Published 04 September 2003) Cite this as: BMJ 2003;327:561
Reply from the BMA
- Vivienne Nathanson, director of professional activities ()
EDITOR—Summerfield's open letter is addressed to three organisations, and the BMA can speak only for itself. I agree with several points he raises. Firstly, I agree that the mere fact of membership of the World Medical Association is not necessarily any guarantee of exemplary ethical conduct. There are good arguments for maintaining an inclusive international organisation that seeks to influence medical associations positively by exposing them to best practice rather than excluding and isolating them.
I agree that reports from organisations such as Amnesty International have indicated problems in Israel, but such reports also show that no country on earth has a blameless human rights record. (The BMA's own human rights report of 2001,1 discussed examples of abuse of human rights, involving doctors as victims, witnesses, or collaborators, in over 100 countries. Abuses range from medical participation in capital punishment, judicial amputations, floggings, and torture through to “routine” acts of female genital mutilation or neglect of prisoners.) This is only a partial picture of the reality of human rights violations worldwide. Many WMA member countries clearly have human rights problems, and it is not always clear what action members should take to address these.
Summerfield is correct in saying that the BMA left the WMA after the Steve Biko affair in the apartheid era. The BMA was then unable to influence the development of WMA policies. Considerable discussion took place about the pros and cons of membership before we rejoined the WMA; wielding influence was a major factor in the decision to rejoin.
A main theme of the BMA's latest human rights book is facilitating change through education, support, and publicising best practice. The democratic view in the WMA is that encouragement to improve is likely to have more success than mere condemnation and is one reason for its admitting the China Medical Association into membership. By raising awareness among medical leaders, the hope is that doctors will ultimately have a positive human rights influence in the communities in which they work. But this is a long process, and there are no easy solutions.
This is not to deny the importance of thorough investigations of all allegations of malpractice or culpable inaction concerning doctors in any country by an appropriately resourced and independent expert body. I agree with Summerfield that such investigations should happen wherever allegations arise, but the problem is to identify by whom. We already have international human rights machinery through the United Nations. Although it may not always be effective, it is hard to see how it could be superseded. Therefore, the BMA has consistently highlighted the crucial role of the UN system of human rights rapporteurs. Problems of access to healthcare services and safe passage of ambulances, for example, are issues that the BMA has drawn to the attention of the new UN Rapporteur on the Right to Health along with examples of other obstacles to health care in many other countries.
Although we are not a human rights campaigning organisation, the BMA has a good record on raising awareness of human rights standards among doctors. We lack the means, the expertise, and the hubris to measure and assess the performance of other national medical associations. The aim of our human rights focus has been to encourage doctors and medical associations to address, where they can, factors that give rise to abuse but not to act as policeman, judge and jury.
I acknowledge that there are different opinions on this subject, and, through lengthy correspondence, Summerfield and I have taken differing views on what could effect change. He has a passionate belief in human rights, which commands respect. The BMA would rather work with him to promote human rights than argue about methods. It is not obvious how exclusion of the IMA—and presumably of many more associations that stand accused of being passive collaborators in systematic human rights abuses in their own countries—will improve the situation. Through regular and robust debates on ethics and human rights, the BMA and the WMA raise awareness among medical associations of international human rights standards more effectively than a system of criticism and boycotts of any medical association.