Medical ethics, the Israeli Medical Association, and the state of the World Medical Association, Derek Summerfield

Medical ethics, the Israeli Medical Association, and the state of the World Medical Association

Author's response to allegation and to BMA

BMJ 2003;327:1107-1108 (8 November), doi:10.1136/bmj.327.7423.1107-b

Letter

EDITOR—I do not misrepresent Blachar: he was uncompromisingin his rejection of a Lancet editorial last year documentingwidespread violations against civilians, including health personnelon duty during the Israeli army invasion of the West Bank.¹Physicians for Human Rights (PHR) Israel describes an "appallingdeterioration" in the attitude of the Israel military towardsPalestinian health and rescue services and Blachar dismissesthem as "political." When he says that civilian deaths are "unintentional"and arise because "terrorists take cover in civilian areas"he is recycling the mantra of the political and military establishment.When a rocket is fired at an apartment block to assassinatesomeone living there, are the inevitable deaths of family andother residents "unintentional"? The reality is that they areregarded as mere collateral damage.

I and others are appalled by Nathanson's supine response tomy open letter.² Her statement that no country is blamelessis a recipe for studied inaction. Imagine a doctor brought beforethe General Medical Council for malpractice whose defence isthat there are many other doctors just as bad, so why pick onhim?

There is no medical association whose track record on tortureand violations of medical neutrality has been so comprehensivelydocumented in recent years as has the Israel Medical Association(IMA). Multiple publications by Amnesty, Human Rights Watch,PHR USA, and others are in the public domain,³ yet Nathansonwrites that allegations need investigation by an independentexpert body "but the problem is to identify by whom." This isastonishing: has Amnesty not been such a body?

Nathanson states that she favours "education." This is rhetoric,surely. Blachar does not lack such education. He and other doctorsin Israel have made their choices with their eyes open overmany years (and it has been a choice, unlike the predicamentfacing ethically minded doctors in, say, Iraq, Syria, or Guatemala,where the price of breaking silence was frequently one's life).The IMA president, Blachar, has never denounced or seriouslyconfronted the Israeli government over torture or violationsof medical neutrality. How can the World Medical Association(WMA) be credible if its new council chairman stands in longstandingbreach of the association's own anti-torture Declaration ofTokyo?

Nathanson's response, on behalf of one of the world's most influentialmedical associations, will have heartened the WMA and IMA leadership,endorsing their calculations. The Israeli political establishment,which is sensitive to Western professional and public opinion,will also have taken note. By contrast, Amnesty and the staffof international agencies such as the Red Cross must be dismayedthat their testimony can be so casually discounted. Nathansonoffers nothing to the doctors in Israel committed to ethicalpractice, not least PHR Israel, which deserves far better.

Finally there are the Palestinian doctors and other health staffwho continue to risk death or maiming in pursuance of theirduty to attend civilians injured by Israeli gun or rocket fire(a daily event). Nathanson's response is likely to increasethe risks that they face every day.

There are historical precedents for the BMA to act with rigourand courage. Without an activist approach to the values at stake—whichmeans sometimes being prepared to to confront—medicalethics on the international stage is reduced to a paper exercise.At present the WMA is a farce.

Derek Summerfield, honorary senior lecturer

Institute of Psychiatry, King's College, London SE5 8AP derek.summerfield@slam.nhs.uk

Competing interests: None declared.

References

Blachar Y. Health toll of the Middle East crisis. Lancet 2002; 359: 1859.
Nathanson V. Medical ethics, the Israeli Medical Association, and the state of the World Medical Association. BMJ 2003; 327: 561-2. (6 September.) [Free Full Text]
Amnesty International. Under constant medical supervision: torture, ill-treatment and the health professions in Israel and the Occupied Territories. London: AI, 1996.

Related Article

Medical ethics, the Israeli Medical Association, and the state of the World Medical Association: Open letter to the BMA: Derek Summerfield
BMJ 2003 327: 561. [Extract] [Full Text]

Rapid Responses:

Read all Rapid Responses

Sorry to hear Israel MA is spineless: Tom Rawlinson; bmj.com, 8 Nov 2003 [Full text]
MEDICAL ETHICS, THE ISRAEL MEDICAL ASSOCIATION, AND THE STATE OF THE WORLD MEDICAL ASSOCIATION: Edwin M Borman, et al.; bmj.com, 8 Jan 2004 [Full text]
reply to Drs Borman and Johnson: derek a summerfield; bmj.com, 11 Mar 2004 [Full text]

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	Medical ethics, the Israeli Medical Association, and the state of the World Medical Association Author's response to allegation and to BMA BMJ 2003;327:1107-1108 (8 November), doi:10.1136/bmj.327.7423.1107-b Letter EDITOR—I do not misrepresent Blachar: he was uncompromisingin his rejection of a Lancet editorial last year documentingwidespread violations against civilians, including health personnelon duty during the Israeli army invasion of the West Bank.¹Physicians for Human Rights (PHR) Israel describes an "appallingdeterioration" in the attitude of the Israel military towardsPalestinian health and rescue services and Blachar dismissesthem as "political." When he says that civilian deaths are "unintentional"and arise because "terrorists take cover in civilian areas"he is recycling the mantra of the political and military establishment.When a rocket is fired at an apartment block to assassinatesomeone living there, are the inevitable deaths of family andother residents "unintentional"? The reality is that they areregarded as mere collateral damage. I and others are appalled by Nathanson's supine response tomy open letter.² Her statement that no country is blamelessis a recipe for studied inaction. Imagine a doctor brought beforethe General Medical Council for malpractice whose defence isthat there are many other doctors just as bad, so why pick onhim? There is no medical association whose track record on tortureand violations of medical neutrality has been so comprehensivelydocumented in recent years as has the Israel Medical Association(IMA). Multiple publications by Amnesty, Human Rights Watch,PHR USA, and others are in the public domain,³ yet Nathansonwrites that allegations need investigation by an independentexpert body "but the problem is to identify by whom." This isastonishing: has Amnesty not been such a body? Nathanson states that she favours "education." This is rhetoric,surely. Blachar does not lack such education. He and other doctorsin Israel have made their choices with their eyes open overmany years (and it has been a choice, unlike the predicamentfacing ethically minded doctors in, say, Iraq, Syria, or Guatemala,where the price of breaking silence was frequently one's life).The IMA president, Blachar, has never denounced or seriouslyconfronted the Israeli government over torture or violationsof medical neutrality. How can the World Medical Association(WMA) be credible if its new council chairman stands in longstandingbreach of the association's own anti-torture Declaration ofTokyo? Nathanson's response, on behalf of one of the world's most influentialmedical associations, will have heartened the WMA and IMA leadership,endorsing their calculations. The Israeli political establishment,which is sensitive to Western professional and public opinion,will also have taken note. By contrast, Amnesty and the staffof international agencies such as the Red Cross must be dismayedthat their testimony can be so casually discounted. Nathansonoffers nothing to the doctors in Israel committed to ethicalpractice, not least PHR Israel, which deserves far better. Finally there are the Palestinian doctors and other health staffwho continue to risk death or maiming in pursuance of theirduty to attend civilians injured by Israeli gun or rocket fire(a daily event). Nathanson's response is likely to increasethe risks that they face every day. There are historical precedents for the BMA to act with rigourand courage. Without an activist approach to the values at stake—whichmeans sometimes being prepared to to confront—medicalethics on the international stage is reduced to a paper exercise.At present the WMA is a farce. Derek Summerfield, honorary senior lecturer Institute of Psychiatry, King's College, London SE5 8AP derek.summerfield@slam.nhs.uk Competing interests: None declared. References Blachar Y. Health toll of the Middle East crisis. Lancet 2002; 359: 1859. Nathanson V. Medical ethics, the Israeli Medical Association, and the state of the World Medical Association. BMJ 2003; 327: 561-2. (6 September.) [Free Full Text] Amnesty International. Under constant medical supervision: torture, ill-treatment and the health professions in Israel and the Occupied Territories. London: AI, 1996. Related Article Medical ethics, the Israeli Medical Association, and the state of the World Medical Association: Open letter to the BMA Derek Summerfield BMJ 2003 327: 561. [Extract] [Full Text] Rapid Responses: Read all Rapid Responses Sorry to hear Israel MA is spineless Tom Rawlinson bmj.com, 8 Nov 2003 [Full text] MEDICAL ETHICS, THE ISRAEL MEDICAL ASSOCIATION, AND THE STATE OF THE WORLD MEDICAL ASSOCIATION Edwin M Borman, et al. bmj.com, 8 Jan 2004 [Full text] reply to Drs Borman and Johnson derek a summerfield bmj.com, 11 Mar 2004 [Full text] Link to the page on the BMJ site back to the top of the page back to the main health page