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



I do not misrepresent Blachar: he was uncompromising in his rejection of a Lancet editorial last year documenting widespread violations against civilians, including health personnel on duty during the Israeli army invasion of the West Bank.1 Physicians for Human Rights (PHR) Israel describes an "appalling deterioration" in the attitude of the Israel military towards Palestinian health and rescue services and Blachar dismisses them 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 assassinate someone living there, are the inevitable deaths of family and other residents "unintentional"? The reality is that they are regarded as mere collateral damage.

I and others are appalled by Nathanson's supine response to my open letter.2 Her statement that no country is blameless is a recipe for studied inaction. Imagine a doctor brought before the General Medical Council for malpractice whose defence is that there are many other doctors just as bad, so why pick on him?

There is no medical association whose track record on torture and violations of medical neutrality has been so comprehensively documented 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 Nathanson writes that allegations need investigation by an independent expert body "but the problem is to identify by whom." This is astonishing: 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 doctors in Israel have made their choices with their eyes open over many years (and it has been a choice, unlike the predicament facing 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 seriously confronted the Israeli government over torture or violations of medical neutrality. How can the World Medical Association (WMA) be credible if its new council chairman stands in longstanding breach of the association's own anti-torture Declaration of Tokyo?

Nathanson's response, on behalf of one of the world's most influential medical 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 staff of international agencies such as the Red Cross must be dismayed that their testimony can be so casually discounted. Nathanson offers nothing to the doctors in Israel committed to ethical practice, not least PHR Israel, which deserves far better.

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

There are historical precedents for the BMA to act with rigour and courage. Without an activist approach to the values at stake which means sometimes being prepared to to confront medical ethics 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.


  1. Blachar Y. Health toll of the Middle East crisis. Lancet 2002; 359: 1859.
  2. 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]
  3. Amnesty International. Under constant medical supervision: torture, ill-treatment and the health professions in Israel and the Occupied Territories. London: AI, 1996.

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