Leading doctors oppose IMA’s force-feeding position

The "rebels," a group which includes four Israel Prize laureates, said it was "strongly opposed" to the Israel Medical Association's directive to doctors against force-feeding hunger strikers.

By JUDY SIEGEL-ITZKOVICH
Updated: AUGUST 24, 2015 03:19
Beduin demonstrators hold signs during a protest in the southern town of Rahat in support of Islamic Jihad activist Mohammed Allan (photo credit: REUTERS)
Beduin demonstrators hold signs during a protest in the southern town of Rahat in support of Islamic Jihad activist Mohammed Allan
(photo credit: REUTERS)
Despite the Israel Medical Association’s recent statement urging thousands of its members to oppose the force-feeding of security prisoners, dozens of senior Israeli doctors, scientists, ethicists, jurists and philosophers are joining together to express the opposite opinion.
The group, which includes four Israel Prize laureates, says it is strongly opposed to the IMA’s position that a physician is forbidden to save the life of a hunger striker against his will. The IMA, it added, also used “professional threats” against those who believed – and were willing to act – differently.
The IMA had argued that international agreements support its policy, and that only if and when a hunger striker loses consciousness can the autonomy of the hunger striker be suspended.
In its position paper, however, the opposing group stated that saving a human life is compatible with “the ethics and values well anchored in the laws of the State of Israel, Jewish religious values and the Patients’ Rights Law – and rulings based on it by the Supreme Court and the district courts.”
The group praised the talents and resourcefulness of Israeli doctors and ethics committees that succeeded in preventing the deaths of hunger strikers in recent years.
Amnesty against force-feeding hunger stikers
“But when a hunger striker completely refuses to stop his hunger strike despite the great efforts to persuade him to do so, the ethical dilemma is in finding a suitable balance between the value of preserving life and the autonomy and free will of the individual,” it said.
The signatories argued that the moral value of saving lives and the ethical and professional value of a doctor saving his or her patient’s life surpasses the hunger striker’s right over his body and autonomy.
“The decision on the timing of lifesaving measures and the suitable ways for doing so to save a life have to be left to the physician who is treating the patient and to the hospital’s ethics committee. These difficult decisions will take effect only in extreme cases when the hunger striker’s life is in immediate danger as a last choice before the patient dies or suffers severe brain damage,” the group said.
The dissident opinion follows the ruling by the Supreme Court to suspend the detention of Muhammad Allan, a 31-year-old Palestinian lawyer and member of the Islamic Jihad terrorist group, who regained consciousness and finally agreed to be fed after 66 days of refusing solid food.
The dissident group added that the medical system and doctors must be “disconnected from political considerations of all kinds,” and “act in an equal way regarding every hospitalized patient independent of the reasons that brought him to this serious medical situation.”
The conscience of the physicians involved must be taken into consideration, the group declared. A doctor who has an ethical problem with treating the hunger striker should leave the treatment team, but only after ensuring that there is another doctor who is willing to care for him, they said.
A doctor who regards life as the utmost value, the group continued – and places that ideal above the patient’s autonomy – should have the right to give the patient the necessary treatment, even against the hunger striker’s will, to keep him alive. This decision must be discussed and approved by the institution’s ethics committee before it is taken, and no pressures or threats should be made against the doctor to prevent him or her from acting according to their conscience, the group continued.
Among the signatories were Prof. Rivka Carmi, president of Ben-Gurion University of the Negev and a prominent pediatrician and geneticist; Prof. Jonathan Halevy, director-general of Jerusalem’s Shaare Zedek Medical Center; bioethics Prof. Yechiel Bar-Ilan of Tel Aviv University’s Sackler Medical Faculty; Prof. Shimon Glick, bioethicist and former dean of the BGU Faculty of Health Sciences; Prof. Michael Gross, ethics expert in the international relations department at the University of Haifa; and Dr.
Ofra Golan, an attorney and chairwoman of the ethics committees of a number of hospitals.
Other signatories were Dr.
Rabbi Mordechai Halperin, head of the Schlesinger Institute of Medical-Halachic Research at Shaare Zedek and a former Health Ministry adviser on Jewish medical ethics; Prof. Michael Tal, chairman of the ethics committee at the Hebrew University; former Supreme Court justice Zvi Tal; TAU philosophy Prof. Assa Kasher, an Israel Prize winner; Prof. Charles Sprung, head of the intensive care unit of Hadassah University Medical Center and former chairman of ethics committees in international societies for urgent medicine; Prof.
Karl Skorecki, chairman of the Rappaport Institute at the Technion-Israel Institute of Technology; and Prof.
Avraham Steinberg, head of Shaare Zedek’s medical ethics unit, pediatric neurologist and Israel Prize laureate.
Most, but not all, of the signatories are modern Orthodox Jews.
A spokeswoman for the Israel Medical Association said that “the holiness of life is an important and central value for every physician.
However, the discussion on force feeding doesn’t deal with the holiness of life but with the participation of doctors in torture, which is forbidden to doctors and unthinkable.
“IMA doctors have successfully treated hunger strikers and prevented their deaths in public hospitals – all with the full support of the IMA chairman and head of its ethics committee,” she said, adding that the IMA “will not go into political positions.”