Israel: Doctors Refusing to Force Treatment on Palestinian Hunger Strikers Must Find Their Own Replacement

An official at the Israel Medical Association says the Health Ministry's order is improper and not customary in other areas of medical ethics

Protesters hold pictures during a rally supporting Palestinian prisoners in Israeli jails on a hunger strike, Ramallah, West Bank, May 3, 2017.
Nasser Nasser/AP

Doctors who refuse to force treatment on hunger striking Palestinian security prisoners whose lives are in danger must find another physician willing to treat the patients, the Health Ministry ordered. 

Over 1,000 Palestinian security prisoners in Israeli prisons, mostly Fatah members led by Marwan Barghouti, began a hunger strike on April 17, demanding additional privileges, and most are still continuing with their strike.

In a letter distributed to Israeli hospitals on Wednesday, the Health Ministry refreshed the regulations and procedures concerning hunger strikers as part of the preparations for treating the striking prisoners, hundreds of whom are still not eating.

A new instruction was added at the end of the letter, saying doctors who think that the patient requires treatment but are unwilling to carry it out against the patient's will – even if the Israel Medical Association has decided that the doctor is allowed to administer such treatment – must immediately transfer the patient to another doctor, who is at least as qualified, and who is willing to carry out the treatment. The doctor must then immediately inform their direct professional supervisor and the hospital management, the letter said.

The new guidelines have led to a great deal of criticism from the IMA. Dr. Tami Karni, the chairwoman of the IMA Ethics Board, says that placing the responsibility of finding a replacement doctor on the physician who refuses to carry out such treatment is improper and not customary in other areas of medical ethics.

In the past, the IMA has strongly objected to allowing doctors to participate in such treatments, including force feeding, and has even petitioned the High Court of Justice against a law permitting the force-feeding of prisoners who go on a hunger strike. The High Court, however, ruled in 2016 that the law is constitutional.

The treatment of hunger-striking prisoners is considered to be particularly sensitive in the medical system and in the Health Ministry. Senior ministry and hospital officials have made great efforts over the years to avoid any actions that could be interpreted as violating medical ethics and human rights, or those of a political nature.

Over the past few years, the health system has had to deal with a number of hunger strikers whose medical conditions seriously deteriorated. In the end, they were kept alive without taking any medical action against their will, because they had either reached an agreement with the government or had received specific medical treatment reaching a level of trust with the medical staff.

Dr. Sigal Liverant, the head of the general medicine division in the ministry, told hospitals that it is best to establish an ethical treatment team to convince the hunger striking patients through dialogue to receive food and treatment. Such a move could prevent the need for the ethics committees in the hospitals to intervene.

The hospital ethics committees are entitled to decide whether to force a patient to receive treatment, including hunger strikers. In 2015, an amendment to the prison regulations took effect, which allows the president of a district court or her deputy to allow providing medical treatment for prisoners on a hunger strike against their will.

The new regulations allow medical intervention for hunger strikers when the patient has ended their objections to treatment; when they no longer refuse treatment; in situations when the patient cannot express such agreement or refusal, such as when they are confused, unconscious, etc; in medical emergencies that pose an immediate danger to the patient's life, or a danger of permanent, irreversible disability exists. Resuscitation, when needed to prevent death, meets all the accepted medical ethics rules, wrote Liverant. No ethical obstacle exists to carry out medical tests, with the patient's agreement or that of the ethics committee.

Karni said the IMA has not changed its position on the matter in any way. Today, when a patient is in a condition in which they lose their ability to express their wishes, doctors will act on their behalf to prevent their death. "So far the doctors have not acted against the ethical rules, and I believe this is what will happen this time too," said Karni.