As the human tragedy in Gaza and the region continues,
the impact on hospitals, patients, and healthcare
providers has consistently made headlines due to the war
induced damage to healthcare systems. The UN Special
Rapporteur on the right to health (1) has emphasized the
severity of the situation, stating that “The practice of
medicine is under attack” and highlighting that “We are
in the darkest time for the right to health in our
lifetimes.” In this challenging context, the significance of
physicians’ perspectives on the ethical stance towards the
conflict becomes particularly noteworthy.
In this article, we focus on the example of “Doctors for
IDF Soldiers’ Rights” letter (2) , endorsed by over 90
Israeli physicians, which ignited controversy by asserting
the Israeli Defence Forces’ (IDF) right and duty to target
hospitals in Gaza, alleging their use as terrorism
headquarters. Signatories contended that prior calls for
civilian evacuation sufficiently discharged moral
obligations to minimize civilian and non-combanant
deaths. In response to this letter, Physicians for Human
Rights–Israel (PHRI) (3) , backed by over 3,500
members and volunteers, criticised the letter’s argument
asserting that it amounts to a “death sentence for
patients.” During times of conflict, physicians often
assume (and are expected to assume) the role of moral
arbiters underscoring the need to preserve life and uphold
human dignity inpublic, professional and political fora.
The assumption is that physicians’ training and practical
formation equips them with a unique moral clarity during
the ‘fog of war’ and prepares them to sound the clarion
call when humanitarian values are violated.
We question whether these assumptions are universally
true and whether physicians intrinsically have the moral
vision and skills to assume such a weightly mantle.
Indeed, as illustrated by the contrasting letters mentioned
above it is clear that physicians hold differing
stanceseven on the issue of targeting hospitals and
patients in Gaza. Accordingly, we advocate for
judiciousness, and caution against excessive reliance on
doctors’voices for moral leadership. We hazard that
physicians are not immune to the political frames used by
stakeholders to impair moral judgement, that they are
prone to being situated within echo chambers that
reinforce particular narratives, and may not be as morally
formed by medical training as presumed. For example,
historical recordsare replete with instances where
medical professionals have been complicit in or coerced
into participating in atrocities, such as unethical human
experiments and complicit roles in state-sponsored
violence.
The limitations of physicians’ moral authority were
epitomised by atrocities committed in Nazi Germany,
Tuskegee and Guatemala, to name a few.
Drawing insights from this historical context and
acknowledging the limitations of physicians as voices of
unassailable moral clarity, we propose a more inclusive
and ethical deliberation that includes moral philosophers,
ethicists, theologians, and other relevantvoices. It is
especially vital, given the origin and foundations of their
discipline, that bioethicists deliberate over and discuss
the present conflict to find common moral ground and a
shared language through which we can call for the
leadership that is required to uphold fundamental
bioethical principles and value for human life. Indeed, it
was only a short while ago that bioethicists were warned
of the “peril of silence” (4) about the ongoing Ukrainian
Russian war.
Experts were called to employ their specialised expertise
to assess the war’s moral and human costs and
encouraged to resolutely speak out against the loss of
human lives. In our view the same applies to this and
other conflicts raging across the world. Bioethicists of all
stripes should have a prominent voice as diverse
disciplinary insights need to be brought together in order
for the muddied moral calculus to become clearer.
Controversial Letter
That said, the Doctors for IDF Soldiers’ Rights letter (5)
has triggered another distinct morally-laden question
namely should the role of physicians be extended to
assume their public endorsement of a country’s army
justifying the targeting of medical facilities within enemy
territory. Where physicians have actively contributed to
war atrocities, international organizations drafted and
issued documents, guidelines and statements with the aim
of defining the broad lines for what ethical conduct ought
to be in the context of war. Illustratively, in its
“Statement in Times of Armed Conflict and Other
Situations of Violence” (1956, revised in 2023) (6) , the
World Medical Association (WMA) adopted an
unequivocal position holding that medical ethics is
identical in both wartime and peacetime, confirming that
the “primary task of the medical profession is to preserve
health and save life.” The WMA also adopted a
principled position towards the protection of healthcare
facilities, especially its “Declaration On the Protection
and Integrity of Medical Personnel in Armed Conflicts
and Other Situations of Violence” (2011, revised 2022)
(7) .
It stressed that, in alignment with the Geneva and other
international conventions, “healthcare personnel and
facilities should never be instrumentalised as means of
war” and concurrently recommended to “never misuse
hospitals and other health facilities for military
purposes.”In our view, and that of other colleagues in
Israel (8), it appears that this letter has crossed a line
bysimply making any hospital in Gaza a potentially
legitimate military target, which inevitably has led to the
loss of life, the destruction of critical life-saving services
and the annihilation of spaces that are sacred to the
medical profession.
War often blurs the lines between right and wrong, and
the morality of actions becomes ambiguous and
contested. Doctors, while experts in their field, may not
possess the expertise required to navigate the complex
ethical terrain of war.Moreover, over reliance on doctors
as moral voices may inadvertently lead to the
militarisation of medicine. Furthermore, placing undue
reliance on doctors may inadvertently place them in an
ethically vulnerablepositions. Support for any kind of
military action erodes trust in the broader
healthcarecommunity.
In times of ambiguity and charged emotions, it is prudent
to adhere to international codes of ethics crafted with an
eye towards broad consensus, such as those of the WMA,
rather than discard them.
References
- https://www.ohchr.org/en/press-releases/2023/12/gaza-un–expert-condemns-unrelenting-war-health-system-amid-airstrikes
- https://cdn.doctorsonly.co.il/2023/11/%D7%A8%D7%95%D7%A4%D7%90%D7%99%D7%9D%D7%9C%D7%96%D7%9B%D7%95%D7%99%D7%95%D7%AA-%D7%97%D7%99%D7%99%D7%9C%D7%99%D7%A6%D7%94%D7%9C.pdf
- https://www.phr.org.il/en/about/
- https://www.cambridge.org/core/journals/cambridgequarterly-of-healthcare-ethics/article/bioethics-ukraine-and-the-peril-of-silence/FEA0F315432009F943E8B6CCC48EE143
- https://cdn.doctorsonly.co.il/2023/11/%D7%A8%D7%95%D7%A4%D7%90%D7%99%D7%9D%D7%9C%D7%96%D7%9B%D7%95%D7%99%D7%95%D7%AA-%D7%97%D7%99%D7%99%D7%9C%D7%99%D7%A6%D7%94%D7%9C.pdf
- https://www.wma.net/policies-post/wma-regu;ations-in-times-of-armed-conflict-and-other-situations-of-violence/
- https://www.wma.net/policies-post/wma-statement-on-the-protection-and-integrity-of-medical-personnel-in-armed-conflicts-and-other-situations-of-violence/
- https://www.phr.org.il/en/physicians-call-eng/
