Difficult and tumultuous days have befallen us all. These days require that we exercise hypersensitivity toward ourselves, our families and our surroundings.
As physicians, we are often expected to link our personal experiences with our professional and ethical duties. We must be patient-centric while tending to our physical and mental health. Maintaining a collegial and businesslike atmosphere in our workplaces is also essential for us and our patients.
Medicine, by definition, must remain neutral and nonpartisan. Medical institutions were always devoid of politics. We worked as multicultural teams and cared for every human being, regardless of religion or origin.
Here are some questions that surfaced from the field. We would love to hear from you about any ethical questions/issues you are having.
Q: What is the medical team required to do when performing a medical procedure and the patient is sedated? Can the medical team leave the patient and go to the shelter when the alarm sounds? It should be noted the patient is aware of the above situation and possibility.
A: According to the ethics rules, a physician must provide life-saving medical care during an emergency and put the patient's best interests first. Alongside these duties, physicians are committed to safeguarding their lives and their physical and mental health, so they must find a way to balance the two.
Exposing physicians to danger during wartime is identical to exposure during a pandemic. Here is a link to the Bureau of Ethics' Position Paper on the limits of medical duty during a pandemic.
The employer must protect physicians' safety; hence - providing a safe work environment is a by-product, i.e., medical institutions must ensure that the procedure is performed in a protected space for both the physician's and patient's sake. If a safe work environment cannot be provided, medical care shall be performed at the attending physician's discretion and in accordance with the security situation. The physician's autonomy condones an informed decision whether or not to perform the medical procedure. In any case, the patient should be informed that the medical procedure is conducted in an unprotected area.
Q: Statements given by physicians to the media.
A: The health system must remain a stronghold of unity and non-discrimination.
In these sensitive and fragile times, we ask physicians to act responsibly, patiently and respectfully and show restraint. Moreover, attention must be given to discourse, social media posts, and statements given to the media, as said by Abtalyon (Pirkei Avot 1, Chapter 1, Mishna 11), "Scholars, be careful with your words." Here is a link to the Position Paper Doctors in the Media – Freedom of Speech vis-a-vis Professional Courtesy.
Q: Are physicians obligated to provide medical care to terrorists?
A: Israeli physicians are bound by international conventions, medical ethics rules and the Physicians' Geneva Declaration. Despite the barbaric and horrific acts of Hamas terrorists, physicians will provide the necessary care in hospitals, the IPS or the military on a needed-only basis. The terrorists will be punished as is customary in a State governed by the rule of law.
We are aware of the difficulty of treating victims of terrorism alongside those who carried out the attack; however, Israeli physicians have always acted in accordance with their professional duty and had to confront difficult situations, and they shall continue to do so.
To read the Hebrew Physician's Oath, Prof. L. Heilprin, 1951, Jerusalem – Click here
To read the Physicians’ Statement (WMA Geneva Declaration) – Click here
Q: Advertising and maintaining medical confidentiality
A: The issue came up around a video analyzing the medical condition of a wounded person.
First, it is important to note that the physician must respect and maintain the patient's medical confidentiality, even post-mortem.
Furthermore, in the Medical Ethics Rules (Doctors and Media) and the Doctors' Regulations (Prohibited Advertisement) 5769-2008, patient pictures are prohibited.
Please, any advertising violates family feelings on these challenging and sensitive days! Be careful and considerate in what you post.
Q: Physicians treating detainees or prisoners of war
A: These days, all medical teams have been called to provide medical care on every possible front. Some of you serve as physicians in reserve duty or hospitals, treating detainees or prisoners of war. To this end, we have concentrated several Position Papers dealing with this issue:
• Ensuring Medical and Health services During the Israeli-Palestinian Armed Conflict - 2003 | Israel Medical Association (ima.org.il)
• Collaboration Between Medical Institutions and Law Enforcement Authorities - 2006 | Israel Medical Association (ima.org.il)
• Prohibition of Physicians' Participation in Interrogations and Tortures - 2007 | Israel Medical Association (ima.org.il)
• Separating and Isolating Prisoners – Without Physician Participation - 2009 | Israel Medical Association (ima.org.il)
Q: Physicians' Statements About the War
A: Even during these tough days, during the war, the physicians' role is tending to the wounded.
Israel Medical Association and Israeli doctors shall remain loyal to their commitment to international covenants, which protect the medical teams and facilities.
Doctors vowed to heal and not kill.
Safeguarding morality unites the State of Israel. Throughout history, Israeli physicians have never agreed to compromise their conscience and morality, which is the modus operandi of our enemies. We shall continue to adhere to our roles, heal, and improve the quality and longevity of our patients' lives.
Dr. Tammy Karni
Acting Chairperson of the Ethics Bureau
Chairman of the IMA Tribunal
IMA response to the call by physicians to bomb terror nests and Hamas headquarters in Gazan hospitals:
The Israeli Medical Association and Israeli physicians are committed to the principles of medical ethics, international law and the Geneva convention. These principles include opposition to deliberate targeting of medical facilities, opposition to deliberately endangering civilians receiving medical care, and opposition to deliberately allowing civilians receiving medical care to be in harm’s way by housing military ordinance and military control and command operational centers under cover of medical facilities where patients are receiving medical care.
Our focus is entirely on helping and healing and not on calls for military actions of any kind. We remain committed to the safety and protection of innocent civilians and to the condemnation and eradication of terror.
November 5, 2023