Health and Human Rights
Volume 361, Issue 9355, 1 February 2003, Page 424
What is the WMA for? The case of the Israeli Medical Association
Derek Summerfield Institute of Psychiatry, De Crespigny Park, London SE5 8AB, UK
The then Head of Ethics of the Israeli Medical Association (IMA), Eran Dolev, gave an interview on Nov 25, 1999, to a four-member delegation from the Medical Foundation for the Care of Victims of Torture, London, UK, headed by the director, Helen Bamber. During the interview, Dolev stated that “a couple of broken fingers” during the interrogation of Palestinian men was a price worth paying for information. Imagine if the Head of Ethics of the British Medical Association (BMA) had said this in relation to police or army interrogations in Northern Ireland.
Dolev's admission crystallised a position that campaigners had inferred from the IMA's silence over many years on the use of torture in Israel.1 In 1996, Amnesty International concluded that Israeli doctors working with the security services “form part of a system in which detainees are tortured, ill-treated and humiliated in ways that place prison medical practice in conflict with medical ethics”.2 Amnesty also pointed to Israeli government statements that detainees were “under constant medical supervision”.2 The IMA took no action, though they have elsewhere stated that they would investigate if irregular behaviour by an individual doctor was reported to them. This stance is disingenuous: the problem is not isolated malpractice (and who would report this anyway, since the word of Palestinian detainees is discounted by the IMA who have never responded to local testimonies), but institutionalised practice—as Amnesty has made clear. The IMA have long been impervious to discreet appeals made to them from organisations such as Physicians for Human Rights (USA) and Amnesty.
Duncan Forrest, one of the delegation from the Medical Foundation, recorded Dolev's admission in an Amnesty publication. After Yoram Blachar, President of the IMA, had written to the J R Soc Med on behalf of Dolev to deny that he had ever made such a statement,3 the delegation repeated the charge in a letter in May, 2002.4 The group noted that this was “a remark which, as readers will understand, was not likely to be forgotten by his audience”.4
As Bamber and colleagues stated,4 Dolev had been defending the use of “moderate physical pressure”—long denounced by the UN Committee against Torture—by Israeli interrogators. Blachar, too, is on record in The Lancet defending this practice.5 It is not often that the president of a national medical association uses a medical journal to defend what the rest of the world regards as torture.5
The World Medical Association (WMA) is the major international watchdog for medical ethics. It was formed with the help of the BMA in 1947 as a key international response to egregious abuses by doctors during World War II. The WMA Declaration of Tokyo lays down a doctor's unconditional duty not to condone or participate in torture or other cruel or degrading procedures. Such frameworks remain highly relevant—e.g., in a study of how doctors functioned in dictatorships in Chile, Uruguay, and Argentina the author concluded that though they continued to follow ethical procedures such as confidentiality, political beliefs or patriotism allowed doctors to collaborate with torture.
I wrote to the WMA to draw their attention to Dolev's statement. Delon Human, WMA Secretary General, replied: “I must come to the defence of the IMA in affirming that they are co-signatories of the WMA Declaration of Tokyo. They have been active collaborators in the WMA's continued struggle to eradicate torture of any kind in prisons and other settings all over the world.” In November, 2002, Human told me that Blachar was a WMA Council member and chairman of its Finance and Planning Committee. Human said he had received a categorical assurance from Blachar that the IMA had done nothing wrong and that Blachar had shown him “classified material” in defence of the IMA position. What does this statement mean?
When the WMA receives a complaint alleging a breach of ethics by a doctor or doctors it asks the relevant national medical association to investigate. But what if the national medical association itself is the problem? The WMA has the power to cancel membership but is loathe to do so. This situation last arose with the Medical Association of South Africa (MASA).
Worldwide criticism of their collusion with the excesses of the apartheid era came to a head over their failure to take action against the police surgeons who stood by as Steve Biko was tortured and murdered in prison in 1977. When the WMA agreed to readmit MASA in 1984, the BMA withdrew from the WMA for a period in protest. Later, MASA acknowledged that the boycott had been a force for change.
Thus, the wider question thrown up by this case concerns the role and effectiveness of the WMA as the watchdog on medical ethics worldwide. The WMA does not audit the practice of its members to ensure that their actions match their words. It seems to ignore published findings by the UN Committee against Torture, Amnesty, and other human rights organisations. To put it plainly, is a toothless watchdog better or worse than no watchdog at all?
Evidence for the statement having been made by the Head of Ethics of the IMA is irrefutable. What kind of ethical leadership have his words offered Israeli doctors, especially those attached to prisons and interrogation centres? Should Dolev not be held to account? Blachar sits on the WMA Council; how is this position compatible with his public defence of “moderate physical pressure”? How is the IMA track record compatible with membership of the WMA?
As it stands, an offending national medical association can hide behind its position as a WMA member. Dolev and Blachar have repeatedly used medical journals to rebut criticism by pointing out that the IMA were signatories to the Declaration of Tokyo. So far, the WMA Secretary General has seemed to endorse this position.