Israeli doctors will not defy an ethical code prohibiting them from force-feeding Palestinian hunger strikers, despite a new Israeli law permitting the controversial procedure in case of imminent danger to a patient’s life, a senior Israeli medical official said Tuesday.
The legal amendment, titled “prevention of hunger strike harms” and passed in the Knesset on July 30, has come under extensive local and international criticism. The Israeli Medical Association — which incorporates the vast majority of physicians in Israel and has consistently opposed the law throughout its three-year legislation process — fears that it may be applied to Mohammed Allaan, a Palestinian held without trial who began his hunger strike over 50 days ago. While he is conscious, doctors believe his life is at risk due to his lengthy fast.
Two Israeli hospitals — Soroka Medical Center in Beersheba, where he was first admitted, and Barzilai Medical Center in Ashkelon — have so far refused to force feed Allaan, although Barzilai has issued conflicting statements as to whether it would force-feed him should his condition deteriorate drastically.
Israel alleges that Allaan is a member of the Palestinian Islamic Jihad terror group and has been involved in planning attacks against Israelis, and has moved to hold him without charges as a preventative measure in a procedure known as administrative detention.
According to the new law, currently being challenged by the Israeli Medical Association in the High Court of Justice, prison authorities may appeal to a District Court judge requesting permission for force-feeding if, based on the medical opinion of the attending doctor, the inmate faces “grave and imminent danger to his health.”
The association filed a 70-page appeal to the court on August 2 seeking to repeal the law, which is set to be discussed by lawmakers in the Knesset in early September. It also opened a 24-hour hotline for doctors treating Palestinian hunger strikers, offering “legal, professional/ethical, and media accompaniment.”
Speaking to the Times of Israel on Tuesday, Dr. Tammy Karni, the chairwoman of the Israeli Medical Association’s ethics bureau, spelled out her organization’s practical and principled objections to force-feeding. She had met with Allaan and his doctors at Soroka Hospital on Saturday, she said, conversed with him for over an hour, and witnessed the “excellent” treatment he was receiving, despite his refusal of any medical intervention.
“I have no idea why he was transferred to Barzilai,” said Karni, a surgeon at the Assaf Harofeh Medical Center near Tel Aviv. “But I am in telephone contact with the doctors there, who are acting in the exact same way as the doctors in Beersheba.”
The risks of force-feeding
From a purely medical point of view, Karni argued, force feeding by binding an inmate to a chair and inserting a tube through his nose into the stomach, runs a higher risk of killing a seriously ill patient than the current practice of psychological counseling. At present, doctors explain the medical risks of a prolonged hunger strike to inmates, and offer treatment to mitigate those risks, such as fluids and electrolytes.
“This is how we’ve been treating scores of hunger strikers so far, until they decide to end the strike for various reasons,” she said. The five hunger strikers to die in Israel expired as a result of physiological complications caused by force-feeding, not starvation, she added.
‘There is a law in Israel against force feeding geese, so how can we practice this on human beings?’
“All those we’ve been treating in the recognized medical way have survived,” she said. “Those who understand medicine realize that trying to force-feed patients on a prolonged hunger strike can result in worse damage than a continuation of the strike.
“We’ve gone everywhere possible to argue that this won’t solve Israel’s security and political problems,” Karni added. “I’m sorry it was dragged into the medical domain.”
In its appeal to the Supreme Court, the Israeli Medical Association is arguing that it is unethical to use medical procedures, such as force-feeding, for non-medical ends, namely to crush a political protest.
In a letter to Israeli Medical Association chairman Leonid Eidelman in June, Public Security Minister Gilad Erdan wrote that “the purpose of hunger strikes is to intimidate Israeli into releasing terrorists. We will pass this law soon and not allow that.” The preface to the new law counters the doctors’ rationale, arguing that hunger strikes are an “illegitimate” form of protest for inmates, as they disrupt law and order in prison, despite the inmates’ basic right to freedom of expression.
From the internationally recognized ethical point of view, though, the Israeli doctors stand on solid ground in refusing to force-feed hunger strikers. The 1975 Deceleration of Tokyo, issued by the World Medical Association, prohibits force-feeding as long as the patient is capable of forming “an unimpaired and rational judgement.” The 1991 Declaration of Malta on Hunger Strikers stipulates that when faced by a “conflict of loyalties” between the patient and prison authorities, doctors’ “primary obligation is to the individual patient.”
“Doctors have a very clear ethical conscience,” Karni said. “We don’t act against our patients… We don’t do things by force, because we’re not soldiers or policemen.”
As far as she knows, no doctors take part in force-feeding anywhere in the world, Karni said. In Guantanamo Bay, the practice of force-feeding US-held inmates who refused a number of meals amounted to “torture, which is prohibited by all ethical standards,” she said.
“There is a law in Israel against force feeding geese, so how can we practice this on human beings?” she wondered. “This law contradicts many basic principles, both legal and ethical.”