Moral and professional responsibilities in the context of Palestinian health-care: a qualitative study on the role of medical associations and professional societies

Abstract

BackgroundIn view of documented and ongoing interference with Palestinian healthcare infrastructure, we aimed to identify the moral obligations of physicians and medical associations when confronted with health and human rights infringements originating from state policies and actors. The nature and extent of professional obligations may not solely depend upon the severity of a particular humanitarian crisis; moral duties to engage in oppositional actions are also shaped by contextual factors such as their likely outcome and effects. MethodsA human rights health-care framework was used to analyse whether strikes on Palestinian hospitals and health-care infrastructure constituted sufficient grounds for physicians to take action (eg, public statements and declarations, advocacy). We used the three principles of professionalism previously employed in Mateen and Rubenstein's framework (2011)—patient welfare, autonomy, and social justice—to identify specific injunctions in medical association charters. Operation Cast Lead (2008–2009) and Operation Protective Edge (2014) were used as examples of state-led attacks with consequences for health-care infrastructure. Previous and ongoing reports of destruction of this infrastructure, and consequent exacerbation of health disparities, have been catalogued by Physicians for Human Rights–Israel, B’Tselem, and Human Rights Watch. Destruction of hospitals and medical facilities were evaluated as clear infringements of human rights; similarly, persistent limitations in access to health-care resources were considered as grounds for the actions described above. As our qualitative study focused on the occupied Palestinian territories, we reviewed the mission statements, position papers, and relevant exhortations of the World Medical Association (WMA), American Medical Association (AMA), and the Israeli Medical Association (IMA) for statements on professionalism norms, ethical obligations, and social responsibilities of physicians and medical associations to oppose conflict generating medical crises, address governmental barriers to professionalism, and advocate for social justice. FindingsA review of 279 policies, codes, resolutions, statements, declarations, and position papers (210 from WMA, 21 from IMA, 48 from AMA) found that all three associations agreed on physicians’ obligations to uphold and promote high standards of care. This is particularly relevant in the Palestinian context, where health disparities surpass those in Israel, especially when infrastructural or access issues are directly related to Israeli governmental policies. The WMA had issued pleas for medical neutrality and cessation of violence in times of conflict (n=4, 2009–2014), most notably their 2012 statement, “WMA Regulations in Times Of Armed Conflict And Other Situations Of Violence.” Since the focus of our review was on the unique case of Israel and Palestine, the state-level medical association's position on professionalism norms in times of conflict was particularly relevant. A 2002 IMA position paper on armed conflict expressed satisfaction with the Israeli army's commitment to assuring medical services. The AMA made no statements about medical professional standards in times of armed conflicts, state-sponsored violence, or governmental policies in violation of human rights, but affirmed the need for physicians to be advocates of health and human rights in general, stating that persecution of physicians anywhere is a threat to professionalism everywhere (Ad Hoc Physicians Persecution Advisory Group). InterpretationThe attacks on Palestinian health-care infrastructure were violations of human rights as defined by Mateen and Rubenstein. Moreover, they served as barriers to professionalism. Medical professionals and associations have a responsibility to speak out against violations of health and human rights. FundingNone.