Israeli doctors may soon confront a dilemma: Should they supervise forced feedings of Palestinian prisoners on hunger strike, per government orders, or heed their medical association's ruling against a practice it calls a form of torture?
Two hundred and eighty-five Palestinians prisoners are fasting in protest at their detention; 70 have already been transferred to Israeli hospitals because of deteriorating health. Many of them today marked their 48th day of fasting, and some of them have been striking since April 24.
The hunger strike began as a protest against the Israeli policy of detention without disclosing the charges. The government insists the secrecy is necessary for anti-terrorism efforts.
Israel is increasingly concerned it will soon have several deaths on its hands. In response to a previous hunger strike by Palestinians two years ago, Prime Minister Benjamin Netanyahu's administration began pushing legislation earlier this year that would allow a judge to sanction force feeding, for which a doctor would need to be present. Physicians would have to chose between respecting a patient's autonomy or ensuring his survival.
Israel insists the force feeding push is to save the lives of the Palestinian strikers, although it is clear from the legislation that the government is concerned about prison rioting and wider unrest if a striker dies.
The legislation passed its first reading in the Knesset, the Israeli parliament, on Monday and Netanyahu is reportedly fast tracking it so that it can be used in the current strike.
A total of a 191 Palestinians are being held in administrative detention after hearings in which their lawyers were denied access to evidence against them, according to the Israeli human rights group B'tselem. Most of them are participating in this hunger strike.
The Israel Medical Association has issued guidelines to doctors against force-feeding in response to the legislative effort and the current hunger strike.
''As physicians it is a very delicate situation and we can't participate in torturing the patient. Force feeding is torture,'' says Dr. Tami Karni, chair of the association's ethics bureau.
The practice also violates the physician-patient relationship, she says.
''We don't want to see the people we are treating die, but in this case every day the physician must speak to his patient to try to convince him to begin to eat, to take things that will prolong his life. A physician must tell him it's dangerous but the principle is always respect the choice of the patient. Physicians all over the world must be a safe place for the patient.''
In its Malta declaration in 1991, the World Medical Association said that ''forcible feeding is never ethically acceptable.''
However, some proponents of force-feeding also cite ethical considerations to make their case. David Rotem, a member of the Knesset from the coalition's hard right Yisrael Beiteinu party, says he supports force-feeding ''because I am against people committing suicide. If you can save them you have to save them. Having people die is a bad thing.''
Heading off riots
For Israeli policymakers, this is especially true because it can touch off rioting in jails and in the Palestinian territories. In the introduction of the Knesset bill, state attorneys argue in favor of force-feeding to avert rioting.
"A hunger strike and the worsening of the condition of the hunger striker are liable to heat up spirits among those outside the prison walls and even cause harm to the public well-being against the background of large scale disturbances or outbursts of violence in solidarity with the hunger striker and his struggle," the attorneys wrote, adding that "considerations related to state security" have to be taken into account by judges.
Under current Israeli law, Israel can detain suspects for renewable periods, usually six months at a time, based on evidence from the Shin Bet security service that is kept secret from the suspect and his lawyer. Yuval Steinitz, the minister of intelligence, defends it as a way of thwarting terrorism and other Israeli officials say the confidentiality is necessary to protect intelligence sources.
Sarit Michaeli, spokeswoman for Israeli human rights group B'tselem, says the number of Palestinians being jailed without charges based on secret evidence ''raises the suspicion that this is being used against people not involved in planning or carrying out an attack but rather that this is more against political activity.''
The hunger strikers in jails are being denied family visits and subjected to ''ongoing raids and inspections'' in their cells, according to Amani Sarahneh, spokeswoman of the Palestinian Prisoners Club, a non-governmental organization that advocates on behalf of the estimated 5,000 Palestinians in Israeli prisons.
Sivan Weizman, spokeswoman for the Israel Prisons Authority, confirmed there were searches of cells but says this is a normal part of prison life, adding that none of the strikers in jail are in danger. Israel's Health Ministry said that the health of the seventy strikers is ''normal'' and that ''none of them is in a life-threatening situation as of today.''
During a hunger strike by Irish republican prisoners in British captivity in 1981, its leader, Bobby Sands, died in the prison hospital on Day 66.
Jawad Boulos, a lawyer for the prisoners club, scoffs at that assessment. He visited 14 hunger strikers in Ichilov and Tel HaShomer hospitals in Tel Aviv on Sunday. The prisoners are shackled to their beds and denied contact with the outside world, he says.
''Every detainee has three guards. They are taking water, salt, sugar and some are taking vitamins at the advice of the doctors. On average they have lost 15 to 16 kilograms [about 35 pounds], they look tired, some have pains in different areas of the body like their head, they have trouble seeing, some are vomiting, some have chest pains. They are all in life danger otherwise they wouldn't be in hospital.''