When Law and Medical Ethics Conflict: The Case of Mohammad Allan

By Maayan Sudai

Mohammad Allan was an administrative detainee in Israel, a Palestinian who had been hunger striking since June 16 to protest his indefinite incarceration. Allan’s health has been deteriorating gradually, and the latest examinations raised concerns that he suffered irreversible brain damage. The crisis in Allan’s health created a tangle for the Israeli government, since releasing Allan was feared to serve as a precedent that would encourage more hunger strikes and symbolize submission to this type of protest, whereas force-feeding him might be considered unethical-illegal torture. This dilemma has brought a head-on clash between Israeli government officials and the Israeli National Medical Association, and led to an internal split between medical professionals regarding their positions on the ethics of the controversial practice of force-feeding.

In the midst of Allan’s health deterioration, the Israeli parliament passed a new law called “Hunger Strike Damage Prevention Act” also known as the “force-feeding law”. The law allows doctors to force-feed prisoners in immediate and imminent danger of irreversible severe damage or death, with a court order. The court could allow such force-feeding after hearing the prisoner (if possible) and an ethics committee recommendation. Moreover, the forced feeding should be carried out in a dignified manner, avoiding pain and suffering for the prisoner. It was declared that physicians will not be forced to comply with force-feeding under this law if they refuse.

In reaction, the Israeli Medical association (IMA) published a position paper expressing fierce opposition to the new law declaring their intentions to appeal it in the High Court of Justice. They claim that force-feeding is torture and called physicians not to follow the law. Dr. Leonid Eidelman the chairman IMA said:

This law is a stain on the Israeli law book. There’s no doubt that Doctors have the duty to follow the rules of medical ethics which is free of politic coalitions influences… in states where the medical ethics was bound to the government, the most horrible acts happened.

In the meantime, the Supreme Court ordered Allan to be temporarily released due to his medical condition, and added that if his condition would further deteriorate and irreversible damage will occur, the warrant will be cancelled.

The latest development in this medico-legal drama is a position paper written by an independent group of academics, physicians and ethicists, opposing IMA’s position and proclaiming that in certain circumstances, force-feeding is ethically justified. The “rebelling” group framed the dilemma as having to choose one of either: death or force-feeding; between autonomy and life. They support the position that when all hope is gone to convince the prisoner to accept treatment, overriding his personal autonomy in order to save his life is the preferred option. They mainly called physicians to act according to their conscience, whatever it is.

Force-feeding of hunger striking prisoners is a good example for how medical professionals are sometimes requested to execute national policy. In this context, tensions arise when the state law conflicts with the professional-ethical code. The parliament searched for an effective tool to address the challenge of hunger striking administrative detainees, and declared that force-feeding is legal. But is it ethical? Depends who you ask.

Interestingly, the parliament allowed physicians to retain their personal judgment and not force-feed if they find it unethical to do so. According to IMA, force-feeding is no different than torture and is against the professional ethical code. Although IMA’s position was recently challenged by an opposing group of physicians, it is evident that in practice, most doctors are reluctant to operate against it. Accordingly, the option of force-feeding was not used in Allan’s case, and it may be a dead letter. No wonder then, that in his Facebook page, Gilad Arden, Israel’s Public Security Minister blamed IMA for Allan’s release by the court saying that the association should learn “to honor the law instead of taking actions which ultimately lead to releasing terrorists”.

What does the Israeli Supreme Court say on the Issue? Theoretically, the high court of justice has the power to override parliamentary legislation when when it conflicts with Israel’s basic laws; however this power is used very scarcely. In Allan’s case, the Supreme Court did not address the ethics of force-feeding, but rather discussed the arrest warrant. It seems that the High Court of Justice will have the opportunity to address this question only when a petition is brought and a physician actually agrees to force-feed a prisoner.  Then, the High Court of Justice will have the difficult task of untangling this medical-political tie.

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