Aug 14, 2015 12:04 PM
Israeli force-feeding law pits doctors against state
The Associated Press
RAMAT GAN, Israel (AP) Hospitalized and shackled, Palestinian Mohammed Allan was 60 days into a hunger strike to protest his detention without charge in an Israeli jail when he slipped into unconsciousness Friday.
Whether or not the suspected militant becomes the first Palestinian prisoner to be force-fed to stay alive under a controversial new law is an issue that has caused cleavages between doctors and the state over medical ethics and Israel's detention policies.
The law, passed narrowly in July, allows a judge to sanction force-feeding or medical treatment if an inmate's life is threatened, even if the prisoner refuses. Israel fears the death of a prisoner on a hunger strike could trigger Palestinian unrest amid the stalled peace negotiations.
Critics of the law call force-feeding an unethical violation of patient autonomy and akin to torture. The Israeli Medical Association, which has urged physicians not to cooperate, is challenging it in the Supreme Court.
"There have been clashes between the IMA and the government, but never on such basic ethical issues," said Dr. Raphi Walden, a member of the group Physicians for Human Rights-Israel.
Lawmakers argue the legislation is needed to deter Palestinian detainees from hunger strikes to pressure Israel for their release or other demands. Supporters also say force-feeding is preferable to letting a patient die.
The law says Israel's prison service must seek permission from the attorney general to ask a judge to allow force-feeding. The judge would then weigh a doctor's opinion, the prisoner's position as well as security considerations before ruling, according to the physicians' group.
Doctors have not known how serious Allan's situation has been lately because he refused to be examined. Authorities transferred him to two different hospitals in the past week, and an ethics committee at each facility authorized a forced exam. In both instances, doctors criticized the committee's decision and refused. Authorities have not yet approached a court to ask for force-feeding authorization.
The 30-year-old Allan was arrested in November 2014 and detained without charge for two six-month periods, under a measure called administrative detention.
Naser Allan said his son lost consciousness and was moved from a ward at Barzilai hospital into the intensive care unit of the facility in the southern city of Ashkelon.
Allan also had convulsions and hallucinations, and doctors were giving him fluids, electrolytes and vitamins after his condition deteriorated, Dr. Hezy Levy said.
He was in stable condition, sedated and receiving oxygen, he added.
"After 60 days of fasting, the body doesn't get many substances that are vital for the functioning of the critical systems in his body," Levy said. "We knew that, we warned about that, we spoke with the family about that ... but we didn't do anything as long as he expressed his will not to get treatment."
Arab-Israeli lawmaker Osama Saadi of the Arab List party went to the hospital and spoke with doctors. He told The Associated Press that Allan is not in a coma yet and that doctors were doing brain scans.
Allan's father said his son had been imprisoned from 2006-09 for alleged affiliation with the Palestinian militant group Islamic Jihad. Allan began the hunger strike after his detention without charge was renewed in May, his family said.
Under the law, there's no precedent for what should happen next as Allan's health deteriorates.
Palestinian prisoners have used hunger strikes before to draw attention to their detention without trial or charges, causing tensions to flare.
Israel has acceded to hunger strikers' demands and sometimes released them. In June, it freed Khader Adnan, 36, a senior activist in Islamic Jihad, after a 55-day hunger strike protesting his detention.
"The law protects the doctor who tries to save the life of a prisoner," said Yoel Hadar, legal adviser to Israel's Public Security minister and an author of the measure. "No country can accept (hunger strikes) as a way to get out of prison."
The U.N. Special Rapporteur on Torture, Juan Mendez, has called force-feeding, even if intended for the patient's benefit, "tantamount to cruel, inhuman and degrading treatment." Several international conventions prohibit the practice, but it remains legal in certain cases in many countries. The U.S. has admitted to force-feeding detainees at its Navy base in Guantanamo Bay, Cuba, and Britain force-fed some Irish Republican Army prisoners on hunger strikes.
The law cannot compel a doctor to force-feed or perform an examination, Hadar said. A doctor who complies could face sanctions from the IMA, Walden said, although any action by the group would not affect the physician's medical license, which is authorized by the Health Ministry.
Doctors and activists point to the law's limited powers to coerce objecting doctors into force-feeding as evidence of political, rather than medical, motivation.
"This force-feeding is trying to be imposed on doctors for security and political reasons, that have nothing to do with medical reasons," Walden said.
For now, doctors involved with Allan's case have remained publicly united against the law, and dozens of doctors protested the measure this week. But some see keeping a patient alive as their primary ethical duty.
Dr. Shimon Glick, a professor of medicine at Ben Gurion University, said he "would have no hesitation" complying with a force-feeding order.
"In our (Jewish) culture, I think human life has precedence, and we don't allow people to die," he said.
Force-feeding requires restraining a conscious and shackled prisoner and inserting a tube into the stomach. This can cause serious pain as well as damage to the esophagus and lungs, Walden said. Two Palestinian prisoners died from complications from force-feeding in the 1980s, after which the practice fell out of use, Walden added.
Since then, hospitals have kept hunger strikers alive without resorting to the practice, Walden said. This includes offering them supplements of glucose, vitamins or electrolytes.
Amany Daiyf of Physicians for Human Rights-Israel said if the law is really meant to save Allan's life, then the government's only option "would be to release him."
This story has been corrected to show that the hospital's name is Barzilai, not Barzalai.
Associated Press writers Shawn Pogatchnik in Dublin, Ireland, Kirsten Grieshaber in Berlin, Edith M. Lederer at the United Nations, John-Thor Dahlburg in Brussels and Mohammed Daraghmeh in Ramallah, West Bank, contributed to this report.