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

Abstract

Background In 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. Methods A 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 healthcare 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.