(C) Daily Kos This story was originally published by Daily Kos and is unaltered. . . . . . . . . . . The moral failing of American medicine in Gaza [1] ['This Content Is Not Subject To Review Daily Kos Staff Prior To Publication.'] Date: 2023-11-21 All medical students across the country take an ethics course during their first year. I remember sitting in small groups using case studies with my classmates, now over a decade ago, discussing the concepts of beneficence (to do good), non-maleficence (do no harm), justice, and autonomy. We learned these guiding ethics through key historical events, like the Holocaust and the Tuskegee Study. Some ethical dilemmas were difficult, pitted principles against each other, and engendered hours of passionate debate. Other cases, where we studied the Geneva Convention and learned about the imperative to protect medical facilities and personnel during war were cut and dry. The conflict in Israel and Palestine is the latest historical example where our ethical principles call for action. Sadly, the medical community has failed to uphold its ethical obligations by not speaking out with moral clarity and consistency about ongoing violence and by suppressing diverse expressions of opinions. The evidence of maleficence in Gaza is clear. The United Nations, the Red Cross, and Doctors without Borders have all documented ongoing violence against civilians, healthcare workers, and health facilities, with over 250 verified attacks against health facilities In Gaza. Physicians are being forced to operate in unconscionable conditions, without analgesia, electricity, or clean water. The violence has led to a new abbreviation used in Gazan hospitals, W.C.N.S.F, “Wounded child, no surviving family.” Most recently, Israel targeted major hospitals in Gaza including Al Shifa and Indonesian hospital, putting hundreds of patients at risk, including dozens of neonates. A Palestinian girl wounded during an Israeli airstrike receives medical treatment at al-Aqsa Hospital in Deir el-Balah, central Gaza Strip, Oct. 15, 2023. (AP Photo/Adel Hana) Non-maleficence, beneficence, and justice all require that we must speak out with consistency and clarity. Just as we condemn the horrific terrorist attacks carried about by Hamas, we must also condemn acts of violence perpetuated by the state of Israel against healthcare workers and civilians. But, the medical community is failing in its universal ethical responsibilities. Over one hundred Israeli doctors recently published an open letter demanding the bombing of Gazan hospitals. Emails and statements from hospitals and medical school leadership have often been one-sided, failing to bring attention to the violence against Palestinian civilians. Contrary to the calls from UNICEF and Doctors without Borders, the Chicago-based American Medical Association House of Delegates overwhelmingly rejected a resolution calling for a ceasefire on November 11th. The Journal of the American Medical Institution (JAMA), one of the premier medical journals, recently published a controversial perspective piece which has already led to a petition calling for a retraction with over 12,000 signatures. Speaking about the morality of bombing hospitals, blocking medicines, and the collateral damage of killing children, the author claims, “Health professionals of goodwill and equally strong commitments to human rights have differing opinions on these questions, which reflects the nature of these questions.” In these instances, our medical leaders are introducing moral ambiguity when there is moral clarity. Drawing the line at the bombing of a hospital filled with sick patients is not complicated. “Health professionals of goodwill” should agree on this. This is the very essence of do no harm. No medical ethical framework justifies killing an innocent patient to target an enemy combatant or shutting off water to millions to squeeze out an underground terrorist cell There are real-world implications from this failure of ethical medical leadership. Statements from medical ethicists that can justify bombing healthcare facilities will only embolden pro-War voices. Silence is also harmful. Physicians may hesitate to speak out because of fear of retribution, because they think the situation is too complicated, or because they work in a diverse environment, with Muslim, Jewish, Black, and Brown colleagues and don’t want to offend. While our leaders may not have met the moment, we must all condemn violence against any civilians and health workers. We must stand up for those being punished for voicing their perspective, elevate the messages and pleas coming from the ground in Gaza, call for a durable ceasefire, and the unrestricted flow of humanitarian support. A lot of medicine is hard. It’s not hard or complicated to see that bombing hospitals is unequivocally wrong. To call for anything less is a clear failure to uphold our ethical oath as physicians. --- Akshar Rambachan, MD, MPH is an assistant professor, hospitalist, and researcher at UCSF. The views and opinions expressed herein do not necessarily state or reflect those of The Regents of the University of California, UCSF, UCSF Health, or any entities or units thereof. 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