To the Editor
Defenders of the Israeli Medical Association and Dr Yoram Blachar may be quick to claim that “cynical manipulation characterizes the broader campaign against Blachar” but there is no evidence that it the case. I signed the petition because I believe there is a simple question to be answered - Is the professional leadership of a global medical body an appropriate position for Dr Blachar? I believe not, and I outline the reasons below. There is no sinister agenda, no anti-semitism at play, no hatred for Jews and no cyncism – only medical ethics at stake. It is important that readers of Forward realise that, and not be led astray by unfounded and often inflammatory allegations to the contrary.
Dr Blachar has been in a leadership position in the IMA since 1995, during which period the IMA has failed to act against reports of medical complicity in torture. Instead of initiating their own inquiries, the IMA and Dr Blachar have repeatedly asked for others to present ‘evidence.’ And, even when presented with such evidence by various human rights groups, the IMA and Dr Blachar have not taken proactive steps to investigate or remediate the situation. Ironically, it is human rights NGO’s in Israel, such as Physicians for Human Rights-Israel that have had to take on this responsibility, with far less power and access to resources than the IMA. PHR-Israel, I am informed, in its recent efforts to investigate cases, is typically given partial files with no registrations from the period of investigation by the authorities.
The IMA has not used its standing in Israel and relative power to gain access to the information that is critical for investigating and preventing cases of torture and medical complicity. Yet, this is exactly what many human rights groups and professional bodies expect of national professional associations and it is exactly the standard that was applied in criticising medical bodies in South Africa who refused to investigate allegations of torture and human rights violations under apartheid. Having lived through a period in South Africa where black peoples’ lives were dispensable because medical professional organizations did not have enough ‘evidence’ to act, I am convinced it is not enough to stand back and wait. It is this leadership upon which Dr Blachar should be judged, since he is now assuming global leadership of the medical profession.
A lot is made about Dr Blachar and the IMA writing letters to Israeli military authorities to restate what are existing international ethical guidelines, which have been cited as evidence of the IMA’s compliance with international norms. This is the most passive form of action and it is easy to understand why such actions are ignored by the security forces and have had little effect. In South Africa under apartheid, the then Medical Association of South African (MASA) established medical panels for detainees in response to allegations of torture by security forces and made much of these panels in national and international counterpropaganda to combat criticisms of apartheid. But, as confirmed at the Truth and Reconciliation hearings in 1997, these were token structures set up to deflect criticism of the MASA when human rights bodies in South Africa were begging them to take more proactive steps. By its own admission, such steps were designed to protect the Association from criticism rather than the victims of human rights violations of security forces.
Why do I say that it is not enough to simply pronounce yourself opposed to torture? In the late 1980s, I was working as a doctor in a rural part of South Africa and attended to a black activist who had been most horribly tortured under interrogation during his detention some months previously. He told me how, in a semi-conscious state, he overhead a medical doctor advising the police how to cover up evidence of his torture if he died. However, he lived to tell his story about his torture and the collusion of the doctor a decade later to a Truth and Reconciliation hearing in 1997. The doctor involved was interviewed the next day by the media, denied the claim and stated that (translated from Afrikaans) “…such behaviour is absolutely contrary to my ethical beliefs as a doctor. But most of all it is directly against my deepest values as a person.” I tell this story because I know that the detainee’s story was entirely consistent with the evidence presented to me. Although Dr Blachar can claim that his “position as well as the position of the leadership of the IMA is firmly and unequivocally against torture of any kind,” it is easy to say you are against torture. What matters, particularly when you are in a position to give leadership to other doctors vulnerable to state pressure, is what you actually do to prevent it and to hold accountable those who allow torture to take place.
A lot has been said about Dr Blachar’s comments published in the Lancet on ‘moderate physical pressure’ being legal. On the one hand, it is claimed he never indicated his support for ‘moderate physical pressure.’ On the other hand, critics cite it as evidence that he tolerated torture. This argument is to miss the point. When, in 1998, the IMA was approached by PHR-Israel, together with prison and police doctors, to clarify its stance on this question of moderate physical pressure, so as to give guidance to prison doctors, it avoided taking any position, and only did so after the Israeli High Court made a legal pronouncement that moderate physical pressure did, indeed, constitute a form of torture. Rather than adopt an independent and critical analysis of the situation, the IMA, under Dr Blachar’s leadership, deferred an ethical judgment to a legal one.
This is exactly what the MASA and the then-South African Medical and Dental Council did in South Africa in the late 1980’s, in trying to avoid disciplining the doctors who were complicit in the notorious and tragic torture and death of Mr Steve Biko. Mr Biko was a political detainee who suffered a head injury whilst being assaulted during interrogation and whose medical care was subjugated to the interests of the security forces, resulting in his death. The medical authorities constantly resorted to a legal fiction to avoid taking action against the doctors concerned, a case which medical students worldwide continue to hear about in their ethics teaching. This approach of hiding behind the law is not the leadership I want at the head of the global organization of doctors today. I want a leader who is able to separate the law from ethics, who is able to stand up for what is the right principle and who will not hide behind legal niceties. It is not a matter of casting “guilt by association” to hold the head of the IMA responsible for not displaying firm leadership. It is his actions and lack of action, when they were most needed, which matter.
So, to call for Dr Yoram Blachar to step down has nothing to do with his ethnicity or my ethnicity, which is also Jewish, or one’s views about the political resolution of the Israeli-Palestinian conflict. It is simply a matter of medical ethics. To say that it is not appropriate for Dr Blachar to preside over the World Medical Association is to say that international standards of medical ethics deserve better.
Professor Leslie London, University of Cape Town, South Africa
Professor Leslie London
Health and Human Rights programme
School of Public Health and Family Medicine
Health Sciences Faculty
University of Cape Town
Anzio Road
Observatory
7925
South Africa
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