Background:
Israeli Prison Service (IPS) policy is to try and block visits of independent physicians to hunger strikers. In the previous hunger strike in 2012, most visits by PHR IL’s volunteer independent physicians were only made possible following court ruling. Much to PHR-IL’s surprise and dismay the MOH now joins this policy by adding more conditions on such visits to make them practically impossible. This conduct runs counter to Israeli law,[1] international law,[2] IPS regulations [3] and various court rulings.[4] Even worse, it unnecessarily puts the lives and welfare of hunger strikers in danger.
PHR IL’s Action & MOH Response:
June 2nd: A request is sent to the IPS to coordinate visits to hunger strikers who appealed to us from 4 public hospitals. An IPS’ response of the same day instructs us to first accept the hospital’s confirmation of such visits, and then ask for the IPS’ permission.
June 3rd: A request is sent to the 4 hospitals:
Meir Hospital informed us that they are no longer there, being returned to the IPS;
Kaplan Hospital refused to answer our request, referring us to the MOH’s Emergency Department;
Ha-Emeq Hospital informed us on July 8th that they are no longer there;
Ichilov Hospital did not respond until this day;
June 5th: In a phone conversation, Noa Tamir, Head of Hospitalization Unit in the MOH Emergency Department tells PHR IL’s staff that once she has the hospitals responses to our requests she will only notify the IPS who can then pass it to PHR-IL.
June 8th: PHR-IL requested to coordinate a visit to Muayed Sharab, an administrative detainee on hunger strike in Eshel Prison in the south. Prisoners’ officer Yehushua Weis told PHR IL staff on a phone conversation that the prisoner must name the physician he wishes to visit him, and he cannot just say he wishes to be visited by a PHR IL’s physician. He also indicated that Sharab is alternated between the hospital and the IPS, and that there is no point in his access to an independent physician as he is treated in both places.
June 8th: PHR IL learns of the MOH policy according to which:
PHR-IL’s physicians do not have a sweeping permission to enter the hospitalized prisoners solely on the merits of being physicians. Not every physician’s visit (this includes PHR-IL’s and ICRC physicians) is one for a “second opinion” as its meaning in the Patient Act [and thus a right secured for all, including prisoners H.Z], and even if it is – receiving a second opinion is one of the things to which the IPS has clear authority to determine regulations as to how such an opinion will be received as long as the IPS keeps the patient’s in custody right to receive one.
The policy paper goes on to explain among other things that:
The IPS is the responsible authority to the whole issue of access to prisoners while in hospital;
The IPS in coordination with the MOH Emergency Department will define the visitors whom have a permission to enter;
In addition, any entry of a physician must be coordinated with the management of the hospitals of the relevant department.
PHR IL’s email to professor Afeq, executive director of MOH, as to our attempts to coordinate the necessary visits, was answered by Ms. Agmon, in Charge of Medical Ethics and Biotechnology, Office of the Legal Advisor, MOH:
“In order for a PHR IL’s physician to visit, he/she must first receive the hospital management agreement, which will be given only if the hunger striker himself (a family request isn’t enough) in the form of power of attorney or waiver of confidentiality.”
The MOH policy amounts to obstructing, delaying or totally preventing visits of hunger strikers by PHR IL’s volunteer independent physicians, thus disregarding the significance of having an independent physician examine a prisoner on hunger strike and the critical establishment of trust that must exist between the two. This principle is entrenched in the World Medical Association (WMA) guidelines, drawing upon the 1991 Malta Declaration,[5] reiterated in an expert opinion issued by a PHR-Israel volunteer physician who followed up hunger strikers in 2012, and was affirmed by the Israeli Medical Association (IMA).[6]
The described MOH policy main ethical failures are in:
Its disregard to the crucial importance of a follow up by an independent physician (which is beyond and essentially of a greater importance than a routine second opinion), making it extremely difficult – if not impossible – to operate;
Its insistence to discriminate hunger strikers from other patients in receiving what the MOH defines as a second opinion. While for other patients to see another physician of their wish, it is enough that the patient or his/her family inform and coordinate it with the treating hospital physician, hunger strikers must first get a permission from the hospital, first signing a power of attorney and waiver of confidentiality, – difficult to obtain as there are considerable problems in access to lawyers – and then an IPS confirmation.
It is PHR-IL belief that the MOH’s policy was design so in conjunction with the IPS’ and the Israeli Security Agency (ISA, the shaback) it will work to isolate the hunger strikers from any opportunity of support or dialogue. Indeed, as reported in Haaretz PM Netanyahu, backed by the head of the ISA, Yoram Cohen, adopted a hard line position of no concessions.
Today, 9th June, PHR IL sent a letter to the MOH demanding that they shall abolish all obstacles to visits of hunger strikers by independent physicians. A copy was also sent to the IMA asking that as a union representing physicians and medical ethics, they will support that demand. In addition PHR IL appealed to all National Medical Associations to join our call for the WMA to voice an unequivocal and clear opposition to the governments proposed bill that aims at making forced feeding legal.
PHR IL calls on the diplomatic and medical community to voice their deep concern to the lives and health of the hunger striker, and demand that
Hunger striking detainees and prisoners will be immediately gain access to independent physicians at their request.
The MOH and IPS will retract from their policy of obstructing access of the prisoners to lawyers and physicians
The government retracts from its intention to pass the bill allowing for forced feeding and will go into negotiation for a peaceful life-saving resolution of the hunger strike
The government and the ISA will end their sweeping policy of administrative detention.
Sincerely,
Hadas Ziv
Public Outreach and Ethics Committee
PHR IL
[1] The Patient’s Rights Law – 1996 specifies: “A patient has the right to obtain on their own initiative an additional opinion regarding their treatment; the attending physician and the medical institution will assist the patient in any way necessary to implement this right.”
[2]The International Convention on Economic, Social and Cultural Rights, 1966. Cf. also Section 25 of UN General Assembly Resolution 43/173, dated 9.XII.88, regarding the principles to protect detained or imprisoned persons: http://www2.ohchr.org/english/law/bodyprinciples.htm#wp1018764
[3] Prison Commission regulation 04.46.00 regarding medical treatment of prisoners and detienees. Section 12 contains an explicit instruction regarding the right of prisoners and detienees to receive visits from medical and para-medical professionals for medical examinations and treatment, at the inmate’s expense.
[4] The court has recognized the right of hunger-striking prisoners and detainees to be visited by a physician more frequently than once a month, in view of the special needs of hunger strikers. Cf. Petition 4614-03-12, Hana Shalabi v. IPS; Petition 9537-02-12, Khader Adnan v. IPS.
[5]http://www.wma.net/en/30publications/10policies/h31/index.html
[6]http://www.ima.org.il/MainSite/ViewCategory.aspx?CategoryId=2841
