As the human tragedy unfolds in Gaza and the surrounding region, characterized by unparalleled levels of destruction and suffering, the plight of hospitals, patients, and healthcare providers has garnered widespread attention in international media. The UN Special Rapporteur on the right to health has emphasized the severity of the situation, stating that “The practice of medicine is under attack” and highlighting that “We are in the darkest time for the right to health in our lifetimes.” In this challenging context, the significance of physicians’ perspectives on the ethics of the conflict is particularly noteworthy.
Here we focus on the “Doctors for IDF Soldiers’ Rights” letter, endorsed by over 90 Israeli physicians, which ignited controversy by asserting the Israeli Defence Forces’ (IDF) right and duty to target hospitals in Gaza, alleging their use as terrorism headquarters. Signatories contended that prior calls for civilian evacuation sufficiently discharged moral obligations to minimize civilian and non-combatant deaths. In response, Physicians for Human Rights–Israel (PHRI), backed by over 3,500 members and volunteers, criticised the letter’s argument, asserting that it amounts to a “death sentence for patients.”
During times of conflict, physicians often assume (and are expected to assume) the role of moral arbiters, underscoring the need to preserve life and uphold human dignity in public, professional, and political fora. We argue that the underlying, although sometimes implicit, assumption here is that physicians’ training and practical formation typically equips them with a unique moral clarity during the ‘fog of war’, and enables them to sound the clarion call when humanitarian values are compromised. We question whether these assumptions are universally true and whether physicians intrinsically have the moral vision to assume such a weighty mantle. Accordingly, we advocate for judiciousness, and caution against excessive reliance on physicians’ voices for moral leadership.
Indeed, as illustrated by the contrasting letters mentioned above, physicians hold differing stances on the issue of targeting hospitals and patients in Gaza. Like many other professionals, physicians can be influenced by political agendas that cloud their moral judgment. They may also find themselves in echo chambers surrounded by univocal narratives that shape their perspectives, and their moral development through medical training may not be as comprehensive as is commonly thought. Indeed, history is replete with instances of medical professionals being complicit or coerced into participating in atrocities such as unethical human experiments and state-sponsored violence. Examples of such include physicians’ actions in Nazi Germany, Unit 731, and Guantanamo Bay.
Drawing insights from this historical context and acknowledging the limitations of physicians as voices of unassailable moral clarity, we propose a more inclusive and ethical deliberation that includes moral philosophers, ethicists, theologians, and other relevant voices. It is especially vital, given the origin and foundations of their discipline, that bioethicists deliberate over and discuss the present conflict to find common moral ground and a shared language through which we can call for the leadership that is required to uphold fundamental bioethical principles and value for human life. Indeed, it was only a short while ago that bioethicists were warned of the “peril of silence” about the ongoing Ukrainian-Russian war. Experts were called to employ their specialised expertise to assess the war’s moral and human costs and encouraged to resolutely speak out against the loss of human lives. In our view, the same applies to this and other conflicts raging across the world. Bioethicists of all stripes should have a prominent voice as diverse disciplinary insights must be brought together in order for the muddied moral calculus, such as that related to targeting hospitals, to become clearer.
Controversial Letter
The Doctors for IDF Soldiers’ Rights letter has triggered another distinct morally-laden question, namely should the moral role of physicians be extended to the public endorsement of a country’s army in justifying the targeting of medical facilities? Where physicians have actively contributed to war atrocities, international organizations drafted and issued guidelines and statements with the aim of defining the broad lines for what ethical conduct ought to be in the context of war. Illustratively, in its “Statement in Times of Armed Conflict and Other Situations of Violence” (1956, revised in 2023), the World Medical Association (WMA) adopted an unequivocal position holding that medical ethics is identical in both wartime and peacetime, confirming that the “primary task of the medical profession is to preserve health and save life.” The WMA also adopted a principled position towards protecting healthcare facilities, especially in its “Declaration On the Protection and Integrity of Medical Personnel in Armed Conflicts and Other Situations of Violence” (2011, revised 2022). It stressed that, in alignment with the Geneva and other international conventions, “healthcare personnel and facilities should never be instrumentalised as means of war” and concurrently recommended to “never misuse hospitals and other health facilities for military purposes.” In our view, and that of other colleagues in Israel, it appears that this letter has crossed a line by simply making any hospital in Gaza a legitimate military target, which inevitably has led to the loss of life, the destruction of critical life-saving services, and the annihilation of spaces that are sacred to the medical profession.
Wars and armed conflicts often blur the lines between right and wrong, and the morality of actions becomes ambiguous and contested. Physicians, while experts in their clinical fields, may not possess the expertise required to navigate the complex ethical terrain of wars and conflicts. Moreover, overreliance on physicians as moral voices may inadvertently lead to the militarisation of medicine. Furthermore, placing undue reliance on physicians may inadvertently place them in an ethically vulnerable position. Support for any kind of military action erodes trust in the broader healthcare community. In times of ambiguity and charged emotions, it is prudent to adhere to international codes of ethics crafted with an eye towards broad consensus, such as those of the WMA, rather than discard them.
Mohammed Ghaly, PhD, Aasim I. Padela, MD MSc, Samer Rashwani, PhD, Ayman Shabana, PhD, Mutaz al-Khatib, PhD
Note: Views presented are the authors’ personal perspectives and do not reflect the positions of any affiliated institutions. The first author acknowledges the dedicated support of his research assistant, Ms. Farah Sadek, for her invaluable assistance in preparing the early drafts of this article.