The present article focuses on the case of the 2012 hunger-strike of Palestinian prisoners in Israeli jails. We analyze the ethical dilemma involved in the way the Israeli medical community reacted to these hunger-strikes and the question of force feeding within the context of the fundamental dual-loyalty structure inherent in the Israeli Prison Services—system. We argue that the liberal perspective that focuses the discussion on the dilemma between the principle of individual autonomy and the sanctity of life tends to be (...) oblivious to the asymmetrical relation of power that characterizes the prison system and to the socio-political context in which hunger-strikes take place. Emphasizing hunger-strikes as political acts implies that health practitioners’ conducts cannot be analyzed only through the prism of clinical medical ethics. It requires a public health ethics’ approach, an approach that understands health in the context of the complex relationship between society, state, organizations, communities and individuals. The authors are both academics and volunteers in Physicians for Human Rights—Israel thus our analysis is based both on sociological and public health ethics principles and on the continuous work and advocacy for the right to health of prisoners. (shrink)

One Health, as an international movement and as a research methodology, aspires to cross boundaries between disciplines. However, One Health has also been viewed as “reductionist” due to its overemphasize on physicians-veterinarians cooperation and surveillance capacity enhancement, while limiting the involvement with socio-political preconditioning factors that shape the impact of diseases, and the ethical questions that eventually structure interventions. The current article draws on a qualitative study of Brucellosis control in Israel, to address the benefits of broadening the One Health (...) perspective to include ethical considerations and the socio-political aspects of health. Using in-depth-interviews, observations and document review, the article analyzes stakeholders’ knowledge (policy makers, practitioners and livestock owners) to understand Brucellosis control interventions in the Negev region of Israel. The analysis highlights four different types of boundaries: geographical, professional, disciplinary and participatory. The variety of boundaries going beyond disciplinary ones, are often neglected by traditional One Health discourses, however they provide clearer understanding regarding the role of the Israel and Palestine relations; enforcement activities and trust creation; and mechanisms of decision-making and public participation, in Brucellosis interventions. A broad One Health analysis that addresses ethical concerns and socio-political environments, as well as human and veterinary medicine, encourages re-framing of causes and solutions when dealing particularly with Brucellosis in the Negev, but more generally with zoonotic diseases, low-trust settings and inequitable distribution of power. The inclusion of historical, political and bioethical considerations of Public Health in One Health creates opportunities to increase the relevance of One Health and expand its scope as a novel scientific paradigm. (shrink)

Three thousand belligerents, mostly belonging to the military arm of Hamas, stormed Southern Israel on October 7th, 2023. Along with 3,000 rockets fired at Israel from Gaza, these belligerents inva...

AbstractWe propose an emerging conceptualization of “intervention hesitancy” to address a broad spectrum of hesitancy to disease prevention interventions among healthcare personnel (HCP) beyond vaccine hesitancy. To demonstrate this concept and its analytical benefits, we used a qualitative case-study methodology, identifying a “spectrum” of disease prevention interventions based on (1) the intervention’s effectiveness, (2) how the intervention is regulated among HCP in the Israeli healthcare system, and (3) uptake among HCP in the Israeli healthcare system. Our cases ultimately contribute to (...) a more nuanced conceptualization of hesitancy that HCP express towards disease prevention interventions. Our case interventions included the seasonal influenza vaccine, the Mantoux test, and the hepatitis B (HBV) vaccine. Influenza and HBV are vaccine-preventable diseases, though their respective vaccines vary significantly in effectiveness and uptake among HCP. The Mantoux test is a tuberculin skin test which provides a prevention benchmark for tuberculosis (TB), a non-vaccine preventable disease. We conducted semi-structured interviews with relevant stakeholders and analyzed them within Israeli and international policy context between 2016 and 2019, a period just prior to the COVID-19 pandemic. We propose the conceptualization of “intervention hesitancy”—beyond “vaccine hesitancy”—as “hesitancy towards a wide range of public health interventions, including but not limited to vaccines”. Results suggested that intervention hesitancy among HCP is rooted in weak trust in their employer, poor employment conditions, as well as mixed institutional guidelines and culture. Conceptualizing intervention hesitancy expands the ability of healthcare systems to understand the root of hesitancy and foster a supportive institutional culture and trust, cognizant of diverse disease prevention interventions beyond vaccination. (shrink)

This book offers a novel understanding of Israeli bioethics that is a milestone in the comparative literature of bioethics. Bringing together a range of experts, the book's interdisciplinary structure employs a contemporary, sociopolitical-oriented approach to bioethics issues, with an emphasis on empirical analysis, that will appeal not only to scholars of bioethics, but also to students of law, medicine, humanities, and social sciences around the world. Its focus on the development of bioethics in Israel makes it especially relevant to scholars (...) of Israeli society- both in and out of Israel-as well as medical practitioners and health policymakers in Israel. (shrink)

While bioethicist Arthur Caplan claims that “The Nazi analogy is equivalent to dropping a nuclear bomb in ethical battles about science and medicine”, we claim that such total exclusion of this analogy is equally problematic. Our analysis builds on Roberto Esposito’s conceptualization of immunitas and communitas as key elements of biopolitics. Within public health theories and practices there is an inherent tension between exclusion (immunitas) and inclusion (communitas) forces. Taking the immunitas logic to the extreme, as National Socialist medicine did (...) in the name of securing the German race, is a constant danger that needs to be taken seriously into consideration when discussing public health policies. The tension between the silencing of the Holocaust in bioethical debates on one side, and the persistent use of National Socialist medicine metaphors, on the other hand, is the focus of this paper. By delving into the meanings and the implications of this two‐edged discourse, we argue that comparing post‐war bioethics with pre‐war medical practices from a biopolitical perspective has the potential to depict a more nuanced account of continuities and discontinuities in bioethics. (shrink)

Scientific medicine carries within it an inherent contradiction. On the one hand, given its general scientific inquiry into health and disease, their conditions, etiologies, and treatments, it makes a claim for universality. To justify this claim, at different times and in different places, scientific medicine has prioritized techniques such as the medical gaze and autopsies to assure its diagnoses; it has applied numerical methods in order to have a better grasp of diseases and their possible treatments; it has used laboratory (...) analyses in order to understand life at its molecular level; and more recently it has introduced Randomized Clinical Trials in order to generalize clinical treatments. On the other hand, contrary to its universalistic claims, scientific medicine sets up and reifies boundaries. It creates distinctions between the healthy and the sick and defines categories, such as gender and race, that have deep political and social meanings. (shrink)

In this essay, we analyze the case study of mass ringworm irradiation conducted in Israel during its first years of existence and its consequences. We analyzed the case study of ringworm irradiation in the framework of racial construction of illness and its treatment, showing the elasticity of race and ethnicity as medical and social categories.

The BiDil affair brought once again to the fore questions of race and medicine. As discussed in other essays in this collection, the emergence of BiDil as the first medication approved and marketed for treating specific racial groups raises important questions for medicine and society: How are race and ethnicity framing our understanding of health and illness? Should treatment decisions be based on the race and ethnicity of patients? Should we encourage the development of race-specific medical treatments in order to (...) reduce health disparities? Or is this approach dangerous, and can it lead to unwanted consequences including racial stigmatization? These questions are not new, and since the introduction of race as a scientific construct in the late-19th century, race has played an important part in the history of medicine, most notoriously during World War II and the Holocaust. Yet the identification of race medicine with Nazi science tends to obscure the vast use of race as a medical construct by a wide range of medical scientists and practitioners across the political spectrum. In many instances, racial minorities were preoccupied with race medicine in order to promote the health of their own communities. One such group was that of Jewish physicians. (shrink)

ArgumentWe examine the creation and functioning of the “Pasteur Institute in Palestine” focusing on the relationship between biological science, health policy, and the creation of a “new society” within the framework of Zionism. Similar to other bacteriological institutes founded by colonial powers, this laboratory was developed in response to public health needs. But it also had a political role. Dr. Leo Böhm, a Zionist physician, strived to establish his institution along the lines of the Zionist aspiration to develop a national (...) entity based on strong scientific foundations. Even though the institute enjoyed several fruitful years of operation, mainly during World War I, it achieved no lasting national or scientific importance in the country. Böhm failed to adapt to new ways of knowledge production, scientifically and socially. The case study of the “Pasteur Institute in Palestine” serves as a prism to view the role of the public health laboratory in the history of Palestine with its ongoing changes of scientific, organizational, and political context. (shrink)

ArgumentTwo medical delegations, one from Palestine and one from the United States, were sent to detainment camps in Cyprus in the summer of 1947. The British Mandatory government had set up these camps in the summer of 1946 to stem the flow of Jewish immigrants into Palestine after World War II. The purpose of the medical delegations was to screen the camps' inhabitants and to propose a mental-health program for their life in Palestine. We examine the activities of these two (...) delegations within the context of their scientific interest in the psycho-pathology of displaced persons after World War II and as part of a broader project of mental hygiene. According to the delegations, the detainees would be a potential source of strength for building a new society if they adapted to life in Palestine. However, they would become a burden if they failed to be absorbed. At the same time, the medical delegations also saw the detainee camps as a potential “living laboratory” for scientific exploration. The case of the two medical delegations in Cyprus is also a story about constructing and transgressing medical borders. Apart from the obvious fact that this case study deals with movement of people, refugees as well as health-care workers, it is also about the transmission of knowledge and professions across the ocean. (shrink)

ArgumentThis paper focuses on the Jewish nursing profession in Poland during the interwar period. We argue that the integration of Jewish women in medical activity under the AJDC (American Jewish Distribution Committee) and TOZ (Towarzystwa Ochrony Zdrowia Ludności Żydowskiej [the Society for the Protection of the Health of the Jewish People]) emerged in Poland less from the adoption of gender equality and more out of necessity. On the one hand, JDC and TOZ needed Jewish nurses and public health nurses to (...) carry out their health campaigns and build a public health infrastructure. On the other hand, a new generation of Jewish women needed job opportunities that would enable them to make a living and be independent. More broadly this case study shows that the implementation of American “reformative” ideals into the local Polish reality, including in the newly emerging public health field, involved adaptation, negotiation, and in some cases, resentment. (shrink)