Cara Hunt, Ayden Eilmus, and Basel Tarab call for bioethicists to advocate for a permanent ceasefire and protection of medical facilities and personnel in Gaza.

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In a recent essay repositioning bioethics to face future challenges, the newly-appointed president and CEO of the Hastings Center for Bioethics Research Dr. Vardit Ravitsky emphasized the need for the field to “evolve and expand.” Without branching out beyond individualistic and health care-focused approaches, our discipline “will compromise its ability to do timely needed work and will become less relevant in today’s world.” We, as practicing bioethicists, couldn’t agree more that global disparities in human flourishing ought to become a core issue for our field. While some healthcare leaders rightfully spoke out decisively following the actions of Hamas on October 7^th,  they became silent in regards to the ongoing suffering, civilian casualties, and targeting of hospitals and healthcare personnel in the Gaza Strip during the Israeli offensive.

Photo Credit: Wikimedia Commons. Image Description: Al-Ahli Arab Hospital in Gaza City in the aftermath of being hit with a projectile on 17 October 2023 during the Israel–Hamas war.

We certainly condemn all violent war crimes perpetrated by the Israeli Military* and by Hamas. We argue here, however, that the severity of the humanitarian crisis unfolding in Gaza—where over 30,000 people have been killed at the time of writing—evokes the ethical horrors to which we must once again raise our voices to condemn. Even at its narrowest conception, the scope of our discipline is intended to safeguard patients and promote justice in healthcare. We cannot overlook the well-documented human rights violations occurring in Gaza, including the targeting of Palestinian hospitals, blocking of humanitarian aid, and targeting of human rights workers. We must consider how our own continued silence in the face of medical war crimes allows misinformation to spread and undermines our potential to “build bridges that reach beyond our territory.” We call on bioethics leaders from both sides to break their silence and call for a permanent humanitarian ceasefire in Gaza, for the release of all hostages, and for the protection of healthcare facilities, personnel, and patients.

As Matt Wynia correctly points out in his recent JAMA viewpoint on war in the Middle East, “the history of medical involvement in the Holocaust is a powerful illustration of what can happen in a society when health professionals adopt and reinforce prevailing sentiments and fail in the duty to speak hard truths in the face of rising racism, dehumanization, and medical war crimes.” Yet, as highlighted in this response letter, Wynia’s assertion that, “some international law experts believe Israel is not doing all it should to avoid harming civilians” is an egregious understatement that omits the quantity and severity of war crimes perpetrated by the Israeli Military, for which UN experts have declared a need for international intervention to prevent genocide.

Bioethics and healthcare leaders have responded publicly to geopolitical issues in the past. The insufficient response to the current Israel/Palestine conflict reveals inconsistencies in our discipline’s pedagogy. We, as academics, should be better prepared to navigate polarizing conflicts and communicate about them effectively, both to the lay public and to our students in the classroom. To do so, while respecting the scope of bioethics, we can take one of two clear paths: 1) take a stand by commenting on military and political affairs, or 2) abstain entirely from commenting on all geopolitical conflicts. Either way, we must be consistent, ensure impartiality, and carefully examine our own values—lessons on bias which are taught extensively in the majority of bioethics programs. We, as bioethicists, reject a stance of silence because we believe in a disciplinary responsibility to demonstrate moral courage and promote justice.

The American Public Health Association is our only major professional organization from the United States to have called for a humanitarian ceasefire in Gaza, drawing on its 2009 policy on The Role of Public Health Practitioners, Academics, and Advocates in Relation to Armed Conflict and War. In sharp contrast, house delegates of the American Medical Association (AMA) voted down a November resolution to support a ceasefire in Gaza, citing that the matter did not meet its criteria of advocacy, urgency or ethical consideration. The American Society for Bioethics and Humanities has been silent, despite its strong policy on academic freedom, which they assert is “especially critical for scholars working in bioethics and health humanities, since this work often involves addressing topics that are potentially controversial.”

The recent war in Ukraine offers a contrasting example of medical professionals and bioethicists taking a stand on matters of armed conflict: leaders from the AMA rightfully issued a strong statement in response to Russian military targeting of healthcare facilities, stating that it “violates every standard of decency. We join physicians everywhere—and especially in Ukraine—who are calling for an end to this war so we can work on healing the terrible damage already inflicted”; and former American Society of Bioethics and Humanities president Joseph Fins argued that bioethicists should avoid the “peril of silence” by denouncing Russia’s war against Ukraine, writing that “we are also positioned by our own history to bring a special kind of expertise to the conversation, knowledge that other academic domains may not possess in quite the same way.” We believe in this approach and call for its application to the ongoing conflict in Gaza.

As the number of civilian lives lost increases each day, bioethics leaders must act with moral courage to name these horrors and identify the systems facilitating them, from all sides of the conflict. In the words of Yale professor Timothy Snyder, “When political leaders set a negative example, professional commitments to just practice become important.” While the politics of this conflict may be complex, the injustices we are witnessing are not. How can we call ourselves ethicists and silently bear witness to thousands of civilian deaths, escalating sanctions, deprivation of basic life necessities, war crimes, kidnapping of hostages, sexual assaults and inhumanity? What are we teaching our students by being unwilling to acknowledge our biases and speak up?

We call on leaders in our field to take academic freedom from policy to practice by fostering an open and public bioethical dialogue about the Israel/Palestine conflict. We must understand that medical neutrality is our ground, not our ceiling and put our biases aside to call for an immediate and permanent ceasefire as the starting point for further steps towards preserving civilian lives. In the words of Dr. Ravitsky, “We now see the urgent need to create spaces for genuine exchange in an increasingly polarized world.”

* To maintain impartiality and objectivity, we move away from using Israel Defense Forces, or Israel Occupation Forces, and we will refer to it herein as Israeli Military.

Note: Views presented are the authors’ personal perspectives and do not reflect the positions of any affiliated institutions.

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Cara Hunt is a Program Coordinator in the Division of Medical Ethics at the NYU Grossman School of Medicine

Ayden Eilmus is a Project Associate in the Division of Medical Ethics at the NYU Grossman School of Medicine

Basel Tarab is the Director of Patient Experience and Co-Chair of the Ethics Committee at Winchester Hospital