July 3, 2022

Doctors under the black flag of the Islamic State

Health care workers face agonising dilemmas.

Looking for dramatic examples of dilemmas in medical ethics? Try being a doctor in territory ruled by the Islamic State. In a disturbing blog post, bioethicist Craig Klugman has sifted through media reports and found many examples of how difficult it can be to work as a doctor or nurse in the occupied city of Mosul or other centres.

* “In some reports, hospitals and health care practitioners are being targeted for death, abduction, and arrest. ISIS has declared that physicians who do not report to work will have their property seized and be exiled. Physician autonomy on whom to treat and on whom to use limited resources has been removed. There are reports of medication and blood being taken by soldiers to be used on their own and not on civilians or other patients, no matter their medical need.”

* Some doctors have refused to treat ISIS wounded. One report said that ten doctors at a hospital in Mosul had been executed for refusing to treat. The scant details suggested that ISIS had forced regular patients out to make room for its own wounded.

Klugman points out the agonising dilemma faced by these doctors. “On the one hand, this resistance can be viewed as bravery and courage—not lending assistance to a regime with which they do not only philosophically disagree but that has also demonstrated a lack of respect for human life. … On the other hand, patients are vulnerable and are people in need. If a physician can help someone in need, is there not an obligation to do so? Did these physicians abandon patients because of a political disagreement?”

* The government of Iraq has alleged that ISIS is trafficking in organs and that a dozen doctors had been executed for refusing to cooperate. Klugman points out that collaborating in organ transplants under these circumstances could be viewed as a war crime. “The tough question is whether a physician is required to sacrifice his or her life in order to not commit an unethical act. If the physician’s family or self is threatened with death for not participating, should that ultimate price be paid?” 

* Medicine under ISIS is strictly segregated by sex. Male doctors are not allowed to touch female patients, nor female doctors male patients. Women doctors are not allowed to work at night, so sometimes women in labour go unattended.

Should the standards of Western bioethics be imposed upon the doctors serving the Islamic State? Perhaps, Klugman suggests, the standards are not so different. He quotes a 9th century philosopher-physician Muhammad ibn Zakariya al-Razi: “The doctor’s aim is to do good, even to our enemies, so much more to our friends, and my profession forbids us to do harm to our kindred, as it is instituted for the benefit and welfare of the human race, and God imposed on physicians the oath not to compose mortiferous remedies.”

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