“Do leaders in health care have any responsibilities to speak out, as health professionals, about the Israel-Hamas war?” asks an op-ed in JAMA.

Yes, says Matthew K. Wynia, of the University of Colorado Center for Bioethics and Humanities, Aurora. He tries to steer a middle course between the two sides in the war by setting out four principles for doctors in a war.

First, health professionals should condemn dehumanization and acts of genocide. “The terrorist group Hamas, however, has repeatedly asserted that its aim is to eliminate all Jews in the region by killing them. This is the definition of genocide, and Hamas has proven intent on carrying it out. Health professionals should condemn both the genocidal aims and actions of terrorist groups in unequivocal terms.”

Second, health professionals should vigorously oppose both antisemitism and anti-Muslim hatred. “In hospitals and clinics worldwide, it is common for Jews, Muslims, Christians, and others to work side-by-side as colleagues and friends, treating people of all faiths equally—we must do everything we can to strengthen and demonstrate those bonds during wartime.”

Third, health professionals have special responsibilities to speak out against certain war crimes. Hamas has committed medical war crimes. “Hamas and its allies shot individual health professionals who were wearing proper medical markings tending to patients on October 7,” he says.

And Israel has been pilloried for attacking hospitals in Gaza where terrorists are sheltering. Wynia does not condemn Israel outright for the ensuring destruction and deaths, but asks if it is doing all that it can to avoid civilian casualties. However, he says: “It is abhorrent in medical ethics to calculate an ‘acceptable’ number of children to kill to defeat even the most heinous enemy.”

He concludes with wisdom from the Talmud: “This is why our primary responsibility in war as in peace is saving lives, regardless who they are or how they have been injured. In this respect, in wartime our profession must remain the living embodiment of religious injunctions to treat every life as sacred, because to save a single life is to save an entire world.”