Wednesday, September 23, 2015

Politics – September 2015 – Gmar Chatima Tova

Dedicated to the memory of Meir Pa’il, may he rest in eternal peace.

Peace One Day is on September 21. Amen!

Support is sought to facilitate the work of the Middle East Study Group. Information at

Politicians and philosophers share a tendency to portray reality and societal aspirations in abstract terms. Political scientists attempt to concretize their concerns and principles.

There is no option to stay. We all must leave.

~Raphael Cohen-Almagor

For the past twenty five years, I have been devoting much of my time to think and reflect on bioethical concerns. This is thanks to my Oxford teacher Ronnie Dworkin who introduced me to this fascinating field. Under Dworkin’s influence I embarked on researching end-of-life concerns. I consider The Right to Die with Dignity (2001) as one of my best books.

This Blog contains more bioethical issues than usual, maybe more than your share of interest. However, I should point out that many bioethical questions have political aspects. Debates in medical ethics are not free from political, religious, ideological, cultural and financial considerations. Many of these debates concern you, my dear reader, whether or not you like it.

On this blog I relate to three issues: euthanasia in Belgium, obligation of physicians to prisoners who start hunger strikes, and the right to die. The latter issue concerns all of us.

After I published my book Euthanasia in the Netherlands in 2004 I felt that I said all that I wanted to say about Dutch policy and practice. I decided not to relate to it until there substantial changes to be implemented that merited an update. I am still waiting for these substantial changes to take place.

Instead, I have focused much of my attention on Belgium that followed its neighbor and has adopted the slogan: Everything you can do, I can do better (or worse). Belgium keeps me busy… I am staggered by the pace of introducing more and more provisions for terminating life. As a Jew, as a human being, I believe in the slogan that saving one human life amounts to saving the entire world. I guess many people in Belgium adhere to different standards.

I support physician-assisted suicide (PAS) and object to euthanasia. There is a clear trend to push for legislation that would administer care at the end of life. The gray area in which physicians operate needs to be closely monitored to serve the patient’s best interest. On September 11, the Californian legislature approved a bill that supports PAS and the British parliament rejected a similar proposal. The debate will continue.

During the past weeks I was asked to submit my opinion to legislatures in Australia and Canada, where similar debates are presently taking place. I wait to see what decisions will be taken. Australia had end-of-life legislation in the Northern Territory but it was short-lived. Canada has such legislation only in Quebec.

In Israel, during the last few weeks one particular story has captured the headlines. The story relates to a Palestinian political/security prisoner who protested against his prison sentence by starting a hunger strike. Physicians and ethicists voiced their opinions whether or not to force-feed him. There are compelling reasons for and against. Here I provide a forum for a position paper, signed by many prominent scholars. I thank my good friend, Professor Shimon Glick, for sending it to me. I welcome your views.

Lastly, I was asked to contribute an entry on The Right to Die to a new Encyclopedia of Global Bioethics. Here I provide the abstract. You can read the full entry on my website at

Reflections on August 2015 Newsletter
Meir Pa’il (9 June 1926 – 15 September 2015)

Israeli-Palestinian Conflict: Low Flames

Israel Reopens Embassy in Egypt

Jeremy Corbyn
California Legislature Approves Assisted Suicide
My New Encyclopedia Entry
Interview to MercatorNet: Confronting the Dark Side of the Internet
New Books
Monthly Poems

Gem of the Month – Tenerife

Light Side – Did you know?

Light Side – The Word “Lovely” in English Culture

Reflections on the August Newsletter

Thanks to all who congratulated us on our son’s Bar Mitzvah. Most appreciated.

Dr Tom Mortier from Belgium commented on Belgian euthanasia under fire again.

Dear Raphael,

Very good that Michael Cook already mentioned your paper in BioEdge. There is definitely something toxic in the Belgian euthanasia policy that the Belgian citizens agree with the clear abuses of paternalistic physicians performing euthanasia to shorten the lives of some patients without their explicit voluntary request. Moreover, these physicians see 'euthanasia' as a 'normal medical practice'. This is most worrying and definitely should alarm the Belgian politicians. However, the opposite is true. For example, the Belgian minister of Health, Maggie De Block, has been trained by the organization of Wim Distelmans to become a 'Leif'-physician. She recently spoke at a benefit dinner for this organization. Therefore, there has been a clear incestuous relationship between these politicians and the Belgian euthanasia doctors to 'normalize' the practice as a 'standard procedure'.  This policy has opened the door to 'economic euthanasia'.

Meir Pa’il (9 June 1926 – 15 September 2015)

I was saddened to hear of the death of Meir Pa’il, a beautiful human being, a man of peace who stood against evil when he saw it, a socialist, a mensch.

Pa’il was one of the most fascinating, colourful and enchanting personalities in Israeli politics. People either loved him or hated him. I loved him.

Pa’il was a man of ideas and a doer; a man of principle who was loyal to his truth and who was not afraid to voice his strong beliefs. Pa’il was charismatic and witty, a sea of knowledge regarding the history of Israel and the Land of Israel taht he loved with all his big heart. Pa’il was a positive man and an eternal optimist. He was one of these rare people who lighten every room he entered.

Pa’il was born in Jerusalem during the British Mandate under the name Meir Pilevsky. Like many army officers he changed his surname to Hebrew and assumed to name Pa’il ("active" in Hebrew; most appropriate considering his ant-like personality). Between 1943 and 1948 Pa'il served in the Palmach. In April 1948 he witnessed the massacre at Deir Yassin. This tragedy made a tremendous impact on his life and thinking. Later Pa’il wrote:

I saw this horror, and I was shocked and angry, because I had never seen such a thing, murdering people after a place had been conquered. Afterwards in the War of Independence it happened in a few other places, but it was the first time in my life I had ever seen such a thing. So I started going around investigating. I didn’t say anything. I did not know their commanders, and I didn’t want to expose myself, because people were going around there, as I wrote in my report, with their eyes rolled about in their sockets. Today I would write that their eyes were glazed over, full of lust for murder. It seemed to be going on everywhere. Eventually it turned out that in the Lehi sector there were more murders, but I didn’t know that then. I didn’t know what to do.

In the Palmach, Pa’il was known as “The Red Zionist.” He never hid his political views and paid a price for being vocal, often taking unpopular views to the ears of his superiors. After the 1948 war, he remained in the Israeli Defence Forces (IDF), mostly in command, combat, training and education duties. Pa’il was commander of the central officer’s training school, commander of the 51st Golani battalion in the 1956 Sinai Campaign, and Deputy Commander of General Tal’s armored group in the 1967 war. Pa’il later headed the IDF Department of Military Theory in the General Staff and wrote the IDF Combat Handbook. In 1971, Pa’il retired from army service with rank of Colonel. Pa’il felt he could have reached higher echelons in the army but Moshe Dayan and Shimon Peres considered him persona non grata and blocked his way.

Pa'il studied history and Middle Eastern studies at Tel Aviv University where he completed a doctorate in military and general history. In 1973 he was among the founders of the Zionist-Socialist Blue-Red Movement, which merged with another small leftist organization called Maki to form the Moked Party, which Pa'il headed.

Pa’il was elected to the Knesset in the 1973 elections on the Moked list, and was the party's only representative in the 8th Knesset (21.1.1974 - 13.6.1977). His main activity was in the Knesset’s Education and Culture Committee. Pa’il sought to increase his party’s influence via mergers with other like-minded small, leftist bodies. Moked merged with them to form the Left Camp of Israel prior to the 1977 elections.

The new party won two seats, which were rotated between five party members including Pa'il. In the 9th Knesset, Pa’il was active in the Knesset Immigration and Absorption Committee, Education and Culture Committee, and Labor and Welfare Committee. Pa’il’s party was excluded from the prestigious Foreign Affairs and Defense Committee.

To speak in the early 1980s about the need for peace with the Palestinians, talking to the terrorist PLO organization, ending the occupation, evacuating the West Bank and a two-state solution was considered almost traitorous in Israel. The Left Camp of Israel failed to win any seats in the 1981 elections and Pa'il was forced to retire from the legislature. Pa’il loved the Knesset activity and was one of its most active members. He felt that while his views were correct, they were also more and more exceptional and eccentric in Israeli society.
Pa’il has published many books in Hebrew about Zionism, Israeli politics and military history. Among his publications: From the Hagana to the Israeli Defence Force (1979), Development of Jewish Defense Capabilities, 1907-1948 (1987), Independence 1948 (1990), Rift in 1948 (1991), The Palmach (1995) and The Commander: Military Leadership in Gentle Way (2003).

Pa’il was a military person, a military historian, a politician and a humanist. As can be expected from such a combination, Pa’il was a bitter cynic with a constant twinkle in his eyes. Listening to him was an experience I relished. I did not know whether to cry or laugh because he would speak about awful things with marvelous, shrewd language. Meirke, as he was known to people who loved him, spoke wonderful Hebrew and had a vast knowledge of Israeli history, politics and the military. During my political activity in Israel we crossed many paths. Years after he retired from politics I recall saying to him: Meirke, if you decide to return to politics and establish a new party, call me. I will be the first to join. Meirke laughed. I loved his laugh.

You can have a glimpse at Meirke, his zeal, his conviction, appreciate his love to Israel, the Bible, the Jewish people, the Land of Israel and to peace at
The Prophecy: Meir Pa'il Interview With Haim Yavin 1981,
Meirke Pa’il. Man of peace. May you rest in peace. You are not alone in your views. You are still a minority. One day, I hope, your views will become a reality. Yes, you were right.

Common sense does prevail. Sometimes it hesitates, sometimes it needs encouragement, but finally it comes about.

Israeli-Palestinian Conflict: Low Flames

The violence continues. The centre is Jerusalem. On September 18, 2015, twenty-one Palestinians and three Israeli Border Police officers were wounded during clashes throughout the West Bank and East Jerusalem. Clashes between Palestinian youths and Israel security forces are becoming an almost daily routine.

Force, of course, will not solve this. The solution is political, in negotiation between leaders.

Israeli and Palestinian leaders are reluctant to meet. The mutual feeling is that they have little to discuss. At present, the gaps between them are too wide and the trust is zero.

Later on Friday, September 18, the Palestinians showed once again that their actions are coordinated between the West Bank and Gaza. One rocket was launched on the city of Sderot. Another rocket was fired at the city of Ashkelon. The latter rocket was intercepted by an Iron Dome battery.

Loyal to its deterrence policy, Israeli retaliated immediately. IDF warplanes carried out three air strikes in the northern Gaza Strip late Friday night.

Violence begets violence. It will not beget solution. So far, the airstrikes fail to deter further launching of rockets. The Palestinians are willing to take on sacrifices. It is not in their interest to see another military campaign launched against them as then the toll of destruction is very high. But they are willing to continue showing their resistance and suffer the measured airstrikes.

The situation is becoming more complicated as there are different terror organizations that are now operating in the Gaza Strip. It is not all Hamas. A Salafist group calling itself the Omar Brigades, which identifies with ISIS, took responsibility for the rocket fire toward Ashkelon. The attack is believed to have been meant as an act of defiance against Hamas, which persecutes the group.

The Hezbollah remains preoccupied in Syria and refrains from involvement in this conflict. The Syrian mess works at present for Israel. But not for long.

Sadly, peace remains a distant dream. Common sense is absent. Both camps are firmly locked in their obstinate positions. The children of Israel and Palestine will continue to suffer.

Source: Haaretz,

Israel Reopens Embassy in Egypt

Some four years ago, Israel was forced to close down its embassy in Cairo. Then hundreds of thousands of protestors took the streets and brought about the end of the Mubarak reign. Some of them also protested against the Israeli presence in Egypt.  Riot police officers later clashed with the angry crowd in a street battle, resulting in the deaths of at least two people. Egyptian commandos rescued six Israeli staff members who had been trapped in the building for 13 hours.

In early September, the Israeli Embassy in Egypt was reopened this week, four years after the dramatic events that took place in Cairo forced Israeli diplomats to evacuate the embassy. Director General of the Foreign Ministry Dore Gold said, "Under the leadership of PM Benjamin Netanyahu and Egyptian President Abdel Fattah el-Sisi, we succeeded in driving away the threats, and we're working together for the sake of stability and prosperity in the Middle East."

Jeremy Corbyn
Jeremy Corbyn is the new leader of the Labour party. Immediately after his election, he sent an email to all Labour members, inviting them to send him questions they wish to ask David Cameron. A different leader.
What are Corbyn’s beliefs? Here is a summary provided by the BBC. While I endorse many of his social beliefs, a friend of Israel he is not.

1. The deficit should be paid off - but not through spending cuts and not to an "arbitrary" deadline. Instead Corbyn would fund its reduction via higher taxes for the rich and a crackdown on tax avoidance and evasion while tackling "corporate welfare" and tax breaks for companies.

2. Britain's railways should be renationalised. He is also opposed to the HS2 rail scheme, saying it would turn northern cities into "dormitories for London businesses".

3. Far more allotments would be good for the UK. He has a plot near his constituency in north London and told the Commons in 2008 that councils and builders "should be doing their best to ensure that every new development includes some allotment space".

(Most English people love to speak about two things: (1) the weather, which they cannot change and of which they often speak with cynicism and dismay; (2) gardening. A proper English home should have a garden, and many English people are proud to spend their weekends gardening. Now, some do not have a garden, or do not wish to grow vegetables in their garden. Thus municipalities provide allotments for people to do just this).

4. Talking to militant groups is necessary to win peace in the Middle East. Corbyn faced heavy criticism for using the word "friends" to describe Hamas and Hezbollah. He has responded by saying he had used the term in a "collective way" adding that while he does not agree with either organisation, a peace process means "you have to talk to people with whom you may profoundly disagree".

5. "Quantitative easing for people" could be used to invest in housing, energy, transport and digital projects. Unlike the £375bn issued electronically by the Bank of England between 2009 and 2012 to buy bonds, gilts and other debts, this would be "QE for people instead of banks", Corbyn says. Tax campaigner Richard Murphy argues these plans would stimulate the economy and boost employment. But Shadow Chancellor Chris Leslie attacked the proposal, saying it would lead to higher inflation and interest rates, hurting the poor most.

6. Replacing Trident would be a costly mistake. Corbyn, a long-term CND member, says plans to replace the nuclear missile system should be ditched. He believes the project's £100bn price tag could be better spent "on our national well-being".

Image copyright Getty Images

7. A National Education Service modelled on the NHS should be established. Under Corbyn, state-funded academies and free schools would be forced to return to local authority control while university tuition fees would be scrapped and replaced with grants. Corbyn would look at ending the charitable status of public schools, although he accepts this would be complicated and might not happen immediately. He reportedly split up with one of his former wives following a disagreement over whether to send their son to a grammar school or a comprehensive. Asked recently if the break-up was over an "an issue of principle", Corbyn told the Guardian newspaper: "I feel very strongly about comprehensive education, yes."

8. Labour should not support air strikes against Islamic State in Syria. Corbyn, who is national chair of the Stop the War Coalition, believes innocent Syrians would suffer and the supply of arms and funds to the Islamic State group should be cut off instead. He opposed military action against the Assad regime in 2013 and was a prominent critic of the invasion of Iraq. His website says he wants to see "illegal wars" replaced with a "foreign policy that prioritises justice and assistance". Asked during a Sky News hustings whether there were any circumstances in which he would deploy UK military forces, Corbyn said: "I'm sure there are some but I can't think of them at the moment."

9. Rent controls should be re-introduced, linking private rents to local earnings, and more council houses should be built. He also believes that council tenants' right to buy their homes should be extended to private sector renters.

10. The Chagos islanders evicted from Diego Garcia should be allowed to return. Some 2,000 people were displaced from the British Indian Ocean territory between 1967 and 1971 to make way for a US air base. Corbyn has been a long-standing supporter of their campaign to go back.

11. The immigration debate has been "quite unpleasant". In an interview with Channel 4 News, Corbyn said the current discourse around the issue "fails to recognise the huge contribution migrants have made to this country". He added: "We should let people into this country who are desperate to get somewhere safe to live".

12. The dispute between the UK and Argentina over the Falkland Islands could be resolved with "some degree of joint administration". In an interview with the BBC in 2013 he said other territorial disputes had been settled in this way, and under such an arrangement the islanders' British nationality could be maintained. He added that during the 1982 Falklands conflict it had been in Margaret Thatcher's interests to "divert attention from her catastrophic economic issues". During the leadership campaign, a Corbyn spokesman said he supported "a long-term negotiated settlement" that took the islanders' views into account.

13. High property prices are leading to the closure of London pubs. In 2013, he said in the Commons that pub companies "make a great deal of money out of selling them" to developers.

14. An arms embargo should be imposed on Israel. Corbyn, who is a patron of the Palestine Solidarity Campaign, said in August that Palestinian refugees should be given a "right of return". He supported a boycott of goods produced in Israeli settlements and of Israeli universities that engage in arms research.

15. Corbyn is a committed republican, but he would not seek to end the monarchy. He told the New Statesman: "It's not the fight I'm going to fight - it's not the fight I'm interested in."

16. Remaining in the European Union but with changes. Corbyn says he is not content with the EU as it stands, but wants to stay to fight for a "better Europe". He had previously refused to rule out campaigning to leave. He also opposes the Transatlantic Trade and Investment Partnership (TTIP) deal.

17. Corbyn backs cycling. He does not own a car and declined to share one with the BBC's Chris Mason for an interview, saying: "I cycle all the time. Actually I've got a confession to make, a rather naughty secret - I've got two bikes." He is also a member of the All Party Parliamentary Group on Cycling.

18. Energy companies should be under public ownership. He says he would be "much happier" with a "regulated, publicly run service delivering energy supplies". He is "totally opposed" to fracking. However, he says deep-mine coal pits in the north of England could be reopened.

19. Ireland should be united. Corbyn has long supported British withdrawal from Northern Ireland and invited Sinn Fein President Gerry Adams to the House of Commons as far back as 1984. He was criticised for observing a minute's silence for eight IRA members killed by the SAS in 1987 and once employed Irish Republican Ronan Bennett as a member of staff at Westminster.

20. A national maximum wage should be introduced to cap the salaries of high earners. He would also introduce a windfall tax on former state assets such as the Royal Bank of Scotland, which he says were privatised too cheaply.

21. Every child should have the chance to learn a musical instrument or act on stage. Corbyn's arts policy also includes directing a greater proportion of funding to local projects, widening access and protecting the BBC.

22. Private Finance Initiative deals with the NHS should be ended by using government funds to buy them out. Writing in the Guardian, Corbyn said they were a "mess" that were costing the health service billions.

23. A "serious debate about the powers of Nato" is needed, but Corbyn has said there is not "an appetite as a whole for people to leave". Corbyn has previously supported withdrawal and believes it should have been wound up in 1990 at the same time as the Warsaw Pact. He also said open eastward expansion of Nato would lead the Russian military to conclude that it had "to expand to counteract Nato".

24. The arms trade should be restricted. Corbyn would like to see the "brilliance and skill of those in the arms industry be converted for peaceful purposes".

Source: 24 things that Jeremy Corbyn believes,, 13 September 2015,


The subject of the appropriate ethical and medical treatment of hunger-striking political prisoners is a constant subject of public attention and debate. Recently the debate concerned a particular Palestinian hunger-striking prisoner, whose treatment involved much heated debate and ultimately involvement of the Israeli Supreme Court. The Israel Medical Association has taken a very clear position forbidding coerced feeding of a hunger-striking prisoner even at a stage when there is clear danger to the prisoner's life and health, until the point when the faster loses consciousness. This position has been presented as an absolute and undisputed position, to the extent that the IMA has indicated that any of its member physicians who impose such treatment will be exposed to disciplinary proceedings for violation of the IMA position. As a result a number of leading Israeli bioethicists, physicians, philosophers and legal experts have decided that it is essential to present to the physicians and the public a differing ethical and professional point of view. The following presentation is intended to protect the freedom of conscience of a physician who chooses to act in accord with Israeli positions on bioethics and law.

We believe that our approach is well substantiated and grounded from an ethical, legal, professional and humanistic point of view

Our analysis is as follows:
There are a variety of hunger strikers, including socioeconomically deprived citizens, workers fighting for improved working conditions and prisoners demanding freedom or improved prison conditions, among others.

There is general agreement that an individual's rights over his/her body (autonomy) includes the right to express protest for his/her cause by a hunger strike.

But when the hunger strike advances to a stage in which there is a clear and present danger to the life of the striker a dilemma is presented. Unquestionably, the appropriate approach from a humanitarian and ethical point of view is to do everything possible to convince the striker to end the hunger strike in order to save his/her life. There should be created an ongoing relationship between the striker and medical representatives outside of the prison. This kind of relationship in which a degree of trust is created hopefully leads to negotiation which can lead to an end of the strike without need for any coercion. Indeed in Israel, in recent years there has been no death as a result of a prisoner's hunger strike, largely because of the extraordinary skilled and devoted efforts of physicians and institutional ethics committees .

However if a hunger striker insists on his/her refusal to end the strike in spite of all efforts of persuasion, the ethical dilemma presents itself on how to find the proper delicate balance between the values of human life and the value of individual autonomy.

The two options then available are:
        Allow continued fasting until death or coerced feeding

There is of course a third alternative, to accede to the demands of the hunger striker. But this is a political/judicial decision beyond the legitimate professional spectrum of physician responsibility. Our discussion is based on the premise that we are dealing with a democratic society, in which the imprisonment is legally imposed with the sanction of the country's highest legal authorities. Further decisions are not in the purview of the physicians.

We, the undersigned believe that in such extreme circumstances, when all persuasive efforts have failed and when there is a clear and present danger to the prisoner's life if the fasting continues, the ethical value of preservation of human life and the professional responsibilities of the physicians to save human life take precedence over the infringement on the individual's autonomy.

This ethical position is based solidly on Israel's laws and on the decisions of the Israeli Supreme Court and district courts:

1. The constitutional Law.-Human Honor and Freedom states that the fundamental rights of Israeli citizens are based on the recognition on the value of human life and on human freedom, as expressed in Israel's Declaration of Independence as a Jewish and democratic state
2. "Do not stand idly by your fellow-man's blood" Law declares that a person is required to come to the aid of another who is suddenly exposed to immediate and serious danger to life, bodily integrity or health, when it is possible to provide assistance. This law obligates all individuals, and certainly medical personnel.
3 Patient Rights Law addresses the delicate balance between the value of life and the rights of an individual on his/her body. It allows imposition of life-saving treatment on a competent patient over his/her refusal if an institutional ethics committee after listening to the patient approves the treatment under the following restrictions: (a) if the patient has received all the necessary information; (b) if the treatment is expected to benefit the patient significantly, and (c) if there is reason to believe that after imposition of the treatment the patient will give retrospective consent.

We feel that the physicians and the medical establishment must act in accord with ethical and professional considerations only, according to the patient's medical condition and in accord with Israeli law. They should not serve any political interests. The legal and political ramifications of the prisoner's state belong outside of the medical milieu.

We therefore feel that once a prisoner is hospitalized he/she is to be treated simply as a patient in accord with ethical and professional standards;
      1. No discrimination on the basis of age, sex ,race, nationality or political ideology.
      2. No discrimination on the basis of their behavior or views. Identical treatment must be given to a terrorist as to any injured individual, to a patient who has brought his disease or injury upon himself/herself (smoking alcohol etc), to a patient who has attempted suicide whether by slashing wrists, jumping from heights or hunger striking until reaching a dangerous state.

Therefore differential treatment of political/security hunger strikers from other patients with similar medical conditions is not proper, and is contrary to professional ethics. In addition, refusal to treat a hunger striker in order to apply pressure on the authorities to accede to the striker's demands is improper as well, and is not compatible with the ethical and professional responsibilities of the physician.

1. Every individual has the right to express his protests or demands by hunger striking. This principle is valid whether the strike is for personal benefit or for freedom from prison for any reason whatever.

2. When the hunger striker reaches a situation of danger to life, physicians have an ethical and professional responsibility to attempt to convince him/her to cease or moderate the fast in order to minimize the danger to life or to permanent injury. This effort is in keeping with the value of human life and that of autonomy and freedom of the subject.

3. When the hunger striker reaches a stage of danger to life he/she becomes a patient, like any other patient, and continuation of the fast becomes a manifestation of suicidal intent. In almost every instance of a political hunger striking, the prisoner does not want to commit suicide or die, but he/she wants to achieve an important  political objective. Preventing death by the physician is thus in some way consistent with the prisoner's autonomy.

4. Thus, when all attempts at persuasion have failed, and there is a clear and present danger to life and the prisoner is a hospitalized patient, the Patient Rights Law comes into effect, irrespective of the fact that the patient is a political prisoner.

5. One should then convene the institutional ethics committee which will listen to the faster and to the medical and nursing staff. The committee may then authorize imposed feeding.

6. The manner of feeding is a medical decision and should be done in as professional and humane way possible under the aegis of the ethics committee.

7. The timing of invoking the ethics committee intervention is the responsibility of the medical staff using their best professional judgement, in accord with the faster's medical condition from moment to moment. The proposal by some to wait until the faster loses consciousness before imposing treatment, while making it easier to treat without opposition from the patient is problematic from two aspects. It exposes the faster to the danger of sudden death or permanent brain damage. In addition it still represents a violation of the faster's autonomy.

8. Imposition of medical treatment, including feeding in a professional, empathic and proportionate manner is not torture even if performed without the consent of the faster, as long as the following conditions are met; a) it is carried out with the intent of life-saving. b) it is carried out in the acceptable medical manner. c) it is carried out in the least traumatic and safe manner. Torture is an activity whose intention is to cause suffering in order to force an individual to behave in a certain manner. Imposed feeding is intended to save life and not to cause pain or suffering, and cannot be considered torture. Indeed allowing continuation of fasting until death causes much more suffering than feeding. And in waiting for unconsciousness to occur before treatment usually involves intubation and induced respiration, again with more suffering than imposed feeding at an earlier stage.

We believe that our approach is founded solidly on the basis of ethics, professionalism, and law. We do however recognize that there are scholars and organizations for whom the value of autonomy, expressed by the desire of the hunger striker to continue until death takes precedence over the value of preservation of human life. According to this approach the physician is to stand aside and permit the faster to die, even if it possible to save his/her life.

But in respecting this point of view we object strongly and protest the position of some of our colleagues and organizations who attempt to create the impression that there is only one possible ethical opinion in this dilemma and that is to prefer the value of autonomy even at the risk of death. We feel that there is another alternative which is the appropriate one.  Our approach is supported by the position of the European Court of Human Rights and by courts in a number of democratic countries which permit imposition of feeding when there develops an immediate and serious threat to the striker's life.

Therefore, we believe that each physician should act in accord with his/her conscience in this sensitive and difficult dilemma:

A physician who feels that there is an ethical problem with imposed feeding on a hunger striker even if this attitude may lead to the death of the striker-should relieve himself/herself from the care of the patient, but only after assurance that there is a replacement physician to treat the patient.

On the other hand, a physician who agrees with our position on saving the life of the striker should be allowed to impose such therapy on the patient, and not stand idly by to witness the death of the patient, all this after discussion and approval by the institutional ethics committee.

It is essential to respect the conscience of the individual physician in controversial areas of medical ethics just as is done in the area of abortions and end of life treatment.  
California Legislature Approves Assisted Suicide

On September 11, 2015, the California State Legislature gave its final approval to a bill that would allow physicians to help terminally ill people end their lives. This issue was on the California State Legislature for many years. Attempts at such legislation were made several times and now the bill has passed. It has been long in the making.

Four states — Oregon, Washington, Montana and Vermont — already allow physicians to prescribe life-ending medication to some patients. The California bill, which passed in the State Senate by a vote of 23 to 14, will now go to Gov. Jerry Brown, who will roughly triple access to doctor-assisted suicide across the country if he signs it. Mr. Brown has given little indication of his intentions.

The California bill is modelled on the law in Oregon, with several notable changes. The California law would expire after 10 years and have to be reapproved, and doctors would have to consult in private with the patient desiring to die, as part of an effort to ensure that no one would be coerced to end his or her life — a primary concern for opponents of the law.

Gallup poll this year found that nearly 70 percent of Americans support physician-assisted suicide, up 10 percentage points from last year.

On the same day, the British Parliament rejected plans for a right to die in England and Wales in their first vote on the issue in almost 20 years. Dr Peter Saunders, campaign director of Care Not Killing, welcomed the rejection of the legislation, saying the current law existed to protect those who were sick, elderly, depressed or disabled. He said: "It protects those who have no voice against exploitation and coercion, it acts as a powerful deterrent to would-be abusers and does not need changing."

But Sarah Wootton, the chief executive of Dignity in Dying, said it was an "outrage" that MPs had gone against the views of the majority of the public who supported the bill. She added that "dying people deserve better".

My New Encyclopedia Entry

“Right to Die”, in Henk ten Have (ed.), The Encyclopedia of Global Bioethics (Dordrecht: Springer-Kluwer, 2015).

Raphael Cohen-Almagor*
Politics, University of Hull, Hull, UK

This entry opens with a concise history of the right to die movement. Then it provides a conceptual framework, explaining key terms that are often utilized by those who advocate physician aid-in-dying: liberty, autonomy, dignity, respect, concern, quality of life, and suffering. Contra quality-of-life considerations, arguments relating to the sanctity of life are presented. Reflecting on whether the physician’s role includes also termination of life, guidelines are suggested that balance between patient’s wishes and our shared concern to prevent abuse, explaining that while physicians cannot be obligated to end life, those who accept that patients do have the right to die may come to their assistance.

Autonomy; Dignity; Ethics; Euthanasia; Physician-assisted suicide (PAS); Physician’s role; Quality of life; Suffering

As always, I’d be happy to email the piece to interested parties.

Interview to MercatorNet: Confronting the Dark Side of the Internet

In a recent interview about my new book I argued that liberty without responsibility is a recipe for chaos. You can read the interview at

New Books

Jonathan Marc Gribetz, Defining Neighbors (Princeton: Princeton University Press, 2014).

This is an erudite, well-researched and well-written book that analyses the relationships between Arabs and Jews, Muslim and Christians in the Yishuv period. It throws fascinating light on the complex relationships by combining historical narrative with personal accounts of people from different denominations.

Gribetz correctly remarks that the histories of the communities of Palestine have generally been studied as separate histories while he tries in this book to explore the interconnectedness of these histories and to argue that there is much one can learn about this society when we view it as a whole, however complex and fragmented.

The Second Aliyah is the most important of all. Many of Israel’s leaders in its first decades arrived in this Aliyah. Gribetz notes that in the minds of those Zionist ideologues, they were engaged in a national-class encounter. In their self-perception, religion was not the real, defining feature.

Gribetz argues that while there were deep concerns about land in the encounter between Jewish and Arab communities, people related to each other as groups with intertwined histories, cultures, and beliefs. These points of intersection and commonality could at times produce a sense of shared interests while at other times they generated hostility and fear.

This book competed for the Shapiro Prize for Best Book in Israel Studies, 2015. I ranked this book very high. I found it broad and compelling both in terms of the research invested in writing this book and in providing analytic thinking about the Arab-Jewish relationships during the final decades of the Ottoman Empire.


 I love to read good thrillers that keep you on your toes, not knowing how the story will unfold. These thrillers are not common.

If you like this genre, I recommend Linwood Barclay's Too Close to Home. The book opens with a horrific event, when a family of three is murdered by an intruder into their home. I had no idea who that intruder was until late in the novel. 

The plot includes a much-too-ambitious academic, an aspiring talented young novelist, a low-moral local politician, ex-cons with no respect for the law, and a middle-class family, your next-door neighbors who have some skeletons in the closet.

Barclay is a talented novelist. I have read some of his books and enjoyed many of them. This thriller is an excellent company for your next travel and vacation.

Monthly Poems

A Calendar of Sonnets: September

O golden month! How high thy gold is heaped!
The yellow birch-leaves shine like bright coins strung
On wands; the chestnut's yellow pennons tongue
To every wind its harvest challenge. Steeped
In yellow, still lie fields where wheat was reaped;
And yellow still the corn sheaves, stacked among
The yellow gourds, which from the earth have wrung
Her utmost gold. To highest boughs have leaped
The purple grape,--last thing to ripen, late
By very reason of its precious cost.
O Heart, remember, vintages are lost
If grapes do not for freezing night-dews wait.
Think, while thou sunnest thyself in Joy's estate,
Mayhap thou canst not ripen without frost!

Helen Hunt Jackson


Each day passes and I miss you more 
Each day passes and I love you more, 
Each day passes and I wonder if what we share can withstand the distance, the time, 
the separation and the loss. 

Will we grow doubtful of our passion, 
Will we hide in our own walls to protect ourselves from the pain, 
Will we withstand the long winter. 

In summer our love shone 
Our love sparkled with every movement between us, 
Our smiles joined our hearts through our eyes. 

We face the autumn my love when things die, 
We face the winter my love when things wait. 
I wonder if we will follow the seasons 
I wonder if we can withstand the cold. 

Each day passes and winter comes close, 
But each day passes and we come closer to spring. 
And each day passes and my hope grows stronger that spring will bring a new life for us.

written September 2010 

Susan Cook 

Gem of the Month – Tenerife

As part of the Bar Mitzvah celebrations and at the request of Roei we travelled to Tenerife, a small Spanish island much closer to Africa than to Spain whose history is dominated by volcanos.

Tenerife has two main parts, the South which is sunny, warm and desert-like, and the North which is greener, wetter and no less beautiful. Tourism is the main industry. More than 75% of the island inhabitants work in services, catering for more than 4 million tourists a year who visit the island. This number does not include tourists from Spain who add some 30% to the tourist count.

Below is a photo from Garachico, a small town that had the misfortune of volcano eruption that covered the entire area. Only one house survived and can be seen below street level. The eruption created natural pools in the sea.

  1. Light Side – Did you know?

 Did you know that at the start of the original recording of the Beatles’ “Hey Jude” Ringo Starr was in the toilet? This is why you hear the drums only after a few lines. The Beatles decided that the introduction of the drums later in the song is a good idea and left it as is.

As we are approaching Yom Kippur, I wish you all good health. May you all be signed in the book of life.

Light Side – The Word “Lovely” in English Culture

I swim. A few days ago the lady at the information desk informed me that this was my last entry before I need to renew the card. This is how she said it:

“This is your last one. Thank you”. And as she returned the card to me she added “Lovely”.


Peace and love.

Yours as ever,


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