Dateline Jerusalem — What would you do? The scenario is a terror attack with multiple injured victims and an injured terrorist. The terrorist’s injuries are s more serious than the victims’. A limited number of medical first responders at the scene. You are a first responder. To whom would you give medical attention first, the terrorist or the innocent victims of terror? This is not a situation where the choice is determined by race, religion, creed or ethnicity. The stark choice is terrorist or victim of terror. What would you do?
This is the controversy facing Israeli emergency medical responders. Physicians for Human Rights appealed to the Ethics Committee of the Israel Medical Assn. to change its guidelines which had called for victims of terror to be treated before treating the terrorists. Therefore, the Medical Assn. recently declared that first responders to the scenes of terror attacks must treat the person with the most serious injury first, even if the injury is only slightly more serious, regardless of whether the person is the terrorist who tried to kill the several Israelis who also require immediate medical attention.
Interestingly, Physicians for Human Rights made no outcry with respect to the Arab medical staff at a clinic in Jerusalem when they refused to help Jewish victims who were stabbed next to the clinic. Two Jews were murdered, a Jewish woman and her 2-year-old child were seriously hurt during that terror attack. Had the Arab medical staff come to the aid of these victims, it has been said that the deaths and seriousness of the wounds could have been avoided with immediate medical treatment. Yet Israel’s hospitals treat Arab terrorists. Magen David Adom, Israel’s national emergency medical services organization, has its medics treat Arab terrorists at the scene of attacks. Magen David says they will treat the most seriously wounded first, even if that means treating the terrorist who murdered, maimed, and injured innocent women, children, and senior citizens.
Another interesting fact is that the Israel Medical Assn.’s change in triage procedure originally was not publicized. “Political and public criticism of the decision during the widespread wave of terror” was feared.
Policy Change Called Absurd
There indeed has been an uproar in Israel. Magen David Adom often speaks in terms of medical ethics and morality, but how ethical and moral is it to treat murderers before innocents? Israel Prize Laureate Prof. Asa Kasher, one of the leading researchers in morality and ethics, called the Israel Medical Assn.’s policy change “absurd.” Prof. Kasher explains that there is a definite difference between medical ethics in a hospital setting and at a terror attack scene where first responders must account for more than just medical considerations. His most compelling argument: “What are we supposed to tell a victim’s family if he dies because we treated the terrorist first? That we are sorry, that we had no choice but to treat the terrorist first?” This is especially relevant when there are multiple victims and limited emergency personnel at the scene.
On the other hand, ZAKA, a community emergency response organization of religious Jewish volunteers who provide rescue, first aid, and first-responder medical emergency services, stated it will always treat victims of terror before giving medical assistance to the terrorists. Said ZAKA’s Chief of Operations: “In the case of any murderer, not just a terrorist, I always would treat the victim and afterwards the murderer or terrorist.” ZAKA instructs its volunteers to do just that. ZAKA takes “care of all Jews, because they were harmed just because they are Jews.” Not that terrorists would be refused treatment, but that innocent victims of terror are ZAKA’s first priority.
United Hatzalah, another volunteer emergency medical service and first responder, treats those at the scene of a terror attack according to the following rule, “the greatest good to the greatest amount of people.” That often means an EMT might not treat the most seriously injured person first if the chances of stabilizing that person are small compared to the chances of stabilizing other patients in mass casualty incidents when resources are limited.
An ancient Jewish adage from 1 Samuel says, “All who are merciful to the cruel will end up being cruel to the merciful.” How apropos today. Rabbi Yuval Cherlow, the ethics chief for the Tzohar rabbinical organization and a member of the Helsinki Committee for medical ethics, said the victim at the scene of a terror attack should always be treated first unless there are unusual circumstances in which it is impossible to determine the identity of the terrorist. Only in that case should severity of wounds take precedence.
What is ethical and moral to you? What would you do?
L’hitraot. Shachar