Helsinki in Zion: Hospital ethics committees and political gatekeeping in Israel/Palestine

This article looks at six months of the author's repeated attempts to obtain approval three Helsinki Committees (HCs, Israeli hospitals’ research ethics committees) conduct ethnographic with Palestinian physicians in hospitals. While was eventually approved and carried out two these institutions, correspondence HC representatives, as well evidence their informal moves institutions’ management, reflect perceptions risks study posed. In hospital, acknowledging political subjectivity challenges definition nationhood exclusively Jewish contaminates allegedly politically neutral medical sphere. These committees exerted power serve institutions state ideology. This, I argue, should not be understood anomalous instances negligence. show how committees’ censorship attuned Declaration guiding text Zionism underlying Embedded powerful regimes ethics, bureaucracy, science, health, employ “unarmed power” that is beyond critique. They are well-oiled “anti-politics machines,” rearticulating concerns into a depoliticized moral discourse. As such, they only limit academic inquiry but also redefine, terms, realm moral. Este artículo analiza seis meses de intentos repetidos del autor para obtener la aprobación tres Comités comités ética investigación hospitales israelíes) conductas etnográfica con médicos palestinos en israelíes. Mientras fue eventualmente aprobada y llevada cabo dos estas instituciones, correspondencia representantes los HCs, así como evidencia sus movimientos informales el manejo las reflejan percepciones riesgos que estudio planteaba. En hospital israelí, reconocer subjetividad política palestina reta definición sentido nación israelí exclusivamente judía contamina esfera médica alegada políticamente neutral. Estos ejercieron su poder servir instituciones e ideología estatal. Esto, argumento, no debe ser entendido instancias anómalas negligencia. Muestro cómo censura estuvo sintonizada Declaración texto guía sionismo subyacente. Embebidos regímenes poderosos ética, burocracia, ciencia salud, éticos emplean “poder desarmado” está más allá crítica. Son “máquinas antipolíticas” bien aceitadas rearticulan preocupaciones políticas un discurso despolitizado. Como tal, ellos solo limitan académica sino también redefinen, términos políticos, [etnografía hospitalaria, neutralidad, nacionalismo, IRB, Israel/Palestina] מאמר זה בוחן שישה חודשים שבמהלכם ניסה המחבר להשיג אישור משלוש ועדות הלסינקי (ועדות אתיקה של בתי חולים בישראל) לקיים מחקר אתנוגרפי עם רופאים פלסטינים. המחקר אושר לבסוף, והתקיים בשני חולים, אך התכתבות נציגי הועדות ועדויות למהלכיהם הנסתרים הנהלות המוסדות הצביעו על תפיסתם את הסיכונים שבמחקר. בבתי בישראל, הכרה בסובייקטיביות הפוליטית פלסטינים מאתגרת הלאומיות הישראלית כיהודית בלבד ו“מזהמת” המרחב הרפואי שנתפס כניטרלי פוליטית. האלו הפעילו סמכותן כדי לשרת ואת האידיאולוגיה הלאומית. אני טוען כי זו אינה רשלנות מקומית ומראה כיצד הצנזורה שהפעילו הייתה בהתאמה ‘הצהרת הלסינקי’ כמסמך היסוד, והציונות כאידיאולוגיה המנחה. נהנות מהסמכות שבארבעה משטרי שיח חזקים: מוסר, ביורוקרטיה, מדע ובריאות ומפעילות כח ‘בלתי חמוש’ אשר אינו נתון לביקורת. הן מכונות משומנות היטב ‘אנטי-פוליטיקה’, מנסחות שאלות פוליטיות בשיח מוסרי. ככאלו, לא רק מגבילות אקדמי, אלא גם מגדירות מחדש, באופן פוליטי, השדה המוסרי. يدرس هذا المقال ستة أشهر من المساعي للحصول على موافقة ثلاث لجان هلسنكي (لجان الأخلاقيات البحثيّة في المستشفيات الإسرائيلية) لإجراء بحث إثنوغرافي مع الأطباء الفلسطينيين العاملين المُستشفيات الإسرائيلية. النّهاية، تمت الموافقة الدراسة، وتم إجراؤها مستشفيين، لكن المراسلات ممثلي اللّجان والأدلة تحركاتهم غير الرّسمية الإدارات المؤسساتية تشير إلى إدراكهم لمخاطر الدراسة. فَفي الإسرائيلية الاعتراف بالذّاتية السّياسيّة للفلسطينيين يتحدّى القوميّة الإسرائيليّة باعتبارها يهوديّة بَحتة و“يلوّث” الحيّز الطّبيّ الذّيّ يُنظر إليه أنه محايد سياسيًا. مارست هذه سلطتها لخدمة المؤسسات والفكر الإسرائيليّ. أنا أزعم أن ليست حالة شاذة الإهمال وأن الرقابة التي مارسوها تتماشى “إعلان هلسنكي” والصهيونية كإيديولوجيا. تتمتع بسلطة الأخلاق والبيروقراطية والعلوم والصحة وتمارس قوة “غير مسلحة” خاضعة للنقد. إنها “آلة مُجَهَّزَة جيداً لمُعاداة السياسة”، تعيد صياغة الاهتمامات السياسية لخطاب أخلاقي مسيَّس. فبذلك، لا يحدّون البحث الأكاديميّ فّحسب، بل يُعيدون أيضًا، تعريف عالم سياسياً. January 2015, applied public hospitals for project that, part, focused on doctors who were citizens. hospitals, it took more than get my approved. third institution, access ultimately denied. My considered citizens Israel, indigenous communities remained within recognized borders Israel after 1948 Nakba (Catastrophe). settler-colonial context where consistently infringes upon citizens’ individual collective rights (Sabbagh-Khoury 2022), studied everyday encounters “borderzones healthcare” (Mattingly 2010). looked country's health system space action negotiations belonging exclusion, intersections professional national borderlands, medicine politics intertwine (Shalev 2016, 2018). It this aim 2015 physicians. Rather quick had anticipated, entered months-long process asked changes terminology design. For example, application referred interlocutors “Palestinian Israel.” One committee claimed “biased” requested change “physicians from Arab sector.” Another hospital's deputy CEO personally intervened ethical process, claiming he “principled disagreement definitions” them “Israeli Arabs.” At time, bewildered by responses committees. How did affect treatment subjects? Having already passed University North Carolina's meticulous wondered: UNC's overlooked important risks? required law appoint review follow World Medical Association's principles involving human subjects: (DoH). called (HCs). about HCs committees, physicians’ came deemed so “risky” “unethical” an object study. The formal feedback received research, numerous revisions approve proposal, integrity ideals neutrality ethnocracy sought protect. address acts censorship, very much both DoH If, Marilyn Strathern (2000, 281–82) argues, arenas audit practices places looking “if one society,” then HCs’ provides clues local limits legitimacy recognition. Indeed, discrepancies between call question idea universal code conduct, aimed establish. But pointing, once again, nonuniversality self-proclaimed values (cf. Heimer Petty 2010) what interesting case. specificity standards enforced commissars draw promote agendas. argue ill usage Censorship integral operation. form contend, particularly potent, grounded authority bureaucratic mechanisms seated conjunction four regimes: ethics. practice institutional role; mandate oversee name “good science”; positioned assigned protect patients; act morality. stake claims objective apparatuses, wielding unacknowledged thus avoiding accountability Ticktin 2012). Ethics stealth draws formalities technicality classified discussions (Katz 2007). Bureaucracies opaque inaccessible, opacity empowers gatekeepers unchecked control (Hoag 2011, 82). veiled makes inscrutable. Bureaucracy ethos rationality efficiency predicated objectivity impartiality (Assor 2021; Herzfeld 1992). thus, many ways, “first cousin science” 84). To “objective” scientific authority, add aura benevolence endowed Even amid war catastrophe, care often regarded “a life” which all other suspended (Redfield 2013, 163). ‘health’ unqualified good (Metzl Kirkland 2010), decisions rarely scrutinized, let alone contested. Presiding over articulate tone avoids inspection opposition (Hamburger 2004). lack training knowledge attend social sciences (Schrag give primacy order, presented separated power. Understanding claim separation key inquiry. Anthropologists agents understand ideas right wrong contexts. do so, or come replace reinforce hierarchies (Rivkin-Fish 2005; Sunder Rajan 2017; 2012; Willen 2019). Bureaucratic “depoliticizing technologies” 82) extremely effective making technical (Ferguson 1994; Grinberg 2018; Scherz 2011) ideological formalistic questions codes Goodman 2020). capacity—formulated terms—to delineate boundaries legitimacy. Research reign manifested discussions, protected technicality, science “benevolent” ambience medicine. look considerations institutional, professional, context. first consider framework DoH, purportedly universal, individualistic liberal bioethics. case approach goes hand Zionist liberalism challenged subjectivity. symbiosis manifests itself coherently ethics: bioethics.” engage under apolitical guise, away eye. Before addressing offer short reading universal(izing) text. Careful conflate textual aspects declaration institutionalized apparatus historically contextually specific instructs individualized classic bioethics Filc 2018), credulously adopted when confronted From its inception, logic guided formation attempt weighed against benefits “science” “humanity.” Association (WMA) scientists aware perceived position “playing God” struggled balance individuals’ safety interest: “society, too, has experimentation” (McDermott 1967, 42). careful consideration risk-benefit/individual-society tradeoff matrix been central since original 1964 through subsequent seven revisions. Guided duty auditors-regulators evaluate risk-benefit ratio being sacrificed benefit collective. trio researcher, subject, regulator, each role: regulator must subject researcher-perpetrator (Jacob Riles like any board (IRB), are, fact, “institutional.” composed researchers employed institution. institution's needs interests committee's point “the term ‘ethics’ inappropriate, ‘risk management’ ‘liability control’ committee” (Annas 1991, 19). formations face inherent conflict interest, acting cases protectors rather contending subjects. unsavory construct ground ways pretense “ethics.” Scholars have long debated “mission creep” IRBs (Shweder 2006) “imperialistic nature,” greater jurisdiction inquiries 2007, 799; see Fassin 2006; Schrag shown restrict populations topics 2004; Hodge 2013) and, importantly, block critical (Ceci, Peters, Plotkin 1985; Katz Such restrictions constraints raise disturbing boards censorial powers. operate aegis laws, regulations, supervision represent policies ideology (Fassin 2006). dual loyalty regulations legal justification not, however, way contradictory. (as countries), obliged comply laws articulated accordance DoH. legislated formed continue operate. Practically, self-checking Shweder state-regulated protocols, cultivate incorporation (Strathern 2000). regulation define kind interacting subjects 2000, 280), different shapes moments history protection (WMA 1964, 33). 2000 added researcher's subject's privacy dignity (Carlson, Boyd, Webb 2004, 711), current 2013 version subjects’ “right self-determination” 2013). Thus, DoH-protected turned gradually strictly “biological” entity independent self-determining Still, forms articulations, individual. key, sense superficial understanding “subjects” appointed argued bounded relation such empirically unsound (Geertz 1979). Instead, anthropologists intersubjective intertwined run together” (Biehl, Good, Kleinman 14). Accordingly, early Margaret Mead's (1969, 361) assertion “anthropological does subjects,” advocating collaborative emphasizes researchers’ commitment (Fluehr-Lobban 2012 “Statement Ethics,” American Anthropological extended concern “communities, identities, tangible/intangible heritage environments” (AAA If participants contexts, attended to. sort envision? earlier versions addressed potential “science,” “humanity,” “society,” Edinburgh revision marked meaningful adding “Medical justified if there reasonable likelihood stand results research” 711). acknowledges communal settings considers community's interests. However, most recent revision, backed responsibility weighs “other individuals groups affected condition investigation” Subjects longer members collectives “global subjects” defined shared condition, echoing “biological citizenship” (Petryna contemporary DoH's conceptualizes scope discerning thought decontextualized (meaning, recognition subjectivity), notion “society.” bureaucratically apply regulations. happens researcher submits takes discrimination focus? respond threatens critically undermine raison d’être ideology? context, reactions worked censor research. lived life student Middle East anthropology, still strikes me: anticipate response? Working carefully IRB back United States, sensitivities Israel/Palestine, immersed mistook weigh posed More troubling might confused originally Hospitals make considerable efforts diverse inclusive proposal could easily seen playing image. just few weeks later seemed evident eluded me naïve moment application. occur would judge lens ethnonational politics. And lenses. fact Ashkenazi men chaired made clear limitations experienced man nearly harsh Mizrahi colleagues wish ask similarly “sensitive” questions. Consider following segments fieldnotes experiences institutions: used word processor's “find replace” function references “Palestinians” “Arabs,” quite literally erasing interlocutors’ identity. Request further edits Hospital X's HC. Trtanslation: “General instructions: title biased, Palestinians, recommended correct Physicians Sector… . Committee decision [in red]: [Application] will corrections accepted” [This figure appears color online issue] A screenshot taken Hebrew. less long-awaited approval. sitting office chief physician, Professor H, hoping his department. On H's wall hung “thank you” plaque given him military service occupied Gaza Strip. issue meeting again H. Both careers, common highly militarized system, senior officials corps (Barilan Barnea 427). suspicious anthropologist coming Social reputation “lefties” overly 20; Hamdy 2017, 300), test clearly pass before granted access. “Hi, you? here wants minorities.” [Bnei Miutim, yet another “code word” Palestinians]. His friendly immediately became serious worrisome. “I … here…. I'll straight face.” He up said, person heads Committee, well, religious person, experienced…. don't problem telling you said: ‘read lips English]—nothing going this! it. They'll say we racists. find aren't, they'll publish it.’” first, entering field Z smoothest all. interviewed found A, physician department chose site participant observation, welcoming. even administrator help expedite process. email notifying proposed “not included jurisdiction” wished proceed study, management's approval.” When tried probe needed obtain, what, precisely, managerial unit grant it, chair rebuffed rudely sponsored answers. Quite disappointed upset, contacted recalling attitude project. responded cutting message, stating “will able handle project” R, CEO, whom copied message. year correspondence, ran conference. events, said apologetically executive management “over head” “out hands.” communication R followed. response request “We thirteen (all West Bank), best knowledge, outstandingly integrated.” length, explained citizens, Arabs,” hundreds hospital. replied, treat our citizen totally equal without regard religion”—as religion. After explanations wrote, admit principled definitions your proposal. According world view, citizenship, nation, religion, purposes.” continued, share dilemma [Z] you.” day, dilemma” solved, “after consultations number prefer conducted [Z].” Upon insistence, agreed meet spacious office. meeting, him, “Don't want know employees really feel?” stood fast opinion, saying, am proud blind matters everyone Israelis.” acknowledged active disinterest allow own objectives. responded, agree anyone enter endanger fabric work together.” initial stages formulating physicians, consulted fieldwork outpatient clinic. asking her advice preparing myself fieldwork, she promptly suggested obtaining approvals possible preparations. She underscored intimated ought detailed, taking requirements. Much surprise, hardly applications better ensure awaited failed come, realized, growing frustration, continuous prevent modify perspective. cannot formally reject applications, resubmissions can request. meets every weeks, consecutive minor cause delay. accompanied explicit requests documented Figure 1, began suspect censorship. gatekeeping ensued. secretary's prompting erase “P-word” perhaps hint regarding HC's inner rejecting applications. head department, questionable undercurrents become apparent. collusions Z, went informing motion. intimidated reaction doctor renowned specialists field, indicates constraining communications were. risk generated responses? O