An unparalleled crisis for Israel's medical system

Guest Column

An unparalleled crisis for Israel

Empty Play Area in Israeli Children's Hospital. (Photo: RHCC/Wikipedia; cropped.) CC BY 4.0.

As the crisis surrounding the only Pediatric Hematology-Oncology Center in Jerusalem unfolds, UCLA doctoral candidate Yael Assor offers an anthropological perspective on the situation and examines the “labeling” of the parties and its impact on the situation and parties involved.

UCLA Younes and Soraya Nazarian Center for Israel Studies, November 21, 2017 - Since early June, the Israeli health system has faced a high-stakes medical crisis, unparalleled in its history. On June 4, the only Pediatric Hematology-Oncology Center in Jerusalem, Israel’s largest city, faced imminent collapse. That day, letters of resignation submitted three months earlier by all nine of the Center’s physicians came into effect. The Center’s several dozen inpatients and hundreds of outpatients were left in the hands of three substitute oncologists.

The physicians’ resignation marked a new phase in their ongoing dispute with the Hadassah hospital management, within which the Center operates. The clash grew out of the recently appointed hospital CEO Ze’ev Rothstein’s efforts to maximize the Center’s profits in the wake of losses suffered during the 2008 sub-prime crisis and as a result of the Madoff fraud. The physicians strongly objected to Rothstein’s plans that would stretch the limits of the patient-to-staff ratio and pose life-threatening risks to children receiving transplants.

The dispute quickly deteriorated when hospital management pushed forward with the new plan despite warnings from Center physicians they would resign if the initiatives were enacted. In March, they handed in their resignation letters with the intention of leaving by June.

As June 4 approached, both sides remained entrenched. In an effort to resolve the crisis, the Israeli Ministry of Health (MH) – responsible for ensuring that all Israeli citizens and residents receive appropriate, equitable healthcare as part of the country’s nationalized health insurance - stepped in as a central actor.

However, the Ministry decided that several physicians cannot dictate major medical-administrative plans to the MH and completely rejected the physicians’ suggested alternative to operate out of another hospital, while failing to negotiate a compromise that would bring the physicians back to the Center at Hadassah. As a result, many months after the dispute began, there is still no feasible solution for the hundreds of children formerly treated at the Hadassah center and the likelihood of their dying preventable deaths increases each day.

New Crisis, Old Characters

The high stakes, the unsolvable dilemma, and the unfolding magnitude of its influence on various avenues of Israeli medicine all make this a historic crisis. As such, when the crisis reached its peak during the summer months, it became a central topic of discussion in the Israeli public sphere in extensive media coverage and several discussions in the Knesset.

Much of the engagement with the crisis followed a prefigured narrative in which there were villains, heroes, and poor sufferers in the fight between them. I want to focus on the role of the sufferers, which was filled by the children formerly treated in the Center and their parents.

While the resigning physicians, hospital management, and the MH were often cast in the media or even parliament discussions as villains (.i.e. “deserting physicians,” “incompetent, corrupted ministry”) or heroes (i.e. “altruistic physicians who relinquished their livelihood for medical principals,” “strong ministry officials who maintain administrative order”), the children and parents transcended this dichotomous moral categorization. Instead, through their clear identification as the primary sufferers of this ordeal, they were (and still are) mostly discussed as victims.

Taking Agency

When socially categorized as victims, individuals are seen as powerless and excluded from decision-making processes; they are often perceived as lacking “agency,” i.e., an individual’s or a group’s capacity to act. Indeed, for all formal medical or administrative purposes, the parents did not have to be part of this ordeal: they were not part of the problem, nor were they part of the solution.

However, as the primary sufferers from this situation, the parents decided early on to take an active role and voice their position in the dispute, which largely backed the physicians in their dispute with the hospital and the alternative solution they offered.

Even before the physicians submitted their resignation letters, a group of dozens of parents organized to pressure all sides to reach a solution. As time passed, they increasingly focused their attention on a massive campaign against the Ministry of Health, pressuring it to reach a solution and claiming their right as citizens to receive appropriate care.

In the two months after the physicians’ resignation, the parents’ campaign reached its peak. For more than a month, they sat in a large protest tent near the Israeli parliament and Supreme Court and conducted multiple press conferences, events with leading Israeli public figures attended by hundreds of supporters, and several demonstrations. They also filed an appeal to the Israeli Supreme Court to force the ministry to solve the crisis at all costs.

Through these various measures, the parents became much more than onlookers in this ordeal. In fact, they became a central driving force in shaping the course of events: they forced all sides to appear before the Supreme Court and participated in its (eventually failed) mitigation process; created unrelenting public pressure on the MH to solve the crisis; and even put some political pressure on the minister himself. In many ways, the parents’ actions have shaped the twists and turns of this ordeal so far.

Making Victims

Yet, throughout the crisis, most media coverage persistently describes the parents as agentless victims who are utilized by other sides of this dispute. Most notably, addressing the parents as victims is used in discussions about their public support for the physicians and their suggested solution. In these discussions, parents are often considered objects used by the physicians rather than as volitional, independent agents.

Consider, for instance, a column written by publicist Sharon Kidon, in which she discussed the conflict over who gets to be labeled heroes and villains in this crisis. Kidon writes, “One side of this dispute has a doomsday weapon and it made good use out of it. This tie-breaker weapon is the sick children, and the first to have discovered this weapon was Prof. Michael Weintraub, who led the physicians and succeeded to transition the parents to his side” (Kidon, June 2017).

Similar to Kidon’s argument that the parents are used as a weapon by physicians are arguments by Ministry of Health officials themselves. For instance, the Ultra-Orthodox news portal Behadrei Haredim quotes people in the (ultra-orthodox) Health Minister’s entourage who said that “the physicians are conducting a defamation campaign against the minister through using the children and by sending off the parents to attack him” (Har Tzvi, June 2017).

To Kidon and to those un-named members of the minister’s entourage, the parents are not themselves a part of this ordeal, but a mere object, a weapon, to be used by the physicians. As such, their claims are not discussed as an independent position, but merely in consideration of those who have “utilized” them in their favor – the physicians. Seeing the parents as agentless victims thus serves as a way to delegitimize and dismantle their claims as mere echoes to others’ voices rather than equal, significant voices in and of themselves.

Furthermore, like a gun that fires, their actions may have an effect on the situation. However, just like we hold responsible the hand pulling the gun’s trigger rather than the gun itself, comparing the parents to a weapon means they do not have responsibility for the effects of their actions. Addressing the parents as agentless victims therefore works to divorce their actions from any responsibility to them.

According to most central strands of ethics theories, responsibility for one’s actions is a central component of the moral action. Therefore, if a person is not responsible for their actions, it is beyond the purview of moral judgment. By treating the parents as victims with no responsibility over their actions, the media, hospital management, and the Ministry of Health managed to avoid passing moral judgement on the parents, an act that would be considered by many as distasteful and conflictual, particularly when considering that we are talking about children with cancer and their parents.

Parents themselves seem to be well aware of all this and frustrated by it. However, there isn’t much they seem to be able to do about it. Without fundamentally changing their positions and backing down on their support of the physicians’ alternative solution – which is agreed by many as the only feasible alternative if no compromise is reached with Hadassah – there is nothing the parents can do to disavow this image.

As the crisis continues to unfold, the paradox continues: while their position as victims has enabled their voice to be heard across the country loud and clear, it has also provided a way for the hospital management, the Ministry of Health, and even the media to disregard and delegitimize them. In the meantime, the parents’ moral demand of care for their sick children is somehow overshadowed in the debate between the opposing sides.

Yael Assor is a doctoral candidate in UCLA's Anthropology Department, a member of the Charles and Lynn Schusterman Family Foundation's ROI Community, and a Van Leer Institute Library Research Fellow. A recipient of the Y&S Nazarian Center for Israel Studies' Graduate Student Research Fellowship, Assor focuses her current work on how expectations in Israeli public media about the ethical conduct of the Medical Package Committee (Va’adat Sal Hatrufot) inform its decision-making process.

 

References:

Har Tzvi, Kobi. 2017. Hadassah Parents: Litzman is Fighting Us [Hebrew: ההורים מ'הדסה': ליצמן נלחם בנו]. 6 14. Accessed October 10, 2017. http://bit.ly/2zYMXbX.

Kidon, Sharon. 2017. On the Hadassah Case and Lost Battles [Hebrew: על מקרה הדסה וקרבות אבודים]. 6 11. Accessed 10 10, 2017. http://bit.ly/2A0LAr8.