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Medicine, Health Care and Philosophy

, Volume 17, Issue 1, pp 155–160 | Cite as

Moral dilemmas faced by hospitals in time of war: the Rambam Medical Center during the Second Lebanon War

  • Yaron Bar-El
  • Shimon Reisner
  • Rafael BeyarEmail author
Short Communication

Abstract

Rambam Medical Center, the only tertiary care center and largest hospital in northern Israel, was subjected to continuous rocket attacks in 2006. This extreme situation posed serious and unprecedented ethical dilemmas to the hospital management. An ambiguous situation arose that required routine patient care in a tertiary modern hospital together with implementation of emergency measures while under direct fire. The physicians responsible for hospital management at that time share some of the moral dilemmas faced, the policy they chose to follow, and offer a retrospective critical reflection in this paper. The hospital’s first priority was defined as delivery of emergency surgical and medical services to the wounded from the battlefields and home front, while concomitantly providing the civilian population with all elective medical and surgical services. The need for acute medical service was even more apparent as the situation of conflict led to closure of many ambulatory clinics, while urgent or planned medical care such as open heart surgery and chemotherapy continued. The hospital management took actions to minimize risks to patients, staff, and visitors during the ongoing attacks. Wards were relocated to unused underground spaces and corridors. However due to the shortage of shielded spaces, not all wards and patients could be relocated to safer areas. Modern warfare will most likely continue to involve civilian populations and institutes, blurring the division between peaceful high-tech medicine and the rough battlefront. Hospitals in high war-risk areas must be prepared to function and deliver treatment while under fire or facing similar threats.

Keywords

Ethics of healthcare management Mass casualty incidents Medical ethics at war 

References

  1. Bar-El, Y., M. Michaelson, G. Hyames, K. Skorecki, S. Reisner, and R. Beyar. 2009. An academic medical center under prolonged rocket attack—organizational, medical, and financial considerations. Academic Medicine 84(9): 1203–1210.PubMedCrossRefGoogle Scholar
  2. Bergron, R.E., and T.J. Curiel. 2006. After the storm health care infrastructure in post-Katrina New Orleans. The New England Journal of Medicine 354: 1549–1552.CrossRefGoogle Scholar
  3. Hebrang, A., N. Henigsberg, A.Z. Golem, V. Vidjak, Z. Brnić, and P. Hrabac. 2006. Care of military and civilian casualties during the war in Croatia. Acta Medica Croatica 60: 301–307. [in Croatian].PubMedGoogle Scholar
  4. Jacob, B., A.R. Mawson, M. Payton, and J.C. Guignard. 2008. Disaster mythology and fact: Hurricane Katrina and social attachment. Public Health Report 123(5): 555–566.Google Scholar
  5. Solomon, Z., and R. Benbenishty. 1986. The role of proximity, immediacy, and expectancy in frontline treatment of combat stress reaction among Israelis in the Lebanon war. The American Journal of Psychiatry 143(5): 613–617.PubMedGoogle Scholar
  6. Svoboda, T., B. Henry, L. Shulman, E. Kennedy, E. Rea, W. Ng, T. Wallington, B. Yaffe, E. Gournis, E. Vicencio, S. Basrur, and R.H. Glazier. 2004. Public health measures to control the spread of severe acute respiratory syndrome during the outbreak in Toronto. The New England Journal of Medicine 350: 2352–2361.PubMedCrossRefGoogle Scholar
  7. Tarrant, J.M. 1943. Moorfields eye hospital in the Blitz. British Journal of Ophthalmology 27: 312–319.PubMedCrossRefGoogle Scholar
  8. Weisskopf, V. 2008. The Jewish Hospital in Budapest under the Nazi occupation (1944–1945). Harefuah 147(81–84): 92. [in Hebrew].Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  1. 1.HaifaIsrael
  2. 2.Rambam Health Care Campus (Medical Center)HaifaIsrael

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