title: The Enemy as a Patient: What can be Learned from the Emotional Experience of Physicians and Why does it Matter Ethically?
abstract: This qualitative research examines the influence of animosity on physicians during clinical encounters and its ethical implications. Semi-structured interviews were conducted with ten Israeli-Jewish physicians: four treated Syrians and six treated Palestinian terrorists/Hezbollah militants or Palestinian civilians. An interpretive phenomenological analysis was used to uncover main themes in these interviews. Whereas the majority of physicians stated they are obligated to treat any patient, physicians who treated Syrians exhibited stronger emotional expression and implicit empathy, while less referring to the presence of the Israeli-Arab conflict. In contrast, physicians who treated enemy combatants or Palestinian civilians showed the exact opposite. Linking these results to the "Implicit Bias" theory, the role of empathy and the beneficence principle in medical ethics, we argue that: (a) the unconscious decreased emotional involvement among the latter group of physicians is a deficiency that needs to be recognized; and (b) this deficiency undermines the principle of beneficence, thereby possibly influencing the fulfillment of the commitment to treat patients. Acknowledging and addressing the potential emotional and ethical deficiencies entailed in encounters with the so-called enemy-patients are of importance to the global medical community, since such encounters are increasingly an integral part of the current political realities faced by both the developed and developing worlds.
authors.forename: Gil
authors.initials: G
authors.lastname: Rubinstein
authors.forename: Miriam Ethel
authors.initials: ME
authors.lastname: Bentwich
mesh_terms: D000533:Altruism; D018912:Arabs / Q000523:psychology*; D026686:Beneficence; D004645:Empathy; D004992:Ethics, Medical; D006806:Human Rights; D006801:Humans; D007407:Interviews as Topic; D007557:Israel; D007585:Jews / Q000523:psychology*; D010820:Physicians / Q000941:ethics* / Q000523:psychology; D036301:Qualitative Research; D013593:Syria; D023481:Terrorism
keywords: beneficence principle; emotional modulation; implicit bias; medical ethics; treating enemy