MEDICINE AND THE POLITICS OF NEUTRALITY: THE PROFESSIONAL AND POLITICAL LIVES OF PALESTINIAN PHYSICIANS IN ISRAEL Guy Shalev A dissertation submitted to the faculty at the University of North Carolina at Chapel Hill in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Anthropology Department at the University of North Carolina. Chapel Hill 2018 Approved by: Michele Rivkin-Fish Peter Redfield Rebecca L. Stein Dani Filc Jocelyn Lim Chua © 2018 Guy Shalev ALL RIGHTS RESERVED ii ABSTRACT Guy Shalev: Medicine and the Politics of Neutrality: The Professional and Political Lives of Palestinian Physicians in Israel (Under the direction of Michele Rivkin-Fish) The Israeli public health system is one of the few arenas in which Arab and Jewish citizens collaborate in their day to day work, with Palestinian citizens comprising 11% of practicing physicians. This dissertation examines how medicine’s ethical framework of universality and political neutrality affects social dynamics in healthcare settings in a context of national conflict. The study is based on 22-months of ethnographic research, including fieldwork in two hospitals and an analysis of in-depth interviews and media content. It demonstrates how Palestinian physicians navigate a delicate balance between ideals of medical neutrality and expressions of suspicion and hostility on the part of Jewish patients and colleagues. In Israel, the ethos of a politically neutral health sphere is a ‘shared fiction’ that is propagated by government officials, hospital administrations, ethics committees, physicians, and patients. An ideal that is loosely based on humanitarian ideas of medical neutrality and professional ethics’ principles of impartiality. But it is hyperbolized to encapsulate entire institutional spaces where “politics” is considered out of bounds. This work looks into the practice of maintaining the Israeli health system hygienically clean from ‘politics.’ The making of an exceptional space within which all non-medical considerations are perceived to be suspended. Yet, this classification of ‘neutral’ and ‘political’ is inconsistent. The rules of purity and pollution are applied selectively to Jewish-Israeli and Palestinian physicians and neutrality iii emerges as an antipolitics that suppresses Palestinian nationality. For Palestinian physicians, upholding ideas of neutrality is critical for their personal survival in the Israeli medical sphere, to maintain a professional identity, and advance a medical career. But they are also painfully cognizant of the limitations of this selectively applied ideal. In making visible Palestinian citizens’ efforts to shape their individual and collective conditions of existence through medical practice, this dissertation illuminates how ideologies of the medical sphere shape their struggle in distinctive ways. It analyzes medicine and healthcare as spaces of micro-level struggles for equality and recognition, and demonstrates how ideas of neutrality serve as fungible political tools in the hands of both hegemonic elites and counter- hegemonic forces in a national conflict. iv To Haviva and Udi Shalev who wanted me to be a medical doctor. v He responds: You and I are two masked authors and two masked witnesses I say: How is this my concern? I’m a spectator He says: No spectators at chasm’s door … and no one is neutral here. And you must choose your part in the end Mahmoud Darwish, From I Have a Seat in the Abandoned Theater (Trans. Fady Joudah) And me, all the words of love and agony that I have written and that I have yet to write and also all those That beat against my temples, that I will never write, Even they will never be salvation for me and for you As in my life I embody your death, You are suffocated because I breathe, You are hungry because I eat, You are bound because I am unfettered, Write it down, Your shackles are my wings Sami Shalom Chetrit, From A Mural with No Wall: A Qasida for Mahmoud Darwish vi ACKNOWLEDGEMENTS This work is dedicated to Haviva and Udi Shalev, my parents, were it not for their generosity and support, I could have not even considered dedicating the past 12 years of my life to the study of anthropology. From them I learn, every Shabbat, that love and giving can know no limits. And, to my late grandmother, Safta’chel, a brave Holocaust survivor who fed me vegetable soup and taught me how frivolous and dangerous national ideologies are. Her courage was an inspiration, and her wisdom I could only fathom years after she passed away. My profound gratitude goes to my advisor and mentor, Michele Rivkin-Fish. For her astute advice in anthropology and excellent professional guidance. But much more, for her genuine curiosity and interest in my work and in me. For considering me a colleague as much as a student. And, for being a mensch. Her mentorship taught me that empathy, care, and friendship are important to academia no less than productivity and excellence. This work would not have been possible without the generosity of the physicians, students, and health professionals who have graciously taken the time to talk with me, share their stories, and for letting me tag along as they cared for their patients. Working among them has taught me hard work and dedication. I am particularly thankful to my Palestinian interlocutors. Whose precarious position in Jewish-Israeli society made their participation in this research truly courageous and recommendable. My dissertation is about you. And I am grateful that you put your trust in me to represent your experiences faithfully. I owe a special debt to my good friend Arsalan Abu-Much. The smartest doctor around, who knows all the lyrics of the classics, and the best non-anthropologist anthropologist I have met. vii I am thankful to the unwavering support of my committee members: Peter Redfield, Rebecca L. Stein, Dani Filc, and Jocelyn Lim Chua. Special thanks go to Peter for always providing a fresh angle, and for his humor and untiring kindness. And to Rebecca, for never making it easy for me, consistently pushing me to refine my thoughts. Thank you to the National Science Foundation, the Carolina Center for Jewish Studies, UNC Center for Global Initiatives, The Greenwall Foundation, and UNC Graduate School for providing financial support for this work. I thank Khalid al-Ali for providing me with his late father’s cartoons which were published with the permission of Naji Al Ali family. I could not have completed this journey without the companionship of faithful friends and colleagues. My continuing dialogue with Yehuda Goodman has been pivotal to my training and thought. Our long hours of writing together in his Hebrew University office were always pleasurable moments of quibbling and learning. I am thankful to Liron Shani, the indefatigable popularizer of Israeli anthropology, my eternal conference roommate, and my guide through the maze of professional networking. Thanks to my good friends Erez Maggor and Noga Keidar for discussions big and small. Traveling across the Atlantic, I was tremendously lucky to meet smart fellow UNC graduate students who generously offered their thoughts and friendship. Thank you to Rudo Kemper and Laura Wagner for reading and commenting on my work and for joining me for so many beers and coffees. My deep gratitude goes to my dear friend Rachel Dotson for her brilliant ideas, countless proofreadings, for long walks along railroad tracks, and even longer conversations about life. Upon coming back to the Middle East, I am thankful to Anat Rosenthal and Inna Leykin, the co-founders of the MedAnth gang, for being my big sisters in Israeli academia. And, special thanks to Guy Aon for skillfully capturing people and ideas with his camera. viii I cannot thank Amit Lazarus enough. For crafting ideas into flow charts, for supporting me when deadlines were looming, for taking me down the Grand Canyon and back up when I was down, and for being the best of friends. Thank you Maayan Turgeman for growing up with me. Your love and humor have become an integral part of me and will forever shape everything I do. Thank you Adi Golan Bikhnafo for taking me in. From you I learn every day to never compromise on justice, compassion, foolishness, and love. And, to Leon. For making me your best friend. For walking with me to wherever I went. For making me laugh so hard. I forgive you for leaving me just one week short of the defense. ix TABLE OF CONTENTS LIST OF FIGURES………………………………...……………………………………….…….…xii LIST OF ABBREVIATIONS……………………………………………………….…………...…xiii CHAPTER I | A Desert Island? Politics of Neutrality and the Israeli Health System………………...1 Palestinians in Israel: Hollow Citizenship, Segregation and Suspicion ...................................... 7 The Shared Fiction of a Neutral Space...................................................................................... 16 The Research ............................................................................................................................. 25 The Monograph ......................................................................................................................... 28 CHAPTER II | Helsinki in Zion: Ethics Committees and Political Gatekeeping in Israel/Palestine………………………………………………………………………33 Society Must be Defended ........................................................................................................ 34 Three Ethics Committees, Three Hospitals ..............................................................................