Doctors and Torture
Most medical graduates do not pose in their academic garb, degree in hand before the photographer, thinking about their wonderful future career as torturers. So how can it be that some are destined for such a role?
The Standing of Doctors in Society
The medical profession is ranked very highly in western communities from the point of view of respectability. Doctors are admired for their commitment to the health and safety of their patients. This is not because of clever marketing, glossy brochures, brain-washing or any other reason other than that for many generations, the medical profession has worked hard to earn its positive reputation. The vast majority of doctors in society feel very strongly about being competent, ethical, personable and compassionate. Medical students often start out without much of an idea of just what a career in medicine entails. There is a required commitment to lifelong learning, major sacrifices asked of spouses and children, periods of intense stress and potential exposure to lethal infectious diseases. The ones who stay on, therefore, have made the choice to accept these burdens as part of their lives. Most members of the public recognize these attributes in the doctors that care for them, and the profession as a whole.
The natural medicine movement has brought conventional “Western” medicine into question as the sole arbiter of health care and how society should approach disease. It has come a long way from its early days at the fringe of society, when spiritualism and even occult practices were intertwined with traditional herbal remedies and oriental medicine. Today, much of natural medicine has gone “main stream”, and has come under the control of the very organizations its early proponents were so critical of; the pharmaceutical giants and government regulatory bodies. In many respects, natural medicine resembles a modern-day repetition of conventional medicine’s history (from a fringe, experimental art to an accepted, institutionalized and heavily regulated science). One thing that natural medicine emphasizes which is starkly contrasted in conventional medicine is its warm-hearted, whimsical and more human face. Natural medicine seems to have fewer checks and balances and less is expected of it by the public in terms of results and proven efficacy. Doctors and hospitals, on the other hand, appear colder, more systematic and industrialized. This difference in perception is a very important one, since it is nothing more than a facade. Because in both fields the providers of care are selfsame human beings, with all their faults.
Patients who have had poor outcomes from medical or surgical care, or have met doctors without personalities, or have been directly injured by negligence, are another major source of medical criticism. The pressure to be perfect is definitely felt by doctors everywhere, and horror stories of aggressive and malicious patients abound in the coffee shops and tea-rooms where doctors converse with each other. There is a fear and distrust of lawyers, litigious patients and journalists. Doctors have the tendency to practice “defensive medicine” which plays into the hands of the industries supplying the medical field (especially pharmaceutical companies). Marketing products to doctors (a generally conservative, safety conscious population of high achievers) has been worked down to a fine art and almost a science. An excellent example of this was the marketing of Volvo cars (supposedly the ‘safest’ car) to the medical profession in the 1980’s (see image). Doctors are sensitive to criticism by the public and by their peers . A doctor’s career rests on the good standing of his name, and nothing brings greater fear than to be exposed to public scandal.
Medical Ethics and Morality
To describe the guiding principles of medical practice with regards to patient care, the term “ethics” is most often used. Morality is not generally referred to due to its religious (especially Christian) connotations. Textbooks discussing medical ethics generally avoid or trivialize religious references, yet the majority of doctors are religious. This could be explained by the heterogeneous nature of the medical profession and the desire not to offend any particular sub-group, but the rejection of religious authority in medical practice has allowed medical ethics to drift away from absolutist, paternalistic principles towards a relativistic, more flexible model based on the primacy of patient autonomy. The general public does not realize that doctors do not necessarily take the Hippocratic Oath (in some countries this does not occur at all), but people are quick to take advantage of the fact that medicine has turned from being a charitable, altruistic profession to one driven by consumerism and legalism.
Despite modern medicine’s reluctance to embrace moral absolutes in its codes of conduct, there is still a strong desire among doctors to “do no harm” in all circumstances, but this is being eroded around the edges. Any side effect, failure of treatment or other adverse effect of a medical intervention is carefully weighed against perceived benefit. Opposition to euthanasia is still strong among doctors in most countries, as they recognize that crossing the boundary of saving lives to actively ending them has serious ramifications. They know that, as soon as hospital administrators learn that euthanasia is cheaper than palliative care, there will quickly be no more palliative care for those who need it. The issue of abortion is different. Here, the termination of a human life has been successfully turned into a sterile, formalized and officially sanctioned procedure. It is promoted as compassionate, just as euthanasia is, but has been easier to enact because surgical termination of pregnancy is the same procedure as that performed for a miscarriage. The pharmaceutical approach is also dressed up as ‘taking a pill to cure your ill’.
The trend to convert previously taboo procedures into legal and apparently ethical ones should be worrying to every person, even if the particular activity itself does not offend one’s personal moral code. The reason is, because the medical profession and the health industry are so powerful, so ubiquitous, that systematic errors or evils, however small, have adverse effects which are magnified and multiplied on a huge scale. This is an understated but clearly understood fact that underlies criticism of the medical profession by natural medicine proponents. Many, who are labeled conspiracy theorists, claim that from the top right to the bottom of the health system, down to the humble family doctor, there is a covert yet conscious effort to undermine society for personal gain. They are right in some ways, but wrong over all. Doctors are poorly educated in medical ethics and are not encouraged to fight for the small things that erode the moral fabric of their profession. Doctors, as a group, do have certain views and mindsets which cause them to perform systematically wrongful acts, from the point of view of moral absolutists. This is not a conspiracy but a cultural flaw. The real conspiracy, if there is one, might be found in fraudulent research and corrupted government advisories – something doctors as a whole are oblivious to and would be rightly shocked and disgusted if and when they discover it.
Terror and Torture as a Tools of Statecraft
Any organism, by design, will adapt in various ways to sustain and perpetuate itself, or its own kind. Governments, as entities, are organic. While they may begin life idealistic, healthy and attractive, during the life cycle, those within government make it their task to maintain their positions of comfort and power, ultimately by whatever means necessary. As such, corruption is almost inevitable. Sustaining the system of government occurs by favoring those that support it and oppressing dissenters. Governments, like living organisms, will also attempt to spread their influence abroad and will tend to favor other governments having similar methods of self-perpetuation. It could be said that there is an association between poorly designed systems of government and the frequency and desperation of the efforts made by the governments themselves in order to maintain power.
Control by governments over an unwilling or dissatisfied population can be an expensive and failure prone undertaking. A formalized police force, judiciary and prison system are the tools for the rule of law that most members of the public are educated about and have an awareness of, but it is much cheaper and frequently more effective to use less moral methods, such as terror. Terror, in this context, is a method of government which aims to control a large population by making an example of a small, representative sample. In many countries it is exercised overtly, but most governments prefer to keep this side of their activities quiet in order to maintain a public and international face of decency and moral superiority. For an eye-opening historical account of some of this type of history of unconventional methods of government, Instruments of Statecraft is a worthy read.
Torture is a particularly nefarious form of unconventional statecraft which has a threefold function. Firstly, it is used to extract sensitive information from suspects. Secondly, it is used for the gratification of the torturers and in revenge for perceived grievances. Thirdly, it is used to instill fear into the public, especially when victims are released back into their communities and tell of their harrowing experiences. Naturally, governments try to justify the practice of torture by claiming that it is in the public interest, particularly with regard to public ‘security’. In modern times, many otherwise respectable nations have either legalized or admitted to having conducted torture on criminal suspects. Here is a summary of nations as listed in Wikipedia:
- Afghanistan – A long history of torture and presently allegations of torture are aimed at both sides of the United States / Taliban conflict.
- Albania – Torture under previous regimes and allegations of same by police under the current regime.
- Algeria – Historically practiced by the French Foreign Legion, and since then to the present during what is called the ‘Dirty War‘.
- Angola – As part of a government war against Cabindan seperatists.
- Argentina – Historically, during the 1970’s ‘Dirty War’.
- Brazil – As part of efforts by government to manage the illegal drug trade, both to interrogate suspects and punish the convicted.
- Chile – Famously practiced by the regime of Augusto Pinochet during the 1970’s.
- China – Outlawed only in 1996, however still widespread.
- France – Historically practiced in several of its colonies (if not all of them), however within France there are many and frequent allegations of torture by police, as recently as 2005.
- Germany – Once commonplace in East Germany, allegations of systematic torture since that time have not since arisen.
- Iraq – Practiced by the now deposed Baathist regim, only to see its widespread resurgence under US occupation. The US Government has been directly involved at the highest levels, as is the Iraqi Government.
- Israel – A long history of torture allegations exists. Torture was legalized in Israel in 1987 (with Palestinians in mind) but outlawed in 1999. Allegations of torture before and after this time abound, both domestically and abroad.
- Nigeria – Systematic and ongoing.
- Russia – Officially illegal. Torture, however, was used in the war against Chechnya. It is said to be widespread domestically.
- Saudi Arabia – While illegal, Amnesty International describes torture in this country ‘rife’.
- Spain – Many allegations of police brutality exist, particularly in relation to anti-terrorist activity.
- United Kingdom – Extensive history, widely covered.
- United States – Extensive history, widely covered.
- Uzbekistan – Allegations of widespread torture exist. Information obtained during torture has been used in investigations by Britain and other democratic countries.
The number of countries condoning torture is much longer and by its very nature, the story of torture is a hidden history. We can be sure that whatever can be found out about torture, there is much more that remains unknown. When reading about reports of torture, it can be assumed that the information is merely scratching the surface on the issue.
Torture is not a haphazard, spontaneous or undisciplined form of violence. Rather, it is an established international industry. Businesses (and governmental departments) are set up to train personnel, sell equipment, and produce entertainment to promote the torture culture:
Chomsky and Herman also point to the international side of torture, including the arms suppliers, the various foreign governments that provide training, and the way torture complexes interact on a global scale. (How Not To Talk About Torture, Ch. III)
The reasons for torture programs are not purely economic, but the system is driven in part by money. It is clear from the list given above that the nations concerned were not conducting torture in order to produce a cheap labor force but to neutralize opposition to whatever agenda the nations are pursuing. Obtaining information is not the only reason for torture. As such, evidence showing that information obtained from questioning torture victims has poor reliability will not make torture obsolete.
The precise methods and details of the practice of torture are occasionally covered in the mainstream media, but it is usually up to activist organizations to pick up the slack in this regard. Corroborating evidence abounds, and it is surprising how little attention is given to the issue of torture on the international stage by politicians who seem all too willing to turn a blind eye for economic gain. The immediate aim of torture is to destroy the victim as a human being, but not to cause death. As such, a fine line is trod, since physical methods are employed to achieve psychological ends. The torture methods themselves are often designed to leave no physical evidence on the victim’s body. Victims may need ‘rehabilitation’ prior to release to the public, which may involve a period of rest and nutrition. If the victim is injured, particularly if this occurs in a setting where torture is not supposed to take place officially, medical attention is sought. Frequently medical involvement is inadvertent, but there is a more ugly and more deliberate place for doctors in torture.
So it becomes clear that doctors (and other health professionals) are called upon to assist at various stages of the torture process. These are people, trained in public universities, of good standing in the general community, who, one way or another, have come to participate in some of the worst imaginable crimes. In many cases, the doctors become the torturers, participating fully and willingly in these heinous acts. How is this possible?
Boiling The Frog: How Doctors Get Involved in Torture
Most medical graduates do not pose in their academic garb, degree in hand before the photographer, thinking about their wonderful future career as torturers. The paths that lead to this endpoint are many, but not all are accidental. Indeed, as frequent as torture is, as many as half of victims will have had a doctor present during their ordeal.
Accounts of how doctors assist during torture describe a variety of roles, ranging from ‘patching up’ injuries inflicted on victims so that the victims can undergo further abuse, supervision and guidance of torture to the fully fledged participation in torture. Doctors have also been involved in conducting medical research on detainees, including in the setting of torture. How do they end up involved in all of this?
The fact is, abuses in medical practice lie on a continuum, as they do in any other occupation. Doctors, being human, cannot be expected to be perfect. Indeed, cases of medical misconduct by doctors have always been a combination of an unscrupulous administration, an unreasonable work environment and a morally weak (or weakened) doctor. In a letter published in the New England Journal of Medicine, it was stated:
The doctors thus brought a medical component to what I call an “atrocity-producing situation” — one so structured, psychologically and militarily, that ordinary people can readily engage in atrocities. Even without directly participating in the abuse, doctors may have become socialized to an environment of torture and by virtue of their medical authority helped sustain it. In studying various forms of medical abuse, I have found that the participation of doctors can confer an aura of legitimacy and can even create an illusion of therapy and healing.
What became clear in the Abu Ghraib torture scandal during the US invasion of Iraq, was that the US Administration had anticipated, planned and authorized the abuses. This occurred, more or less, from the highest levels of authority downwards. No doubt, individuals working at the prison believed that they were some how protected from being exposed or prosecuted because of this chain of authority.
It is not difficult to imagine a hypothetical situation where a doctor, perhaps one who is employed in a prison, is called to attend to an injured prisoner involved in a scuffle with a guard. It is reasonable to assume that the doctor is not without ambition and would like a comfortable career both within the military and in the community afterwards. As such, this doctor would hope to have cordial relations with his fellow staff. He could probably be coaxed into performing one or another small but incriminating act, such as stitching up a laceration on a prisoner inflicted by a guard without reporting it to the relevant authorities. It has frequently been the case around the world that institutions, such as prisons, have been used as the cover for a torture program. So, it is not difficult to imagine our good natured, well intentioned doctor being asked to help out in a special interrogation, perhaps in connection with a ‘highly secret mission’ of some kind, authorized at the highest levels. The doctor’s job might be merely to make sure the prisoner is not hurt… much. It might be put to the doctor that until now, nobody was supervising this activity (since it was so secret) and prisoners’ lives were put at risk. As such, the doctor may initially think he is being invited to be the prisoner’s advocate. Add to this tempting offers of increased pay, promotion and ‘whatever’ else the doctor wants, with some kind of subtle reminder of what the doctor stands to lose. This combination of fear, greed and lust is a common and time proven method used to corrupt individuals. It probably works more times than it fails.
Once a doctor agrees to this, there is no turning back. He has given himself entirely to blackmail and while it is easy to imagine how the doctor might at some point develop cold feet and no longer wish to be involved, the organization conducting the torture will have foreseen it. At this point the doctor will have placed his life and that of his family at risk. There are, of course, a multitude of other ways that a doctor may be ensnared into participation in torture.
Thus, not all environments which are “atrocity producing situations” need to appear as such. A well documented example is that of the Soviet psychiatric system, where political prisoners were detained and abused under false psychiatric diagnoses:
The treatment included various forms of restraint, electric shocks, electromagnetic torture, radiation torture, entrapment, servitude, a range of drugs (such as narcotics, tranquilizers, and insulin) that cause long lasting side effects, and sometimes involved beatings. Nekipelov describes inhuman uses of medical procedures such as lumbar punctures.
These abuses occurred in prominent public buildings which were otherwise used to treat genuine patients. It is alleged (and very likely) that many of the systems of abuse which existed in the Soviet era have not ceased operation, but merely serve new masters.
The Psychology of the Torturer
The Milgram Experiment is used to explain how an individual may be brought to act against his or her conscience to harm another individual, under the direction of an authority figure. It has its faults and confounding factors, but the study elegantly shows how easily people can be led to an immoral act through an otherwise virtuous motive, in this case obedience. The author stated:
Ordinary people, simply doing their jobs, and without any particular hostility on their part, can become agents in a terrible destructive process. Moreover, even when the destructive effects of their work become patently clear, and they are asked to carry out actions incompatible with fundamental standards of morality, relatively few people have the resources needed to resist authority.
Making people commit evil acts is apparently a pretty easy task. In addition to obedience to authority, other psychological tools such as dehumanization, sexualization, religious duty, and telling torturers falsehoods about the victim are employed. Once a torturer has overcome his moral inhibitions (of which there may have been none to begin with), getting him to enjoy it is usually only a matter of time. The reason is that many of the basic human desires are fulfilled in the act of punishment, particularly the desire for control and power over others. Many torturers also obtain sexual gratification from their work. It is easy to see how torturers can lose all sense of proportion and become a danger to people besides the designated victims.
There are even public attempts to justify torture, as if to encourage those already committing it. For example, the rather pathetic argument of the ‘ticking time bomb’, where a person is tortured to extract urgent information that would supposedly save many lives, is in reality a fictitious one, yet it was enough to convince a democratic parliament to pass a law permitting torture.
The public is led to believe that torture is about extracting information, but in fact torture serves many other roles, as we have described already. However, torturers, like the public, believe what they want to believe:
“When torture takes place, people believe they are on the high moral ground, that the nation is under threat and they are the front line protecting the nation, and people will be grateful for what they are doing,”
Being a torturer can almost be made out to be the dream career choice: save your nation, feel powerful, take your frustrations out on a subhuman (who deserves it anyway), please your deity, live out your secret sexual fetish, get paid a heap of money and rise in social standing. Sadly, in such a job advertisement there would be thousands of applicants.
A doctor is involved, in part, to temper the torture process so that the physiological limits of the victim are not breached, by interpreting physiological monitoring devices, assessing consciousness, and maintaining the victim’s vital parameters. As such, the doctor may feel he is doing the right thing, doing his regular job and feeling powerful in his own way. Being human, the doctor will also find gratification from all of the other psychological factors which favor the torture behavior. The doctor will find it difficult to reject the cognitive dissonance which confronts him, namely that his actions perpetuate intense and senseless suffering, yet prevent death.
Conclusion: The Prevention of Torture
The most important thing a doctor can do is refuse to participate in a system that abuses people, be they prisoners, detainees, or poorly behaved patients. The problem is that “relatively few people have the resources needed to resist authority”. While many doctors are strong leaders, many are relatively docile and belong to an authoritarian system. Ask any intern what he or she would really do if ordered to perform a wrongful act on a patient by a supervising doctor. There is a good chance that the wrongful act would duly take place, unless the intern was already trained in recognizing and managing such a situation effectively.
Sadly, in many countries where torture is rife, doctors are themselves afraid of imprisonment and abuse, should they become activists for the abolition of torture. In their case, it is up to doctors abroad who interact with members of the said countries to do their part in pressuring governments to outlaw the practice and protect those who expose incidents of torture.
Even in the western world, it is a fact that there is grave lack of clear understanding among doctors of where the limits lie with respect to the treatment of patients (or detainees). Medical schools and medical students tend to view medical ethics as a low priority, whereas in reality a sound knowledge of medical ethics is the secret to a good night’s sleep for a doctor, a thing that no amount of money can otherwise buy.
It is clear, therefore, that prevention of medical participation in torture begins in the education, training and management of the medical profession as a whole, particularly in areas where doctors are likely to treat patients whose care is not altogether voluntary (the mentally ill, the elderly, prisoners, etc.). It cannot be restated enough times that a doctor needs to feel justified in refusing to do the wrong thing. The word ‘torture’ needs to be brought into the public limelight. There must be no compromise on the intrinsic wrongfulness of torture in any circumstance.
The Medical Foundation for Care of The Victims of Torture suggests:
“The solutions include exposing and prosecuting members of the security services who still use unnecessary or disproportionate force in handling suspects and detainees,” he says. “This requires multi-agency action, and healthcare professionals can play an essential part in the process with the careful assessment and documentation of evidence of ill-treatment.”
I would add to this that doctors need to be educated, as part of their psychiatry terms, in recognizing the physical and psychological signs which suggest that patients may have been abused or tortured.
So it is, that by refusing to participate, recognizing abuse, documenting and then exposing the perpetrators, that doctors can go some way to undo the wrongs done by their peers and by the system in which they work.