A Duty of Care
I read with utter horror that psychologists and medical doctors were involved in the interrogation of captured terrorism suspect Abu Zubaida. Regardless of whether you consider the questioning of Zubaida to be torture or simply interrogation technique, there is no way it can be seen as anything but coercive. And medical people have no place in a coercive environment of that nature.
Doctors work in the coercive environment of prisons all the time, of course, but the doctor has no interaction with the restrictive requirements of prison (s/he doesn’t say whether the criminal should be incarcerated or not). The doctor’s only concern in a prison is his duty of care to the prisoners; to maintain their health. This is as it should be.
In the context of interrogation, all of that duty of care flies out of the window. Saying that the questioning of prisoners at Guantanamo was not torture because a doctor could have stopped it at any time, is merely using the medical profession to legitimize an ethically doubtful technique. This is something that no doctor should ever be attempting. Anyone who has sworn an oath to “first do no harm” should not be trying to decide what level of coercion can be considered “harmless”. Clearly, no level of coercion is ever truly harmless. But the ethics of the psychologists involved is far worse:
“The CIA psychologists had personal experience with SERE [Survival, Evasion, Resistance and Escape - the technique used by the US military to train soldiers to resist torture] and helped convince CIA officials that harsh tactics would coerce confessions from Abu Zubaida without inflicting permanent harm. Waterboarding was touted as particularly useful because it was “reported to be almost 100 percent effective in producing cooperation,” the memo said.”
So two psychologists (men trained in the alleviation of psychological harm) persuaded the CIA that waterboarding was not torture because it was not permanently harmful. Say what? Pulling out your fingernails without anaesthetic is not permanently harmful if done carefully – the nails grow back. Electrocution is not permanently harmful – the burns heal fully unless very deep. What crackpot decided that something wasn’t torture because it did not cause permanent harm? Joseph Mengele?
There are some who argue that patriotism should predominate over medical ethics:
“But Michael Gross, a professor at the University of Haifa in Israel and the author of “Bioethics and Armed Conflict: Moral Dilemmas of Medicine and Warfare,” said that if physicians think particular harsh interrogation techniques do not constitute torture, there is no reason they should not participate.
““Physicians are faced with a hard dilemma,” he said. “They have professional obligations to do no harm, but they also have a duty as a citizen to provide expertise to their government when the national security is at stake. In a national security crisis, I believe our duties as citizens take precedence.””
That is an extremely dangerous line to take. History is full of medical men who threw away their ethical stance in the name of loyalty to a country. These men did unspeakable things simply because they thought they were serving a cause rather than an ancient oath. But the hippocratic oath is there to protect our integrity and our relationship with our patients. Doctors who ignore a duty of care to patients, ignore the fundamental bedrock of medical practice. How can a patient trust his physician, when the physician may be serving the interests of the state rather than the patient? What if it is in the interests of the state to conduct dangerous medical experiments? Or kill someone in the name of “national security”?
Let me put it in a more common medical context. What if the state informs you that it cannot afford treatment for every single woman with breast cancer and asks you to choose which ones will have treatment? Will you advocate for your patient, or follow the state’s lead and deny them treatment? Note, I am not here talking about withholding futile treatment, but essential, life-saving treatment.
If we do not bring these doctors who participated in interrogations to account, how can our patients trust us to advocate for them? I am, therefore, in complete agreement with Dr Stephen Miles here:
“Steven H. Miles, a professor of medicine at the University of Minnesota and author of “Oath Betrayed: America’s Torture Doctors,” said the actions described in the memos were the “kind of stuff that doctors have been tried, convicted and imprisoned for in other countries — and that’s what should happen here.””
At the very least these doctors and psychologists should be immediately struck off and never allowed to practice medicine again. Otherwise we are in danger of letting medicine become a tool of the state, rather than a service to the people.
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Apr 19 09 7:25 pm
Just to be the Devils advocate I would like to compare the Medical profession with the Clergy.
The 10 Commandments say ‘Thou shall not kill’. The Clergy in the Armed Forces are there for the welfare of the troops and will hold prayers and bless troops before they go off into battle to kill the enemy. Is this OK? Or is it only OK in certain circumstances like fighting the evil of Nazi Germany? What is the dividing line? However they are giving a blessing to go off and kill.
The Medical Profession should not do harm. But is it as simple as that? By aiding an interrogation they may be saving a number of lives, maybe thousands, at the expense of harming one. Looking at it the other way, they allow 1000′s to die for the price of one life.
Morally, at the time of the interrogation, it is wrong. But war is immoral and one has to make tough decisions and the lives of your own should be a priority – especially when the enemy abide by no conventions at all!
Apr 19 09 7:50 pm
mawm: However they are giving a blessing to go off and kill.
Most Army clerics would dispute that. I doubt if any of them would see it as blessing killing in any way. They are usually asking God to protect the men they have care for. In a way, the “duty of care” for military clergy is to protect the souls of the troops. You could argue that, for the troops to survive, the enemy has to die, but that is not entirely true. They could surrender.
By aiding an interrogation they may be saving a number of lives, maybe thousands, at the expense of harming one.
I could use this same argument to justify experimenting on you without your consent. In fact, this argument has been used to justify virtually every atrocity since the dawn of time. It was used to justify crucifying Jesus.
The essential flaw in the argument is that one believes that one can correctly see the consequences of the action proposed – that killing or harming one person will save many. Unfortunately for the argument, the consequences of the action are rarely predictable and certain enough to justify the harm. In this instance, there is absolutely no evidence that waterboarding Abu Zubaida did anything for the safety of Americans.
Apr 19 09 9:32 pm
That’s nothing. The State demands Doctors kill if requested, and Doctors may no longer cite “conscientious objection” if they don’t believe in killing. This law was recently enacted in Victoria, Australia for example.
ZenTiger’s last blog post..Obama calls on Jack Bauer
Yes, I agree that the Victorian law is despicable. Also despicable was the lack of response from doctors and their representatives. I expect the first test of this law to underline the dangerous breach in medical ethics it tries to enforce.
Apr 19 09 9:48 pm
“…there is absolutely no evidence that waterboarding Abu Zubaida did anything for the safety of Americans.”
Assuming that’s true, it’s no argument against waterboarding. The object of interrogation is to discover whether threats exist and to uncover connections which will be of use in neutralizing those threats.
If harsh interrogation–even torture–would have avoided an obscenity such as Beslan (you do remember Beslan?) then I for one would have no problem at all with it.
What’s often overlooked is that a person doesn’t end up in Gitmo for merely kicking someone’s dog–they’re all ‘players’ of varying degrees of lethality.
kg’s last blog post..Hussein gives Che a chance
Apr 19 09 10:16 pm
kg: Assuming that’s true, it’s no argument against waterboarding
I am not arguing against waterboarding, only against a doctor’s participation in it. Whereas I have no problem with a doctor giving advice on whether a certain interrogation technique is likely to cause harm or not, under no circumstances should he be advocating the technique, condoning the technique or participating in it. To do so is to advocate harm to an individual, temporary or otherwise. This is a breach of the hippocratic oath. No doctor should be allowed to practice if he willingly breaches the oath.
Though it would be great to avoid another Beslan. I still don’t think that the end justifies the means, particularly when, as I have pointed out, the ends are by no means certainly obtainable.
Apr 20 09 12:17 pm
Thanks for the reply, McD.
I don’t believe it’s necessary for the ends to be certainly attainable if the stakes are high enough. A reasonable chance is enough.
Of course no doctor should breach that oath, but many thousands do, for all kinds of reasons. Since the West is in an existential fight most of us who are aware of what’s at stake are going to view the docs who are the subject of your post rather more tolerantly. (but then, most of us didn’t take that particular oath, I must say!).
There are other imperatives involved here, and if–as a soldier–it had been necessary for me to hold a doc at gunpoint and force him to break his oath in order to save a greater number of innocent lives then I most certainly would have.
kg’s last blog post..drooling idiocy or cynical lies? You decide:
Remind me not to be around when you start waving guns about!
Apr 20 09 4:02 pm
Nah, those days are over for me.
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