Steven Miles has a new editorial in the British Medical Journal on medical complicity with torture and the spotty record of accountability:
Doctors’ complicity with torture: It is time for sanctions
By Steven H. Miles
It is an arresting thought. More doctors abet torture than treat the millions of victims. More than 100 countries condone the use of torture. A third to a half of torture survivors report that a doctor oversaw the abuse.1 Many prisoners never see the doctors who refined the techniques to minimise evidential scars, prolong pain, or cause psychological destruction.2 Estimates of the numbers of torture victims do not include people whose murders disappear when a doctor writes “natural causes” on a death certificate.
The medical profession ought to dissociate itself from torture-a practice that destroys institutions of civil society; that is used against colleagues of conscience, and that has far reaching adverse mental, physical, and social consequences. Instead, medical societies and licensing boards offer lofty condemnation, which is most ardently aimed at offenders abroad rather than accomplices at home.
Doctors who abet torture rarely face professional risks. Governments will not punish a doctor for helping them carry out their crimes. Few medical societies or licensing boards have the courage and constancy of vision to investigate or censure colleagues who carry out the law of the land. In principle, medical societies support ethics codes like the World Medical Association’s Declaration of Tokyo, which bars doctors from complying with torture. In practice, they sustain the policy of impunity.3
The exceptions are instructive. The Nuremberg trial of Nazi doctors for war crimes was the birth of bioethics. That admirable court was convened by victors over defendants from a vanquished nation. But it is the wrong place to look for solutions to the common problem of doctors complying with torture. The problem today is holding doctors accountable for abetting torture and cruel, inhuman, or degrading treatment of their own citizens. Such cases have occurred after a torturing regime loses power. Brazilian medical licensing boards began investigating doctors for collaborating with torture during the last years of military rule. Initially, the government blocked sanctions against doctors; within a decade of civilian government sanctions against doctors took hold.4
In Greece, Dimitrios Kofas, a doctor stationed at the persecution section of a prison in Athens, was sentenced to prison within a year of the military junta being deposed.5 The Chilean Medical Society actively investigated complaints against doctors and expelled six doctors for overseeing torture during Pinochet’s rule.6 Three years after Argentina’s junta fell, Dr Jorge Berges was sentenced to prison for carrying out torture.7 A South African medical board tabled complaints against police doctors who failed to report or treat the fatal head injury inflicted by police on civil rights leader Steven Biko; two doctors were punished eight years after his death.8
A more secure foundation for this kind of accountability can and should be laid. The World Medical Association’s Declaration of Hamburg states that licensing boards should deny licences to doctors who are guilty of war crimes, including torture.9 Unfortunately, that declaration only applies to immigrating doctors who are accused of crimes in another country. For example, there was a successful campaign to deny a Belgian licence to an immigrant doctor who had been active in Rwanda’s genocide.10 The BMA is one of a few medical societies that support sanctions against doctors who torture, but it has not established a means to implement such sanctions.11
Countries wax and wane in their practice of torture. Foundations for making doctors accountable for this crime must be laid during periods of civil society. At such times, each national medical society and licensing agency should assert that medical complicity with torture and cruel inhuman or degrading treatment is a punishable breach of medical ethics that cannot be excused by law and for which there is no term limit. In the United States, California is considering a law that would ask its licensing agencies to inform health professionals that participating in coercive interrogation, torture, or other forms of cruel, inhuman, or degrading treatment or punishment may subject them to prosecution.12
The recruitment of the medical community in support of torture has far reaching effects. It harms prisoners. It deprives all prisoners of hope in the humanity of the medical staff. A civilian medical community that acquiesces to torture by its military members cannot credibly protest against foreign doctors who carry out torture. Such a community can hardly support doctors who are endangered for their resistance against torture. The prestige and values of medicine make it a crucial part of the campaign to abolish torture.
“I will guard my art and my life.” That pivotal promise of vigilance in the Hippocratic oath acknowledges that medical professionalism is not an easy virtue. Diverse enticements lure doctors from the core of medicine: “I will use regimens for the benefit of the ill but from what is to their harm or injustice, I will protect them.” Governments that practice torture need doctors. The medical accomplices of torture must not rest in the confidence that they can violate civil society and the ethics of medicine with impunity.
Cite this as: BMJ 2008;337:a1088
Steven H Miles, professor of medicine and bioethics
1 Center for Bioethics, N504 Boynton, Minneapolis, MN 55414, USA
From the archive: Two recent news stories have dealt with torture. Doctors protest against surgeon held for six years at Guantanomo (news story; doi: 10.1136/bmj.a1071); Medical evidence exposes US use of torture-includes embedded video clip (news story; doi: 10.1136/bmj.a490)
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- Stover E, Nightingale E. The breaking of bodies and minds. Washington DC: American Association for the Advancement of Science, 1985.
- World Medical Association. Guidelines for medical doctors concerning torture and other cruel, inhuman or degrading treatment or punishment in relation to detention and imprisonment (Declaration of Tokyo). 2006. www.wma.net/e/policy/c18.htm.
- Amnesty International. Brazil. Human rights violations and the health professions. 1996. http://asiapacific.amnesty.org/library/Index/ENGAMR190251996?open&of=ENG-346.
- Amnesty International. Torture in Greece: the first torturers’ trial 1975. London: Amnesty International, 1977.
- BMA. Medicine betrayed. London: BMA, 1992.
- Human Rights Watch. Argentina. 2006. www.hrw.org/reports/2001/argentina/argen1201-02.htm.
- McLean GR, Jenkins T. The Steve Biko affair: a case study in medical ethics. Dev World Bioethics 2003;3:77-95.[CrossRef]
- World Medical Association. Statement on the licensing of physicians fleeing prosecution for serious criminal offences (Declaration of Hamburg). 1997. www.wma.net/e/policy/c16.htm.
- Hall P. Doctors and the war on terrorism. BMJ 2004;329:66.[Free Full Text]
- British Medical Association. The medical profession and human rights: handbook for a changing agenda. Torture. 2001. www.bma.org.uk/ap.nsf/Content/MedProfhumanRightsRecommendations#Torture.
- California Senate 19. Health professionals: torture. 2008. www.leginfo.ca.gov/cgi-bin/postquery?bill_number=sjr_19&sess=CUR&house=B&author=ridley-thomas.
Steven Miles, MD
N504 Boynton, 410 Church St SE
Minneapolis, MN 55455-0346
July 31st, 2008