The tortured patient: A medical dilemma

Hastings Center Report

Volumn 41, Issue 3, 2011, Pages 38-47

  Lepora, Chiara ^a   Millum, Joseph ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; ASSISTED SUICIDE; ETHICS; HUMAN; MORALITY; PHILOSOPHY; PUNISHMENT; TORTURE;

CAPITAL PUNISHMENT; ETHICAL ANALYSIS; HUMANS; MORALS; PHILOSOPHY, MEDICAL; SUICIDE, ASSISTED; TORTURE;

EID: 79960140559     PISSN: 00930334     EISSN: 1552146X     Source Type: Journal    
DOI: 10.1353/hcr.2011.0064     Document Type: Note

References (76)

1. Amnesty International, "Doctors and Torture," Amnesty International annual report (New York: Amnesty International, 2002).
2. Pentagon's Joint Task Force at Gitmo, "Interrogation Log Detainee 063 in SECRET ORCON-Classified Army Documents," 2002-2003, Guantanamo: U.S. Army, p. 83.
3. "On another occasion said he had to intercede after expressed concern that Al Nasihiri's arms might be dislocated from his shoulders. Explained that, at the time, the interrogators were attempting to put Al Nasihiri in a standing stress position. Al Nasihiri was reportedly lifted off the foor by his arms while his arms were bound behind his back with a belt.
4. C.I.A. Inspector General, "Special Review; Counterterrorism Detention and Interrogation Activities (September 2001-October 2003)," Central Intelligence Agency, document number 2003-7123-IG, p. 44.
5. Ibid., 77.
6. L.S. Rubenstein and S.N. Xenakis, "Roles of CIA Physicians in Enhanced Interrogation and Torture of Detainee," Journal of the American Medical Association 304 (2010): 569-70;
7. O.V. Rasmussen et al., "The Ethical and Legal Responsibilities of the Medical Profession in Relation to Torture and the Implications of Any Form of Participation by Doctors in Torture," Medicine and War 8, no. 1 (1992): 44-47.
8. D. Luban, "Unthinking the Ticking Bomb," in Global Basic Rights, ed. C.R. Beitz and R.E. Goodin (New York: Oxford University Press, 2009), 181-206;
9. M. Gross, "Doctors in the Decent Society: Torture, Ill-Treatment and Civic Duty," Bioethics, 18, no. 2 (2004): 181-203.
10. United Nations, Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (Geneva, Switzerland: United Nations, 1984).
11. J.S. Bybee, "Interrogation of al Qaeda Operative-Memorandum for John Rizzo, Acting General Counsel of the Central Intelligence Agency," U.S. Department of Justice, 2002, p. 18.
12. D. Allbrook, "Medical Participation in Flogging and Punitive Amputation in Pakistan," Medical Journal of Australia 1, no. 10 (1982): 411.
13. Although interrogation and punishment have quite different functions, both can involve torture. In both cases, what is wrong about the act is the same-it is the unjustified infiction of severe pain or suffering. Moreover, in practice it is normally difficult to separate the infiction of punishment, intimidation, coercion, and the extraction of information from one another: the same act may serve all these functions.
14. G. Maio, "History of Medical Involvement in Torture-Then and Now," Lancet 357 (2001): 1609-1611.
15. Geneva Conventions, Convention (IV) Relative to the Protection of Civilian Persons in Time of War, 1949.
16. United Nations, Principles of Medical Ethics (1982): Resolution 37/194 (Geneva, Switzerland: United Nations, 1982).
17. World Medical Association, "Declaration of Tokyo: Guidelines for Medical Doctors," World Medical Journal 22, no. 6 (1975): 87-90;
18. World Medical Association, World Medical Association Declaration on Hunger Strikers, November 1991 (revised in 1992 and 2006), http://www.wma.net/en/30publications/10policies/h31/index.html;
19. American Medical Association, "Opposing Cooperation of Physicians and Health Professionals in Torture," Resolution 10 (amendment, A-05), June 18, 2005;
20. American College of Physicians, "The Role of the Physician and the Medical Profession in the Prevention of International Torture and in the Treatment of Its Survivors," Annals of Internal Medicine 122, no. 8 (1995): 607-613;
21. American Psychiatrists Association and American Psychologists Association, "Against Torture: Joint Resolution of the American Psychiatric Association and the American Psychological Association," 1985 Position Statement, http://www.apa. org/news/press/statements/joint-resolu-tionagainst-torture.pdf;
22. World Psychiatrists Association, "Madrid Declaration on Ethical Standards for Psychiatric Practice," August 25, 1996 (revised in 1999, 2002, and 2005), http://www.wpanet.org/detail.php?section_id=5&content_id=48.
23. Amnesty International, "Report 2009: The State of the World's Human Rights," Amnesty International annual report, 2009.
24. O.V. Rasmussen, "The Involvement of Medical Doctors in Torture: The State-of-the-Art," Journal of Medical Ethics 17, no. 4 (1991): 26-28.
25. United Nations, Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment.
26. C. Lepora, "Meta-Analysis of the Literature on Medical Participation in Torture," personal communication to Michael Gross, 2009.
27. R.M. Hare, "The Ethics of Medical Involvement in Torture: Commentary," Journal of Medical Ethics 19, no. 3 (1993): 138-141;
28. M.L. Gross, Bioethics and Armed Confict: Moral Dilemmas of Medicine and War (Cambridge, Mass.: MIT Press, 2006), 211-44.
29. S.H. Miles, Medical Ethics and the Interrogation of Guantanamo (New York: Routledge, 2007), 5-11.
30. M. Nowak, "What Practices Constitute Torture? US and UN Standards," Human Rights Quarterly 28, no. 4 (2006): 809-841.
31. Gross, "Doctors in the Decent Society."
32. F. Allhoff, "Physician Involvement in Hostile Interrogations," Cambridge Quarterly of Healthcare Ethics 15, no. 4 (2006): 392-402.
33. Our use of "accessory" is related to, but should not be confiated with, legal concepts with the same name. For a comprehensive analysis of the legal notion of complicity.
34. L. May, "Complicity and the Rwandan Genocide," Res Publica 16, no. 2 (2010): 135-52.
35. M.T. Brown, "Moral Complicity in Induced Pluripotent Stem Cell Research," Kennedy Institute of Ethics Journal 19, no. 1 (2009): 1-22.
36. You would like to place Zubaydah in a cramped confinement box with an insect. You have informed us that he appears to have fear of insects. In particular, you would like to tell Zubaydah that you intend to place a stinging insect into the box with him. You would, however, place a harmless insect in the box
37. Bybee, "Interrogation of al Qaeda Operative," 18.
38. J.J.C. Smart, and B.A.O. Williams, Utilitarianism: For and Against (Cambridge, U.K.: Cambridge University Press, 1973), 87-100.
39. C. Kutz, Complicity: Ethics and Law for a Collective Age (Cambridge, U.K.: Cambridge University Press, 2000), 74-81.
40. T. Keneally, Schindler's Ark (London, U.K.: Hodder and Stoughton, 1982).
41. C.A.A. Reis et al., "Physician Participation in Human Rights Abuses in Southern Iraq," Journal of the American Medical Association 291 (2004): 1480-86;
42. T.A. Brennan and R. Kirschner, "Medical Ethics and Human Rights Violations: The Iraqi Occupation of Kuwait and Its Aftermath," Annals of Internal Medicine 117, no. 1 (1992): 78-82.
43. For instance, Norman Daniels argues that, in the years when HIV was still a deadly condition, doctors and dentists had a duty to treat HIV-positive patients. The "moderate risk" of contracting the disease they undertook was not different from similar risks they agreed to expose themselves to when they become doctors;.
44. N. Daniels, "Duty to Treat or Right to Refuse?" Hastings Center Report 21, no. 2 (1991): 36-46.
45. S.H. Miles, "Torture: The Bioethics Perspective," in From Birth to Death and Bench to Clinic: The Hastings Center Bioethics Briefing Book for Journalists, Policymakers, and Campaigns, ed. M. Crowley (Garrison, N.Y.: The Hastings Center, 2008).
46. G. Seelmann, "The Position of the Chilean Medical Association with Respect to Torture as an Instrument of Political Repression," Journal of Medical Ethics 17, SUPPL. (1991): 33-34.
47. W.J. Kalk and Y. Veriava, "Hospital Management of Voluntary Total Fasting among Political Prisoners," Lancet 337 (1991): 660-62;
48. T.L. Beauchamp and J.F. Childress, Principles of Biomedical Ethics, 6th ed. (New York: Oxford University Press, 2009), 99-149.
49. As reported in personal correspondence and in the literature.
50. J. Pagaduan-Lopez, "Medical Professionals and Human Rights in the Philippines," Journal of Medical Ethics 17, SUPPL. (1991): 42-50;
51. Brennan and Kirschner, Medical Ethics and Human Rights Violations";
52. V. Iacopino, "Turkish Physicians Coerced to Conceal Systematic Torture," Lancet 348 (1996): 1500.
53. Pentagon's Joint Task Force at Git-mo, "Interrogation Log Detainee 063 in SECRET ORCON - Classified Army Documents," Guantanamo: U.S. Army, 2002-2003, p. 83.
54. World Medical Association, "World Medical Association Declaration on Hunger Strikers";
55. B. Arda, "How Should Physicians Approach a Hunger Strike?" Bulletin of Medical Ethics 181 (2002): 13-18.
56. F.R. Parker and C.J. Paine, "In formed Consent and the Refusal of Medical Treatment in the Correctional Setting," Journal of Law, Medicine and Ethics 27, no. 3 (1999): 240-51.
57. "Every human being of adult years and sound mind has a right to determine what shall be done with his own body; and a surgeon who performs an operation without his patient's consent commits an assault, for which he is liable in damages;.
58. Court of Appeals of New York, Mary E. Schloendorff, Appellant, v. The Society of the New York Hospital, Respondent 1914; Geneva Conventions, Convention (IV) Relative to the Protection of Civilian Persons in Time of War;
59. D. Bertrand and T. Harding, "European Guidelines on Prison Health," Lancet 342 (1993): 253-54.
60. "Principle 1: Health personnel, particularly physicians, charged with the medical care of prisoners and detainees have a duty to provide them with protection of their physical and mental health and treatment of disease of the same quality and standard as is afforded to those who are not imprisoned or detained
61. United Nations, Principles of Medical Ethics (1982): Resolution 37/194.
62. C. Lepora, M. Danis, and A. Wertheimer, "No Exceptionalism Needed to Treat Terrorists," American Journal of Bioethics 9, no. 10 (2009): 53-54.
63. S.H. Miles, "Doctors' Complicity with Torture-Time for Sanctions," British Medical Journal 337 (2008): a1088.
64. Rasmussen et al., "The Ethical and Legal Responsibilities of the Medical Profession in Relation to Torture and the Implications of Any Form of Participation by Doctors in Torture."
65. D. Brock, "Conscientious Refusal by Physicians and Pharmacists: Who Is Obligated to Do What, and Why?" Theoretical Medicine and Bioethics 29, no. 3. (2008): 187-200;
66. M. Wicclair, "Conscientious Objection in Medicine," Bioethics 14, no. 3 (2000): 205-227.
67. Smart and Williams, Utilitarianism.
68. Compare Thomas Nagel, who writes: "First, it is a confusion to suggest that the need to preserve one's moral purity might be the source of an obligation. For if by committing murder one sacrifices one's moral purity or integrity, that can only be because there is already something wrong with murder. The general reason against committing murder cannot therefore be merely that it makes one an immoral person. Secondly, the notion that one might sacrifice one's moral integrity justifiably, in the service of a sufficiently worthy end, is an incoherent notion. For if one were justified in making such a sacrifice (or even morally required to make it), then one would not be sacrificing one's moral integrity by adopting that course: one would be preserving it.
69. T. Nagel, "War and Massacre," Philosophy and Public Affairs 1, no. 2 (1972): 123-44, at 132-33.
70. Smart and Williams, Utilitarianism, 117;
71. Wicclair, "Conscientious Objection in Medicine," 218.
72. Brennan and Kirschner, "Medical Ethics and Human Rights Violations: The Iraqi Occupation of Kuwait and its Aftermath";
73. Seelmann, "The Position of the Chilean Medical Association with Respect to Torture as an Instrument of Political Repression."
74. We should point out that it is not a physician's primary duty to collect evidence against torture, and no physician would be "excused" for participation in torture on the grounds that she did it only to collect evidence. Reporting could be a com pensatory practice only for physicians who have been coerced into assisting torture, or who were justifiably complicit on the grounds we have suggested.
75. P.B. Polatin, J. Modvig, and T. Rytter, "Helping to Stop Doctors Becoming Complicit in Torture," British Medical Journal 340 (2010): c973.
76. S. Miles and A. Freedman, "Medical Ethics and Torture: Revising the Declaration of Tokyo," Lancet 373 (2009): 344-48.