Physicians and Torture

Torture is a health care issue. Especially when physicians are complicit, as they evidently were during the Bush administration, in the CIA’s Office of Medical Services, where they facilitated torture of prisoners: [via The Daily Dish: the original JAMA article is behind a paywall.]

An important new study came out today. It’s from the Journal of the American Medical Association about the deep and unethical involvement of CIA doctors and psychiatrists in pioneering torture techniques for the Bush-Cheney administration. . .

The CIA Office of Medical Services

  • purported to subject some techniques to “medical limitations,” but those claimed limitations imposed no constraint on use of torture, e.g., allowing weight loss up to serious malnutrition, noise up to level of permanent hearing damage, exposure to cold water right up to development of hypothermia, shackling in upright sitting or horizontal position for 48 hours (and longer with medical monitoring);
  • placed no medical limitations at all on the use of isolation, hooding, walling, cramped confinement or stress positions except in some cases avoidance of aggravation of pre-existing injury;
  • ignored medical and other literature on effects of these forms of torture, and instead cited sources like NIH web site, wilderness manuals and WHO guidelines.
  • recognized dangers of certain enhanced methods but nevertheless approved them, e.g., that waterboarding risks drowning, aspiration pneumonia, and laryngospasm; sleep deprivation can degrade cognitive performance, lead to visual disturbances and reduce immune competence acutely; prolonged standing can induce dependent edeme, increased risk for DVT, cellulitis.

I spent a considerable amount of time yesterday trying to imagine circumstances where health care professionals in a supposedly free society could justify their participation in torture of their patients. Because there is no way around this bald fact: those being tortured were patients of these physicians. They assumed care; they took up responsibility for their treatment and well-being.

I came up empty. I suppose one could make the argument that physician participation mitigates the worst effects of torture, as if having waterboarding (for example) supervised by medical personnel somehow minimizes poor outcomes and creates and justifies acceptable practice. In short, it’s all routinization and normalization: torture as a medically prescribed treatment. But do we really want torture to be medically “administered” to ensure acceptable outcomes?

There are certain ethical touchstones all health care professionals must abide by: beneficence, non-maleficence, autonomy and justice. We must work for the patient’s good. We must not do harm. We must respect the patient’s choices in accepting or rejecting treatment. We must ensure patients are treated equally without regard to externalities. It’s hard to see which of these principles isn’t grossly violated.

“Conduct disgraceful and dishonourable to the profession” is the traditional formulation when health care professionals are found guilty of misconduct. I guess it would apply here.


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  1. #1 by jennjilks on Thursday 05 August 2010 - 0926

    Excellent points. I’ve often pondered this one: how more than one person can participate in such acts. I can see one person going to the dark side, alone, but two or three gathered together in complicity?

  2. #2 by Lisa on Thursday 05 August 2010 - 1020

    very good points. it shocks me what physicians can justify under normal working conditions, so this is just even more sad to read

  3. #3 by Cartoon Character on Thursday 05 August 2010 - 1553

    Well, you might as well go further back in history. I know this is only a forum thread…but it sure is a frightening read:

    • #4 by torontoemerg on Thursday 05 August 2010 - 1658

      Yep. Eternal vigilance is the only answer, I think.

  4. #5 by thenonconformer on Thursday 05 August 2010 - 1623

    The adequate Treatment for Canada’s failing health system firstly is criminal prosecution and jail for the bad doctors, bad nurses for failing to help the sick people adequately but still having enforced, Real management, supervision of doctors, nurses, medical and hospital workers. It is still a criminal act now for any doctor, nurse, hospital administrators, medical supervisor not to provide medical care to any seniors. How many have been prosecuted for this in the last year?

    • #6 by torontoemerg on Thursday 05 August 2010 - 1657

      Nonconformer: I actually get that you read somewhere that commenting on other people’s blogs will drive traffic to your site, but if you’re going to comment here, at least make an effort to make it relevant to the post at hand. Thanks.

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