Primum Non Nocere: When Doctors Betray Their Oath
Josef Mengele, the Nazi doctor who experimented on concentration camp prisoners
Today’s debate blog comes from Savino Sciascia, who discusses the participation of doctors in torture and other human rights abuses. What do you think of this question? Register your opinion in our polls and talk about it in our Facebook discussion.
The complicity of medical providers in torture is still a deep open wound in Global Health
The Hippocratic Oath declares “ἐπὶ δηλήσει δὲ καὶ ἀδικίῃ εἴρξειν”: physicians must treat all patients to the best of their abilities, respect patient privacy, and do them “no harm or injustice”.
The human rights community’s attention to the complicity of doctors and other health workers in torture or cruel and inhuman treatment has rarely been debated and only few cases (often concerning political prisoners in detention settings) obtained a right visibility. Sometimes, our attention is focused on the story of “one patient”, as the case of Tan Guihua, who was detained in 1999 and sent to the Jiaozhou Mental Hospital in Shandong province for supporting and practicing a form of spiritual meditation. Because she refused to renounce her beliefs she was repeatedly tortured by medical personnel using electroshock therapy, and was force-fed antipsychotic medicines (1). But this is only an example of thousand of silent stories about abuses of patients.
These actions may be done in compliance with state medical policies, in contradiction to them, or in their absence, but when they do occur they can be described as torture or cruel, inhuman, or degrading treatment (CIDT), in which case both the medical provider and the state must be held accountable.
A precise definition of CIDT has yet to be articulated. The International Covenant on Civil and Political Rights (ICCPR), the first international treaty to explicitly address torture and CIDT, provides that “no one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment. In particular, no one shall be subjected without his free consent to medical or scientific experimentation.” Furthermore, the World Medical Association’s Declaration of Tokyo expressly condemns medical participation in torture, cruel and inhuman or degrading treatment, or “any act to diminish the ability of the victim to resist such treatment.”
Despite these declarations and oaths, and calls for a permanent “International Medical Tribunal” to prosecute medical personnel who violate human rights, the complicity of medical providers in torture or CIDT is still a deep open wound in Global Health. What is shocking is we are not debating about historical officially condemned events, (as those that came to light during the Nuremberg trial of Nazi physicians) but human rights associations routinely report situations of abuses and torture, even far from detention or conflicts settings. Given these strong condemnations of abuses and torture, it is surprising that many doctors are unaware of the notorious cases of torture or degrading treatment by members of their profession. Moreover, relatively little is known about medical students’ attitudes about such a global health torture. We can presume the idealism of medical students and one might assume that they would subscribe to the Hippocratic ideas. Nevertheless, very little information is available about this debate (2). If no one during Medical School has the farsightedness of speaking about this dark side of medical world, how will the physicians of tomorrow be able to be prepared to stop these abuses?
To date, health providers in medical facilities, juvenile detention centers, orphanages, drug treatment centers, are forced to withhold care or engage in treatment that intentionally or negligently inflicts severe pain or suffering for no legitimate medical purpose. According to the 2010 World Report, Human Rights Watch has reported on a wide range of abuses against patients and individuals under medical supervision, including the practice of forcible anal and vaginal exams, female genital mutilation, and the failure to provide life-saving abortion, palliative care, and treatment for drug dependency.
Health providers, their respective professional associations, and human rights actors therefore too rarely act forcefully to stop provider abuse and end abusive state policies. As a first step toward addressing these abuses, human rights advocates and medical practitioners and associations need to recognize how medical provider behaviors and state health policies can constitute torture or CIDT.
Only by expanding recognition of these abuses, engaging in joint advocacy between health and human rights activists, and strengthening accountability and redress mechanisms, will abusive laws and policies be effectively addressed and torture and CIDT in healthcare settings be prevented.
Perhaps then, the Hippocratic aim of primum non nocere can be realized.
References:
1.Human Rights Watch and Geneva Initiative on Psychiatry, Dangerous Minds: Political Psychiatry in China Today and its Origins in the Mao Era (New York: Human Rights Watch, 2002), http://www.hrw.org/en/reports/2002/08/13/dangerous-minds.
2. Jonathan Bean, David Ng, Hakan Demirtas, Patrick Guinan, Torture, Volume 18, Number 2, 2008