10 May 2011

Doctors at Guantánamo Bay get cryptic ethical advice

by Kate Melville

Medical involvement with torture is prohibited by law and the fundamental tenets of the medical professional, and yet sometimes it is the right thing for doctors to do, argue two bioethicists in a controversial new paper published in the Hastings Center Report.

The new paper is timely, in light of strong evidence - appearing last month in PLoS Medicine - that there exists medical complicity in torture at Guantánamo Bay.

Amnesty International estimates that physicians and other medical personnel are implicated in at least 40 percent of cases of torture or "enhanced interrogation techniques." The dilemma physicians finds themselves in, according to the authors of the new paper, bioethicists Chiara Lepora and Joseph Millum, is that to care for tortured patients at the request of their torturers may "entail assisting or condoning terrible acts," but to refuse may in some cases mean abandoning a patient in need of a doctor's care or who desires such care.

Lepora and Millum argue that there are degrees of complicity, and it can be outweighed by other factors, such as the tortured prisoner's desire for treatment. They contend that dilemmas facing physicians arise because different principles, such as refraining from doing harm and respecting a patient's wishes, come in conflict with each other. As a result, they write, "This dilemma is real and... sometimes the right thing for a doctor to do, overall, is to be complicit in torture."

Interestingly, the authors attempt to provide guidelines to physicians for minimizing complicity. Physicians can minimize complicity by ensuring that their actions do not share the wrongful intentions of the torturers and that they perform the physician role in such a way at to "mitigate, prevent, or help redress acts of torture," they suggest. Whistle-blowing is one example they cite, noting that physicians who have been coerced into assisting with torture have often been sources for international tribunals redressing the torture.

In something akin to having-your-cake-and-eating-it-too, Lepora and Millum do not recommend altering professional and legal prohibitions against physician involvement in torture. Such powerful condemnations offer aspiration to a world without torture and they can help doctors avoid involvement, they claim.

The ethical murkiness doesn't become any clearer. "Other things being equal, it is better for a physician not to be complicit in torture," they note in their conclusion. "But other things are rarely equal and... a physician ought sometimes to accept complicity in torture for other moral reasons."

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Source: The Hastings Center