Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
If nothing else...
- Rebecca A. Drayer (5 August 2008)
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Torture and the Israeli Medical Association
- Asad Khan (14 August 2008)
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To The Editor: The NAS and the DIA, Strange Political Bedfellows
- thomas e goffman (9 September 2008)
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Medical associations and torture
- Christopher J Burns-Cox (2 February 2009)
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Response from the BMA
- Vivienne Nathanson, Ann Sommerville, Head of Ethics, BMA (2 February 2009)
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Details of BMA action needed
- Christopher J Burns-Cox (26 February 2009)
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Israel Medical Association
- Steven H Miles (1 March 2009)
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Rebecca A. Drayer, Clinical Instructor Univ. of Rochester Medical Center, Rochester, NY 14625
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If nothing else, physicians participating in torture should think about this: the government currently in power will not always be in power.... A similar issue exists in the United States with respect to physician participation in capital punishment. The state of North Carolina requires that a physician monitor "the essential body functions of the condemned inmate." Recently, the North Carolina State Medical Board voted to sanction any member who participated in an execution in his/her capacity as a physician. The Department of Corrections successfully challenged this, stating that it was interference in the justice system. The case is now under appeal, but it definitely has a chilling effect on those who would try to stand up against an unethical law. Competing interests: None declared |
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Asad Khan, Respiratory Physician Royal Blackburn Hospital, Blackburn, Lancashire, UK, BB2 3HH
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Modified on legal advice, 21 October 2008
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I extend my heartfelt thanks to Professor Miles for his hard-hitting editorial. Indeed, it is nothing short of a disgrace that the medical profession in the 21st century continues to be associated with torture- a practice which should be the antithesis of our very existence as doctors. To harm- when one’s duty is to heal- has to be the worst form of moral corruption. Miles provides arresting examples of this practice in Greece, Brazil, Chile, Argentina, South Africa and Rwanda. The case of Israel has been discussed in these columns previously, and I feel obliged to bring it to readers’ attention again. Over a decade ago, Amnesty International concluded that Israeli doctors working with the security services ‘form part of a system in which detainees are tortured, ill-treated and humiliated in ways that place prison medical practice in conflict with medical ethics’. [1] More recently, the Public Committee Against Torture in Israel (PCATI) issued a report titled ‘Ticking Bombs’ in which the experiences of 9 Palestinian men are documented in detail. In just these 9 cases, there are 22 entries referring to Israeli doctors. The doctors saw the prisoners at various points before, during and after torture, did not take an adequate history, made no protest on their behalf and typically returned them to their interrogators after prescribing simple analgesia. [2] What is appalling is not just that doctors continue to be involved in torture in Israel, but that the IMA- which signed the anti-torture Declaration of Tokyo in 1999- consistently refuses to condemn or investigate the practice. Miles hits the nail on the head when he states that medical societies play a key role in sustaining ‘the policy of impunity’; the silence of the IMA is a prime example. It is worthwhile remembering that in 2007, the President of the World Medical Association (WMA) Dr Jon Snaedal stated that the WMA was urging doctors to document cases of torture when they encountered these- he went on to add that the absence of documenting and denouncing such acts ‘might be considered as a form of tolerance and of non-assistance to the victims’. Shockingly, representatives of the IMA have, on occasion, appeared to condone torture; in 1999, Professor Eran Dolev (then the IMA’s head of ethics) remarked that ‘a couple of broken fingers’ during the interrogation of Palestinians was worthwhile for the information it might provide. [3] The IMA President Dr Yoram Blachar justified the use of ‘moderate physical pressure’ during interrogation in the Lancet. [4] (Blachar was elected to the Presidency of the WMA in 2007.) It is precisely this attitude- coupled with the IMA’s refusal to condemn the wider, persistent violation of the right to health in the occupied Palestinian territories- that has sparked a campaign for a boycott of the IMA by a group of concerned British doctors. [5] Unfortunately, whenever there is any criticism of the IMA is voiced in these columns, it is immediately met with a storm of accusations of ‘anti- Israel bias’ and anti-Semitism. I expect the same if this Rapid Response is published. However, if such criticism was directed instead against the Brazilian or Rwandan medical associations, nobody would make the allegation of ‘anti-Brazilian’ or ‘anti-Rwandan’ bias. As for the question of ‘why Israel’- well, why not? If the Chinese or Sudanese medical associations were being implicated, Western governments would be the first to voice condemnation. What is unique about Israel is that despite its ignominious record of human rights violations and torture, it continues to be feted as a beacon of democracy in the darkness of the Middle East and is funded and armed to the teeth by the West. Miles is right. It is time for sanctions. 1. Amnesty International. “Under constant medical supervision”: torture, ill-treatment and the health professions in Israel and the Occupied Territories. London: Amnesty International, 1996 2. http://www.stoptorture.org.il/files/140[1].pdf 3. Bamber H, Gordon E, Heilbronn R, Forrest D. Attitudes to torture. J R Soc Med 2002; 95:271-2 4. Blachar Y. The truth about medical ethics. Lancet 1997; 350:1247 5. Dyer O. Group of British doctors calls for a boycott of the Israeli Medical Association. BMJ 2007; 334:871 Competing interests: None declared |
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thomas e goffman, Director (MD) Cancer intelligence and research, Virginia beachVirginia 23455, USA
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The high impact, New England Journal of Medicine, among other medical journals has consistently published editorials on the moral pitfalls of physicians becoming involved in interrogation and torture. Steven H Miles did an excellent job in discussing this subject recently in the British Medical Journal (1). In the US, on August 13, 2008 the National Academies (National Academy of Science; National Academy of Engineering; Institute of Science, and the National Research Council) of the United States published “For Immediate Release” a document entitled: “National Security Intelligence Organizations Should Monitor Advances in Cognitive Neuroscience Research.” Included in the announcement was mention of development of drugs or technologies that can alter human physical or cognitive abilities from an earlier monograph that needed updating. Although funding was clearly stated as coming from the Defense Intelligence Agency (DIA), the Academy, of course, serves pro bono as “advisors to the nation on science, engineering and medicine.” The DIA has classically provided intelligence in warfare and in peacetime to the Pentagon. The new volume can be obtained for $66 on the NAS website; it’s a National Academies Press publication. The authors are listed as Committee on Military Methodology for emergent neuropsychological and cognitive/neural research in the next two decades. Of note, the DIA has been given new domestic powers by becoming one of the agencies exempted from the Intelligence Authorization Act of 2005. The first NAS announcement was linked to a new monograph by senior scientists, entitled: Emerging Cognitive Neuroscience and Related Technologies. Does the best of the scientific/medical community have no such qualms about the expansion of means of interrogation? Surely new advances in cognitive neuroscience are not going to be used by the DIA to help its agents stop smoking. In fact examples are given of problems getting information out of those made citizens because of their perilous situation in their home country. The use of drugs and new psychological techniques on citizens seems all the more curious. All this has caught the counterculture media as “mind manipulation,” which, in fact, is not an entirely inappropriate label. References 1.Miles, SH. Doctors’ complicity with torture. BMJ 2008;337:a1088 The author cites no conflicts of interest Thomas E. Goffman, MD, FACP
Competing interests: None declared |
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Christopher J Burns-Cox, Consultant Physician Southend Farm, Wotton-under-Edge GLOS GL12 7PB
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Stephen Miles reminds us of the well known fact that in many countries doctors assist in torture. We should all be grateful to him for raising again this horrific cruelty. "In principle, medical societies support ethics codes like the World Medical Association's Declaration of Tokyo...In practice they sustain the policy of impunity."
In 2001 the BMA stated, regarding Israeli doctors and Palestinian captives: "In 1999 a variety of forms of 'moderate physical pressure' were regularly used, some of which involved the prisoner being forced to spend hours in an uncomfortable position or being force to sway violently back and forth, while handcuffed, for hours on end. Israeli doctors examined detainees prior to interrogation to ensure that they were fit enough to withstand the 'moderate physical pressure' (1) (2). At no time has the Israeli Medical Association apparently acted on its members who assist torture. Has the BMA, aware of the torture, raised the matter with the Israeli Medical Association or the World Medical Association? (1) The Medical Profession and Human Rights2001 publ. Zed Books and BMA. p 64-65 (2)Livneh,N. (1999) 'Why are Israeli doctors forced to be present in Shin Bet torture cells?'Haaretz January 29. Competing interests: None declared |
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Vivienne Nathanson, Director of Professional Activities, BMA BMA, BMA House, Tavistock Square, London WC1H 9JP, Ann Sommerville, Head of Ethics, BMA
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Dr Burns-Cox might have referred to to an important page at the end of the BMA book that he quotes from. This sets out the BMA procedures for human rights interventions (The Medical Profession and Human Rights, page 537) which are the criteria by which the BMA responds to all reputable allegations it receives about medical abuse. The protocol was drawn up in the 1980s, since which time the BMA has been writing even-handedly in response to allegations of doctors' involvement in torture, all over the world. Countless letters have been sent to many governments and medical associations over the past three decades, including to the Israel Medical Association (IMA). Very few responses were received but this is not surprising - the BMA's previous human rights book, Medicine Betrayed, (p59, published 1992) emphasised that when the BMA wrote to every medical association in the world (over 100) asking what it was doing about doctors' involvement in torture, only 8 replied. The BMA works closely with a network of reputable medical human rights organisations called the International Federation for Health and Human Rights (IFHHRO) who also write in response to every allegation of abuses by doctors. Colleagues in IFFHRO include both the Israeli Physicians for Human Rights and their Palestinian counterparts. They provide an admirable lesson about how all of us as doctors can try to work together for our shared aims rather than simply allocating blame. In addition the BMA proposed and got through the WMA changes to its Regulations in Times of Armed Conflict and to the Declaration of Tokyo which made it absolutely unarguable that every doctor ha a personal responsibility to speak out against torture and to resist involvement in it. At the debates in the WMA I raised, with the other BMA representatives, the importance of support for such actions by each and every medical association. The BMA understands, from colleagues at the International Red Cross that the revised policy has been very helpful to their work. Competing interests: VN and AS both have responsibility for the ethics and human rights work of the BMA. VN is a BMA delegate to the World Medical Association, and a member of the executive of the International Rehabilitation Council for Torture Survivors (IRCT) |
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Christopher J Burns-Cox, consultant physician Southend Farm,Wotton--under-Edge, GLOS GL12 7PB
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In their rapid response of February 2 Vivienne Nathanson and Ann Sommerville say the BMA has written to the Israeli Medical Association about members assisting in torture. As a BMA member I request details of the letters sent to the Israeli Medical Association and of the replies received. Did the BMA write to the World Medical Association about Israeli medical association actions and policies on Israeli doctors involvement in torture? If so, what was written and what was the reply? As William Blake said there is no General good but only good in 'minute particulars' - these are completely lacking so far! Has the BMA really done enough? Please publish this official correspondence. Competing interests: None declared |
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Steven H Miles, Professor of Medicine University of Minnesota, 55455
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On February 18, 2009, the Ethics Board of the Israel Medical Association (IMA) agreed to investigate cases of possible physician complicity (by failing to document and report signs and prisoners' complaints of torture). The extent of the investigation is unclear but may involve up to six physicians. This is an important and encouraging step. I have currently compiled a list of about seventy physician (excluding the World War II experience) who have been investigated and sanctioned. I should deeply appreciate it if Dr. Burns-Cox or Dr. Khan could help me find the instances in which the British medical authorities investigated and sanctioned physicians who were complicit in the torture of prisoners from Northern Ireland. Competing interests: None declared |
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