Past And Present

Medicine and the Gulag

BMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6970.1726 (Published 24 December 1994) Cite this as: BMJ 1994;309:1726
  1. Igor Kosserev, professor of pedagogic and medical psychology Russian Academy of Natural Sciences, Moscowa,
  2. Ralph Crawshaw, n, foreign membera
  1. aMoscow Medical Academy of IM Sechenov, Moscow, Russia
  1. Correspondence to: Dr R Crawshaw, Department of Psychiatry, Oregon Health Sciences University, Portland, OR 97201, USA.

    The nature of the medical treatment of prisoners in the Gulag has emerged from accounts published by survivors. Over a period of 70 years some doctors entrusted with the medical care of prisoners failed to discharge their ethical duties, contributing to the prisoners' neglect and suffering. The medical profession must carefully examine what occurred and properly assign responsibility for ethical as well as unethical medical acts. Understanding the history of these ominous events will alert doctors worldwide to the importance of medical autonomy in the support of imprisoned patients.

    After the 1917 October Revolution millions of Russians were unlawfully imprisoned in their country, tortured and often incarcerated in the Gulag for long periods.1 Their medical care devolved on prison doctors, some of whom under political tyranny failed to discharge their traditional role as protectors and advocates of patients.2 This paper examines the ethical and unethical behaviour of prison physicians largely on the basis of surviving personal accounts, and it calls for a fully documented study to alert medical practitioners everywhere who may be under political or institutional duress to remain vigilant to their power to harm.

    The Gulag

    The Gulag did not spring unbidden from virgin soil. Russia has a long history of an oppressive penal system; it goes back to 1724 with the reforms of Peter the Great, who fostered a policy that “the police are the soul of the people.”3 Subsequent tsars elaborated on the concept of a police state by using the vast area of Siberia as a prison without bars. Ostensibly, medical services in the Russian prisons and labour camps of the times were on a par with what the general population could expect, without any systematic use of doctors as agents of government discipline.4 If V I Lenin's experience of three years' detention …

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