Helping to stop doctors becoming complicit in torture
BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c973 (Published 26 February 2010) Cite this as: BMJ 2010;340:c973
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
I very much doubt that the new resolution of the UN Human Rights
Council will have any effect. States, military, police and prison
services that currently allow medical asistance with torture will continue
to do so.
We do not know exactly what actions our own British Medical Association
has taken over collusion with well publicised torture by members of other
national medical associations.
The World Medical Association has a very grand title but what evidence is
there of its activity against doctors assisting in torture? It appears to
be toothless and gutless.
The new UN resolution is a move in the right direction but whilst national
medical associations and the WMA turn a blind eye to medical involvement
in torture the illegal activity, humiliation of the medical profession and
suffering of the abused will continue.
Competing interests:
None declared
Competing interests: No competing interests
While clarifying ethical responsibilities relating to the abuse and
torture of prisoners is undeniably a positive development (1), most
doctors will have no exposure to such situations during their working
lives. It might be helpful to consider also the moral agency of doctors
and other health workers who witness, or are complicit in, forms of abuse
which fall short of torture (2). Defining a broader spectrum of complicity
would allow doctors to develop an ethical sensibility that this is a wider
professional problem, and not just restricted to extreme cases.
Of particular relevance is the role of doctors, nurses and therapists
who witness institutional abuse of older people in healthcare settings,
such as nursing homes and hospitals. Institutional abuse can be
characterized by poor care standards, lack of a positive response to
complex needs, rigid routines, inadequate staffing and an insufficient
knowledge base within the service (3).
Throughout the developed world there have been numerous scandals
relating to nursing homes (4), and it is a striking feature how many
doctors and nurses have been tolerant of endemic poor care up to the point
of the scandal breaking. Joint working is required between gerontologists,
ethicists, family doctors (who provide much of the care in nursing homes
in the developed world) and nurses to break the cycle of complicity in
such abuse, and develop a more effective sense of moral agency and
appropriate action in such situations.
1) Polatin PB, Modvig J, Rytter T. Helping to stop doctors becoming
complicit in torture. BMJ 2010;340:c973
2) O'Neill D, Collins R, Medical ethics and prisoners, Lancet, 373,
(9667), 2009, p896
3) Working Group on Elder Abuse. Protecting Our Future. Stationery Ofice,
Dublin, 2002.
4) Lindbloom EJ, Brandt J, Hough LD, Meadows SE. Elder mistreatment in the
nursing home: a systematic review. J Am Med Dir Assoc. 2007 Nov;8(9):610-6.
Competing interests:
None declared
Competing interests: No competing interests
A helping hand...?
This article succinctly covers what is undoubtedly an important issue
for many healthcare professionals across the world, but fortunately a more
remote issue for most practising professionals.
However, your caption for the accompanying picture reads "a prisoner
is 'helped' to his cell...at Guantanamo Bay". I obviously object to the
verb 'helped' which is hardly the most accurate verb that could be used to
describe 2 burly soldiers half-lifting half-dragging a blinded handcuffed
and bound barefooted detainee across the courtyard with a further 7
soldiers standing at an arms length. The wording in the caption suggests
a 'complicitness' by your publication.
Competing interests:
None declared
Competing interests: No competing interests