Doctors and the war on terrorism
BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7457.66 (Published 08 July 2004) Cite this as: BMJ 2004;329:66
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Hall states that, “doctors have an important role in detecting,
documenting, and prosecuting torture” and that it is important that
“doctors accused of participation in torture, war crimes, or crimes
against humanity are denied a licence to practise until the allegations
have been dealt with”.
On 12 May 2004, Hugh McManners, an ex British Army Special Forces
officers wrote a feature article in The Independent newspaper. He
reported that British soldiers regularly tortured (stressed) prisoners.
(1) He also stated that stressing was performed "with close medical
supervision".
"British military regulations governing this sort of treatment (stressing)
are very tight, with constant surveillance, mandatory sleep periods, and
each candidate timed and checked constantly; with close medical
supervision to ensure blood circulation is healthy."
I presume that, either British Army doctors or medical staff acting under
their direction provided this supervision and provided input into the
writing of these regulations
After reading McManners article, I reported my suspicions to the GMC.
I have received an E-mail informing me:
The Caseworker has requested guidance from our Standards Team, once
he receives this guidance he will respond to your enquiry. SMcdonald@gmc-
uk.org
However, the investigating officer also informs me that, in general, the
GMC only undertake an investigation if a doctor is identified by name. It
seems unlikely therefore that the GMC is well equipped to root out
torturing doctors since it is unlikely that victims or lay investigators
will know their names.
As far as I know Scotland Yard has not investigated McManners’s claim
although, as Hall states under section 134 of the Criminal Justice Act
1988, they are empowered to do so. Is this because they are unaware of
it? If so, should I report my suspicions to them? Moreover, more to the
point, to whom in the Police Force do I report my suspicions?
305words
1.
http://argument.independent.co.uk/low_res/story.jsp?story=520315&host=6&...
CC:
SMcdonald@gmc-uk.org Investigating Officer, GMC
features@independent.co.uk Features editor, The Independent newspaper
Competing interests:
None declared
Competing interests: No competing interests
Sufferers of reactive arthritis would benefit from not having doctors
call their disorder after the Nazi doctor named Hans Reiter[1]. I notice
many doctors avoid the Reiter word in letters, but use it on request slips
- having the cake and eating it too. And that war’s been over for nearly
60 years.
[1]Wallace DJ, Weisman MH. The physician Hans Reiter as prisoner of
war in Nuremberg: a contextual review
of his interrogations (1945-1947).Semin Arthritis Rheum. 2003
Feb;32(4):208-30.
Competing interests:
None declared
Competing interests: No competing interests
Subject: Doctors and the war on terrorism
From: Dr Elisabeth McElderry
Chair
Dr Elizabeth Waterston
International Councillor
Dr Douglas Holdstock (author for correspondence)
Editor, Medicine, Conflict & Survival
Medact
The Grayston Centre
28 Charles Square
London N1 6HT
Email: info@medact.org
We strongly support the recent editorial (1) condemning the use of
torture in the interrogation of detainees, even those suspected of covert
or other terrorist activities, and of any complicity by health
professionals in such activity. Similar views have been expressed by
Robert Jay Lifton (2). He fears, for instance, that fatal abuse may have
been concealed by attributing death to conditions such as heart disease.
Both call for openness in reporting possible misconduct.
As Hall notes, existing international ethical codes prohibit medical
involvement in torture, while acknowledging the role of doctors in
documenting and prosecuting it; recognition of possible risk factors is
important, ignorance no excuse. We endorse his call for appropriate
education of all doctors, but particularly those in the military, the
prison service, and concerned with asylum seekers. We accordingly propose
that a postgraduate education course in this field should be instituted,
perhaps by the Faculty of Public Health, and should be a requirement of
the training of doctors working in these specialities.
1. Hall P. Doctors and the War on Terrorism. BMJ 2004; 329:66 (10
July 2004)
2. Lifton RJ. Doctors and Torture. New Engl J Med 2004; 351:415-416
Competing interests: None declared
Competing interests:
None declared
Competing interests: No competing interests
A recent conference in Ireland examined the role of nurses and
midwives in the Third Reich. Particular emphasis was placed on nurses who
entered the profession to care for people and ended by actively killing
them, justifying
their actions by saying "I did it gently - if I hadn't done it, someone
who was rough may have killed them and the patients would have suffered
even more". Many doctors were tried for war crimes during the Nazi era,
and their
justifications were sometimes more along the lines of "benefits to
science" or "I was only following orders from a higher authority".
Doctors (and there must be nurses) involved in torture and
incarceration in Iraq, and at Guantanamo Bay, in time to come, will try to
justify their actions, maybe using similar arguments. By remembering the
lessons from
history, we may understand, and be better able to judge when that time
comes.
Competing interests:
None declared
Competing interests: No competing interests
One who calls upon religion to impose politics surely will invoke
cruelty in the compassionate.
"One who calls upon religion to impose politics surely will invoke
cruelty in the compassionate." (British Medical Journal, Rapid Responses
7:13)
Delightful! But, I don't see innocence in it.
Things change. There is no such thing as an "innocent person"; there
are only persons who so far have not behaved in a guilty way. A medical
doctor can be guilty of torture, for example Josef Mengele; but, that
person then no longer should call upon God to witness innocence.
Competing interests:
None declared
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"He who pities the cruel may eventually impose cruelty upon the
compassionate" (A Talmudic saying)
Having read the editorial by Dr. Hall I somehow wonder if I've missed
the point regarding protecting the human rights of potential victims of
terror. Far from supporting torture of any kind, I also wonder what would
the author consider as a legitimate approaches towards people suspected as
being associated with terrorism (e.g. such as those presenting themselves
in a video, a few weeks ago, decapitating a kidnapped American citizen in
Iraq). I somehow doubt that a relaxed discussion over a cup of tea would
persuade such "gentlemen" to provide security agencies the information
required to protect the rights of the rest of us, the innocent majority of
mankind.
Competing interests:
None declared
Competing interests: No competing interests
Peter Hall draws attention to the important role medical staff have
in reporting torture and declining to participate in it.
In a survey surveying Human Rights Abuses in Southern Iraq between
1991 and 2003, 47% of people reported one or more of the following abuses
among themselves and household members since 1991: torture, killings,
disappearance, forced conscription, beating, gunshot wounds, kidnappings,
being held hostage, and ear amputation.(1)
The BBC reports on the case of Noful Daoud, a man who had both of his
ears cut off in 1994 by a surgeon in Basra Hospital. His ears were removed
on the day Saddam's order was given:
"I was taken to Basra Hospital and blindfolded," he said. "They cut
off my left ear by mistake and so they chopped off the right one as well.
Without my ears, I haven't been able to get a job or get married."(2)
The Iraqi government is currently engaged in a process of offering
plastic surgery to these victims.
Physician participation in human rights abuses was extensive in
Iraq.(3) Seventy-one percent of questioned physicians reported torture
was a problem to an extreme extent in Iraq since 1988. They reported
their peers involvement as a group as "extremely or quite a bit involved
in human rights abuses", as much as 50% for nontherapeutic amputation of
ears as a form of punishment, 49% for falsification of medical-legal
reports of torture, and for falsification of death certificates. The
physical threats to physicians, and their families, from the Iraqi
Fedayeen Saddam were put forward as the main reason for complicity in
these abuses.
Increasing human rights and ethics education of physicians, legal
provisions to ensure effective monitoring, sanctions for physicians who
commit abuses and ensuring the independence of physicians from state
authorities were all put foward by Iraqi doctors as potential future
solutions to such occurances. One can only hope that the improved
conditions in Iraq can allow such changes to be made.
In the short-term, given the urgent need for medical staff in Iraq,
those doctors in Iraq who were complicit in torture will continue to work.
In the long-term, Peter Hall's call for doctors to be prosecuted for
particpation in torture "regardless of the nationality of the victim or
where the violation took place" is perhaps a debate best held by Iraqi
civil society. Given the nature of the extremely repressive and brutal
regime that dominated Iraq prior to liberation, it may be that they will
take a road to reconciliation and forgiveness - rather than an extensive
debridement of their health system of physicians forced to participate in
human rights abuses.
Regards
Anthony Cox
1. Amowitz LL, Kim G, Reis C, Asher JL, Iacopino V. Human Rights
Abuses and Concerns About Women's Health and Human Rights in Southern
Iraq. JAMA 2004:291:1471-1479
2. New hope for mutilated Iraqis. BBC online. New hope for mutilated
Iraqis. http://news.bbc.co.uk/1/hi/world/middle_east/3795785.stm(accessed
on 12th of July 2004).
3. Reis C, Ahmed AT, Amowitz LL. Kushner AL, Elahi M, Iacopino V.
Physician Participation in Human Rights Abuses in Southern Iraq. JAMA
2004;291:1480-1486
Competing interests:
None declared
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Concerning the imprisonments at Guantanamo, the U. N. Convention
against torture might be applied there; it surely would apply in Iraq.
The other issue is interrogation. At Guantanamo, military
authorities and others have confirmed in press announcements or interviews
that they have been interrogating the prisoners at Guantanamo.
However, U. S. Federal law, Title 10, Chapter 47, explicitly is
enforced in all places or circumstances under U. S. military control, in
war or in peace: This Chapter is the Uniform Code of Military Justice.
Article 31 forbids any person from interrogating anyone who is under
military control and is not charged with an offense. An "offense" need
not be a crime but may be a violation of military regulations. The
reason is not to protect rights but to ensure valid interrogations.
Article 36 states that neither the President nor any of his workers may
establish any rule or regulation conflicting with, or inconsistent with,
Chapter 47.
The only exception allowed in the law is found in Article 2(12) by
implication: Interrogation without charge is allowed of persons
explicitly designated prisoners of war, because this Article recognizes
application of the Geneva Convention regarding prisoners of war, and that
Convention permits such interrogation.
Given the chain of command, the admitted interrogations at Guantanamo
must have involved more than one person per incident, making these
interrogations conspiratorial.
Therefore, one must conclude that felonies against U. S. Federal law
have been committed by (a) certain individuals present at Guantanamo
during interrogation, as well as (b) those authorizing such
interrogations.
Many members of the current administration should be considered hoist
by their own jingoism, because they are apparently in serious violation of
the law of the nation they insist is so close to God that it should ignore
the sinful and ignorant treaties, and other errors, of the UN.
A copy of the law under discussion may be downloaded at:
http://www.jag.navy.mil/documents/UCMJ.pdf or searched at
http://uscode.house.gov/usc.htm .
Competing interests:
None declared
Competing interests: No competing interests
Is it a question of ethics?
"and above all, do no harm" [to your patient]
Whatever happened to the sacred oath that we as physicians supposedly
pledged on graduation?
Torture, whether verbal or physical, whether in war or peace has no place
in medicine FULLSTOP!
As an ex-military doctor I had to deal with this same "devil" - it was
either "country or my ethics". Country came second best I'm proud to say -
I resigned the service in protest, disgusted with what I was seeing.
Dr Momia Teariki-Tautea
Competing interests:
Nil
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