Intended for healthcare professionals


Clinical care and complicity with torture

BMJ 2018; 360 doi: (Published 02 February 2018) Cite this as: BMJ 2018;360:k449
  1. Zackary Berger, associate professor1 2,
  2. Leonard S Rubenstein, senior scientist2 32 3,
  3. Matthew DeCamp, assistant professor1 21 2
  1. 1Johns Hopkins School of Medicine, Division of General Internal Medicine, Baltimore, MA, USA
  2. 2Johns Hopkins Berman Institute of Bioethics
  3. 3Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health
  4. Correspondence to: Z Berger

In the light of US Central Intelligence Agency guidelines that limited routine care of detainees to promote torture, Zackary Berger and colleagues call for sanctions against health professionals who cooperate

The UN Convention against Torture defines torture as “any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person” by someone acting in an official capacity for purposes such as obtaining a confession or punishing or intimidating that person.1 It is unethical for healthcare professionals to participate in torture, including any use of medical knowledge or skill to facilitate torture or allow it to continue, or to be present during torture.234567 Yet medical participation in torture has taken place throughout the world and was a prominent feature of the US interrogation practice in military and Central Intelligence Agency (CIA) detention facilities in the years after the attacks of 11 September 2001.891011 Little attention has been paid, however, to how a regime of torture affects the ability of health professionals to meet their obligations regarding routine clinical care for detainees.

The 2016 release of previously classified portions of guidelines from the CIA regarding medical practice in its secret detention facilities sheds light on that question. These show that the CIA instructed healthcare professions to subordinate their fundamental ethical obligations regarding professional standards of care to further the objectives of the torturers.12

This document adds yet another disturbing element to our understanding of medical complicity in torture, suggesting a need to strengthen international and domestic ethical declarations to promote accountability for such complicity.13 As an executive order by the US President outlines continued transfer of prisoners to Guantanamo Bay,14 and the President has not ruled out the use of torture, a …

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