A leaked report by the International Committee of the Red Cross (ICRC) has concluded that medical personnel were involved in interrogation and torture performed overseas by the CIA according to reports in the New York Times. The practices reported by the ICRC have been known about for some time. The way that this has been reported in the media seems to imply that there is something especially bad about the involvement of medics in torture, that this makes it even worse. But why should this be?
The report concludes that the involvement of health professionals in torture was a ‘gross breach of medical ethics’. But one limit to this claim is that it isn’t clear whether the individuals who were responsible for monitoring the health of prisoners being interrogated were actually doctors. They may have been physician assistants or medically trained military personnel. If the concern with health professionals being involved in torture is that this breaches the rules that are supposed to govern their behaviour it might make all the difference what the professional qualifications of the torture assistants were. But would it really make it better if the assistants were soldiers or CIA officers who had received some medical training? What if they were scientists or vets?
In one way we might think that torture involving doctors would be better than torture without medical supervision. The reason that doctors have been recruited to assist with torture is in order to prevent prisoners dying during interrogation, or becoming seriously injured or unwell. If prisoners are subsequently glad to be alive, and not to have suffered major physical injury or illness it may be better that their torture was limited in some way by the presence of medical personnel.
Sometimes we hold doctors to higher standards than the rest of the community. We may, for example, feel particularly aggrieved if a doctor gossips about our health to another patient, but not be concerned (or as concerned) if this is done by our hairdresser. But the moral requirement not to torture or to assist in torture is not of this nature. It is something that should have equal force on a doctor or a CIA officer, a hairdresser or a vet.
None of this is to condone the practices revealed in the ICRC report. But the reason that it is wrong for doctors or other health professionals to assist in torture is because it is torture – not because they are doctors.
But there is another possible use of medical supervision in torture.
It could be used to allow much more severe torture, while keeping the probability of death or permanent injury the same.
Perhaps the point is that doctors may do something not so benign as making torture “better” – they may make it worse. Assume that the torturers intend not to kill or seriously injure their prisoners. In the absence of doctors then, they might tend to err on the side of caution, engaging in less dangerous and maybe less painful forms of torture. Having doctors on hand may enable them to go much further, say by giving them the ability to safely inject drugs that cause excruciating pain. This is where medical ethics comes in: just as a doctor has a special duty of confidentiality because we need to be able to entrust her with very private information, it’s not unreasonable to think that a doctor has a special duty to use her training for good because her medical teachers (and the society that funds her education) needs to be able to entrust her with powerful tools that can be used for good or for ill.
[Apologies for the delay in publishing these comments.]
Ralph, Simon,
thanks for your comments
you both suggest that medical involvement in torture may lead to worse torture (ie more dangerous, and more painful). That is certainly a possibility, and would indeed give us (even) more reason to condemn the practices that the ICRC reports.
But the reason that it would be worse is because the pain and risk to the prisoner is greater. It would be just as bad if the presence of a medical scientist led to more severe torture.
The presence of a doctor in an interrogation would not *necessarily* lead to more severe torture. The severity of the harm inflicted on the prisoner could be unchanged, or could (as I suggested above) be less.
How likely is it that medical presence in CIA interrogation would lead to greater or lesser harm to prisoners? That is an empirical question for which there is no data that I am aware of.
Simon – you also point to the special duty of doctors to use their skills for good rather than evil purposes. But, as I argued above, the moral duty to refrain from torture is not a special one that applies to doctors – it should apply to all of us, regardless of the letters after our name, or whether we have pledged the hippocratic oath.
Thanks Dominic, I think there are at least two different duties being confused here:
1) The moral duty to refrain from torture.
2) The moral duty of a medical professional to refrain from using her training for harmful ends such as torture.
My comment said that the breach of (2) in this case was the relevant breach of medical ethics at issue. In your reply, you say that (1) is not a duty that applies only to doctors. That is beside the point.
You might have observed instead that duty (2) is parasitic on duty (1) in this example; there would be nothing wrong with a doctor assisting in torture, you might think, if torture weren’t something that it’s already bad for everyone to engage in. Perhaps this thought explains why you didn’t distinguish the two duties at issue. But it cannot of course show that there is no special duty (2) that is violated by medical professionals in a case like this. Doctors are in a special position of power and trust, by misusing that power they violate the trust, and that is itself a wrong. This sort of wrong is similar to the special wrongs involved in judges engaging in corruption, or policemen engaging in beatings.
Simon,
good comments.
So one reason why it might be worse for a doctor to assist in torture rather than a non-doctor is that this involves the breach of two duties instead of just one. I am not sure though whether the wrongness of an act is straightforwardly related to the number of duties that are forsaken. That will depend on which moral theory you apply.
There are some reasons that may be lurking behind the intuition that it is worse if a doctor engages in torture than a soldier (say).
Firstly, our judgement of the agent may have shifted more if our expectations are higher to start with. So if we expect an agent to be particularly righteous, and then they do something horrible, they will fall further in our esteem than if we had low expectations of them to start with. But that is not to say that our final judgement of them, or of their action is any different. Perhaps we expect more of judges than we do of investment bankers?
Second, it is possible that the torture will be perceived as worse by the victim if the person doing the torture is someone that they trust. The betrayal of trust might add to the psychological damage inflicted. This is one reason why we might think it worse if a child is abused by a close family member than by a stranger.
Third, we may feel that the involvement of doctors in torture – if it becomes widely known, may threaten community trust in doctors more generally. If this were to occur it may undermine an important social institution. Perhaps this is part of the reason why it is particularly wrong for policemen to engage in beatings.
One of the reasons why I suggested that it made no significant difference whether or not the CIA interrogations were assisted by doctors or by medically trained non-doctors is that the practices seem paradigm examples of extremely wrongful behaviour. Maybe they can’t be *more* wrongful by virtue of the identity/qualifications of the person doing the torturing (or assisting it).
But here is another question.
What if the interrogation techniques were justified?
Imagine that under the new US administration a terrorist is interrogated using techniques that are unpleasant or invasive, but are not torture. Would it be worse for that interrogation to be assisted by a doctor?
cheers
Dom
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