Miles at BMJ on Sanctions for Doctors Who Torture

A new editorial by Steven Miles in the British Medical Journal, Doctors’ complicity with torture: It is time for sanctions (BMJ 2008;337:a1088), describes the serious shortcomings inherent in a society where ethical prohibitions against harm are not backed up by the instrumentation of accountability.

As Dr. Miles laid out in his excellent book, Oath Betrayed: Torture, Medical Complicity and the War on Terror, participation by physicians in the torture of detainees by the military and intelligence agencies is both rampant and uncontrolled by outside ethics or governmental watchdog agencies. While the American Medical Association formally forbids its members participate in such activities, a letter published by The Lancet last year, signed by 260 doctors, pummelled the AMA for not taking the issue of doctor complicity in torture seriously, accusing the U.S. medical establishment for turning

...a blind eye to the abuse of military medicine at the Guantanamo Bay prison in Cuba, doctors from around the world said in a letter published Friday in a prestigious British medical journal.

Health care workers in the U.S. military seem to have put their loyalty to the state above their duty to care for patients -- and American regulatory bodies have done nothing to remedy the situation....

In his new editorial at BMJ, Dr. Miles writes:

The medical profession ought to dissociate itself from torture—a practice that destroys institutions of civil society; that is used against colleagues of conscience, and that has far reaching adverse mental, physical, and social consequences. Instead, medical societies and licensing boards offer lofty condemnation, which is most ardently aimed at offenders abroad rather than accomplices at home.

Doctors who abet torture rarely face professional risks. Governments will not punish a doctor for helping them carry out their crimes. Few medical societies or licensing boards have the courage and constancy of vision to investigate or censure colleagues who carry out the law of the land.

Rather than look to the Nuremberg Trials as an instance of how to hold medical professionals responsible for illegal acts -- being the juridical proceedings of a conquering nation over its vanquished opponent -- Miles cites the attempts by governments in Greece, Chile, and Argentina to sanction and imprison doctors or medical personnel in their own countries that have been implicated in torture or other crimes carried out in the process of engaging in their medical role.

Dr. Miles continues:

A more secure foundation for this kind of accountability can and should be laid. The World Medical Association’s Declaration of Hamburg states that licensing boards should deny licences to doctors who are guilty of war crimes, including torture... Unfortunately, that declaration only applies to immigrating doctors who are accused of crimes in another country....

Countries wax and wane in their practice of torture. Foundations for making doctors accountable for this crime must be laid during periods of civil society. At such times, each national medical society and licensing agency should assert that medical complicity with torture and cruel inhuman or degrading treatment is a punishable breach of medical ethics that cannot be excused by law and for which there is no term limit....

A civilian medical community that acquiesces to torture by its military members cannot credibly protest against foreign doctors who carry out torture. Such a community can hardly support doctors who are endangered for their resistance against torture. The prestige and values of medicine make it a crucial part of the campaign to abolish torture....

The medical accomplices of torture must not rest in the confidence that they can violate civil society and the ethics of medicine with impunity.