Abstract
The letter from Sudan is apposite. It describes a current tragedy, that, like many others, is going on ‘under the radar’. Certain brave elements have tried to expose brutality by government forces, but the sad truth is that once a state institutionalises violence, it rarely relinquishes this trait, unless the slate can be totally wiped clean, as happened with the Nazis in Germany.
The medical profession must also acknowledge its acquiescence in such brutality. The use of torture has long been condemned, both as a means of injuring political opponents the state and of extracting information. Though torture is nothing new, as visits to medieval castles’ dungeons or ‘oubliettes’ readily demonstrate, it has become a quasi-science.
Nazi doctors abused their profession by carrying out experiments on prisoners, and their publications were roundly condemned (even if scientifically verifiable), but shockingly the report on CIA involvement in torture in Iraq and Afghanistan provides clear evidence of medical involvement in torture techniques. 1
In fact, two doctors, James Mitchell and Bruce Jessen, were paid the colossal sum of US$81m for their ‘expertise’ in advice concerning the use of torture methodology, for which, it has been rightly said, they deserve to be tried for crimes against humanity, just like the genocidists in Rwanda.
But, alas, the USA involvement in torture is nothing new. 2 Another doctor, one AE Rollins, invented the so-called ‘Tucker telephone’ in the 1960s. This was an electrical device that, wired to toes and genitals, delivered electric shocks at varied frequency and intensity to restrained prisoners. In the shockingly crude, gloating parlance of the perpetrators, prolonged application of the device, which often resulted in multi-organ failure or insanity, was termed ‘a long-distance call’, as the device had to be cranked continuously. It was frequently used on Viet Cong prisoners. 3
Reports of US doctors involved in torture appeared in 2004, and Lifton, who published a work on atrocities committed by Nazi doctors, 4 sought to understand how this happens. 5 Recent revelations have directly implicated the US Secretary for Defence, Donald Rumsfeld, in instructing doctors to monitor interrogation techniques and to use medical information to expose the vulnerability of prisoners’ emotional and physical states. 6
Sullivan concludes, ‘After a while, you get numb reading these stories. They read like accounts of a South American dictatorship, not an American presidency. But we learn one thing: once you allow the torture of prisoners for any reason, as this President did, the cancer spreads. In the end it spreads to healers as well, and turns them into accomplices to harm.’
Though this betrays an unjustified sense of superiority, the point is decidedly correct. Although originally used in the Spanish Inquisition, ‘waterboarding’ was popularized by US authorities, who went to lengths to justify its use by maintaining it did not quite amount to torture. In a land of psycho-analysts, the use of euphemisms is the name of the game; thus, torture is just ‘enhanced interrogation’. 7
Miles goes on to recount how an Iranian doctor, Ramin Pourandarjani, died in custody after exposing torture in his own country. He received no international support for his stance. While many doctors in countries where repressive regimes once held sway were finally brought to trial, this has not happened in the USA, where, significantly, a ‘War on Terror’ initiated by President Bush used terror to pursue his goals.
Amnesty International, as ever at the forefront of exposing abuse, has published a commendable treatise, describing how doctors get involved in torture through five stages: bureaucratic necessity; persuasion; pressure and threats; workplace involvement; and a general lack of consideration of medical ethics. 8 Doctors may not be directly involved in the torture process, but may be behind the scenes (as were Mitchell and Jessen), or implicated in ignoring clinical evidence, withholding appropriate treatment or in the falsification of reports. The role of medical associations in this respect is, clearly, to maintain honesty in medical practice, and to be ready to be whistle-blowers.
I can do no better than quote Jesper’s conclusion: ‘When the unambiguous role of the doctor as the protector and helper of people is questioned, it affects the medical profession all over the world.’ 9