Argentina: torture, silence, and medical teaching

 bmj.com Justo 326 (7403): 1405

 
More than 30 years ago I asked my surgical instructor about petechial lesions on the scrotums of
some criminals interned in the surgical ward. The shocking answer was, "Oh, yes, the police make
them all go through 'the machine' before taking them to the hospital." The machine, the "picana
eléctrica," was a device for torturing prisoners with electric shocks, usually in the vagina, testicles,
mouth, anus, or nipples. I was horrified by the fact itself but no less by the matter of fact tone in
which the answer was given. As a medical student I was pretty powerless, but I went to the head of
the surgical service and tried to lodge a formal complaint. I was rebuffed without any chance to make
my argument heard.
Since 1983 we have been living under a "democratic" government, but torture is still rampant in
Argentina. Sergio Gustavo Durán was arrested by the police in 1992. He was 17 years old. The arrest
was routine—he wasn't involved in any criminal activity. The next day he was found dead. Puncture
wounds reported in the autopsy by the police doctor were explained as "scratching lesions." A
subsequent non-official autopsy described intraalveolar haemorrhages typical of the "dry
submarine," a torture in which a plastic bag is put over the head until the victim nearly suffocates.
The authors of this crime were not detained until four years later, when some of them, though
fugitives, were still getting their monthly pay from the police. The police doctor is being prosecuted,
but the verdict has not yet been issued. Every year several episodes of this kind are denounced by
human rights organisations, each time starting the usual chain of denial and cover up from official
institutions, often with the collusion of doctors.
We should make human rights central to our teaching
But what I wish to comment on is the continuing passivity of medical teaching organisations—
difficult to understand in a democracy. Sergio Pesutic, a Chilean psychiatrist, has described the
phenomenon of torture and the role of Chilean health professionals, ranging from active complicity
to denial of its existence and sometimes to resistance. He concluded that several primary prevention
measures should be taken to avoid torture, including the incorporation of human rights teaching into
formal and non-formal medical curriculums, the application of codes of medical ethics, and research
into the long term effects of torture. It's high time to heed Dr Pesutic's suggestions.
Although most Argentinian doctors react with horror to the idea of torture, the medical establishment
has not come to the same categorical rejection. Human rights is not yet a standard subject in medical
schools, even in bioethics courses. The national academies remained silent on the issue after the end
of the military dictatorship in 1983. In 2001 most of the members of the National Commission of
Biomedical Ethics resigned in protest at the appointment of Alberto Rodríguez Varela, a former
justice minister in the military dictatorship. Ironically but alarmingly, Dr Rodríguez Varela was
proposed by the National Academy of Moral and Political Sciences.
Dr Pesutic described torture as the "criminal expression of a perversion of society's values." The
criminal and unethical behaviour of doctors involved in or colluding in torture reflects a society's
moral decline. The US bioethicist Edmund Pellegrino wrote: "Protection of the integrity of medical
ethics is important for all of society. If medicine becomes, as Nazi medicine did, the handmaiden of
economics, politics, or any force other than one that promotes the good of the patient, it loses its soul
and becomes an instrument that justifies oppression and the violation of human rights." I agree with
other writers that the social and economic status of doctors places them closer to the well off and
influential than to the poorer sectors of society and that, historically, torture has targeted poor people
and their advocates. Almost all current victims of police brutality and torture practices in Argentina
are poor and so are relatively defenceless. Argentinian doctors, although not usually rich, have high
social prestige—perhaps this accounts for their silence.
Until a serious effort is made to reconstruct a values system that is based on people's intrinsic
dignity, torture will persist —as it did in my student years, long before the military took power. This
reconstruction must involve access to education and health for all and the eradication of misery. As
doctors we should make human rights central to our teaching, and students must learn that to be
complicit with torture is despicable.
However, military dictatorships are not responsible for all our evils. Shared social values in
Argentina have deteriorated so much that there is little chance of putting an end to these crimes
against humanity without a serious commitment to change by all social groups. Perhaps this is a
warning to other countries in these uncertain days, when the deaths of human beings are termed
"collateral damage"—an expression of scorn for human dignity.
Luis Justo, chair in bioethics
Comahue National University, Argentina 



 

Doctors, interrogation, and torture

British Medical Journal 2006; 332: 1462-1463

Medical associations’ statements on human rights are welcome, but we all need to do more to prevent abuses

Luis Justo

Universidad Nacional del Comahue, professor in charge, bioethics ()

 

 It is our duty as doctors to reject any attempt to bend our ethical aim to do no harm and to alleviate suffering. We should also actively resist any attempt, however powerful, to corrupt the idea of human dignity.

Prompted by concerns about detainees’ human rights in US military prisons, several medical associations have spoken out in the past month about the role of doctors in interrogation. These statements should bring medical debate on human rights to the forefront—along with news of the deaths of three prisoners in the US base at Guantanamo Bay[1] and the recent statement by the Council of Europe Secretary General that “Legislative and administrative measures effectively to protect individuals against violations of human rights committed by agents of foreign security services operating on the territory of member States appear to be the exception rather than the rule.”[2]

One of the main reasons for reopening the discussion about the duties of health workers in the “war on terror” and its ethical implications are the so called biscuit teams (behavioral science consultation teams (BSCT)). These teams operate in US military prisons and comprise psychologists, psychiatrists, and other health workers. Last year’s report by Vice Admiral Albert Church III, director of navy staff for the US Department of Defense, on the development, promulgation, and dissemination of interrogation techniques in Guantanamo Bay, Afghanistan, and Iraq stated that biscuit teams assisted in interrogations: “[I]t is a growing trend in the Global War on Terror for behavioral science personnel to work with and support interrogators. These personnel observe interrogations, assess detainee behavior and motivations, review interrogation techniques, and offer advice to interrogators. This advice can be effective in helping interrogators collect intelligence from detainees; however, it must be done within proper limits. We found that behavioral science personnel were not involved in detainee medical care (thus avoiding any inherent conflict between caring for detainees and crafting interrogation strategies) nor were they permitted access to detainee medical records…. However, since neither the Geneva Convention[s] nor US military medical doctrine specifically addresses the issue of behavioral science personnel assisting interrogators in developing interrogation strategies, this practice has evolved in an ad hoc manner.”[3]  

Biscuit teams’ advice to interrogators should be questioned, given that “the following interrogation techniques were considered by the [US Department of Defense] to be humane and permitted by its interpretation of law: isolation for more than 5 months, sleep deprivation lasting 48 to 54 days during which interrogation took place 18 to 20 hours per day, degradation, sexual humiliation, military dogs to instill fear, and exposure to extremes of heat and cold and loud noise for long periods—and combinations of these techniques.”[3] [4] Regulations about what is considered “humane” for the Department of Defense may change over time, but it is clear that its criterion for “humanity” has dire ethical flaws.

Fortunately many medical associations are reacting to this grim prospect. Last month, the World Medical Association revised its Tokyo declaration on torture by making clear that “The physician shall not countenance, condone or participate in the practice of torture or other forms of cruel, inhuman or degrading procedures, whatever the offense of which the victim of such procedures is suspected, accused or guilty, and whatever the victim’s beliefs or motives, and in all situations, including armed conflict and civil strife.”[4] [5] The basic premise in the association’s statement is pristine: “The physician’s fundamental role is to alleviate the distress of his or her fellow human beings, and no motive, whether personal, collective or political, shall prevail against this higher purpose.” No degree of imperial political convenience must be allowed to tamper with this simple but precise definition, and every democratic citizen in the world—not only those who are doctors—should reject any legalistic attempt to justify torture.

The American Medical Association made a long awaited policy statement this month that “Physicians must not conduct, directly participate in, or monitor an interrogation with an intent to intervene, because this undermines the physician’s role as healer.”[6] The American Psychiatric Association, too, has just reiterated its position that psychiatrists should not participate in, or otherwise assist or facilitate, the commission of torture of any person and that no psychiatrist should participate directly in the interrogation of person held in custody by military or civilian investigative or law enforcement authorities, whether in the United States or elsewhere. Direct participation includes being present in the interrogation room, asking or suggesting questions, or advising authorities on the use of specific techniques of interrogation with particular detainees.[7] The American Psychiatric Association also says that “psychiatrists who become aware that torture has occurred, is occurring, or has been planned must report it promptly to a person or persons in a position to take corrective action.”

Intellectuals and academics must also take a stand. They need to discuss and debate the “philosophy of torture” (if such an oxymoron exists) and to show its inherent incompatibility with the idea, albeit imperfect, of democracy. The use of euphemisms such as “harsh interrogatory” to describe torture should also be academically discredited, since it contributes to public mystification.[8]

There is also an urgent need to make clear to all health workers that participation in torture or abuse of prisoners is against the ethical core of healthcare professions. National and international medical codes and covenants on participation in torture or abuse of prisoners are a good starting point, but they are not enough. Health students should be educated explicitly on active engagement with human rights, going beyond considering health to be a human right and ensuring abstention from participating in any behaviour which demeans human rights.

Annas and Grodin’s proposal 10 years ago for an international court to judge the behaviour of physicians and other health workers and to keep records on complicity in human rights violations merits further discussion.[9] In their words, “the world’s physicians and lawyers should work together to develop and support worldwide mechanisms to articulate and enforce standards of medical ethics and human rights, including the establishment of an international organization dedicated to this cause, and a permanent tribunal with the authority to punish human rights abuses.” An International Medical Tribunal could initially act by making public statements denouncing physicians who have commited established violations of human rights, but could also make use of its influence to urge national medical associations to revoke their license to practice. It would be a demanding task, but it would be worth the international effort to do it.

 

Competing interests: None declared.

  

    1.      BBC News. Triple suicide at Guantanamo camp. 11 Jun 2006. http://news.bbc.co.uk/go/pr/fr/-/1/hi/world/americas/5068228.stm (accessed 14 Jun 2006).

    2.      Council of Europe Secretary General’s supplementary report under Article 52 ECHR on the question of secret detention and transport of detainees suspected of terrorist acts, notably by or at the instigation of foreign agencies, June 14th 2006. www.coe.int/t/E/Com/Press/Source/SG_Inf(2006).doc (accessed 16 Jun 2006).

    3.      Church AT. ISFT final report 2005. Executive summary (unclassified). Medical issues related to interrogation, p 19. www.defenselink.mil/news/Mar2005/d20050310exe.pdf (accessed 16 Jun 2006).

    4.      Rubenstein L, Pross C, Davidoff F, Iacopino V. Coercive US interrogation policies: a challenge to medical ethics. JAMA 2005;294:1544-9.

    5.      World Medical Association: Declaration of Tokyo. Guidelines for physicians concerning torture and other cruel, inhuman or degrading treatment or punishment in relation to detention and imprisonment. Adopted by the 29th World Medical Assembly, Tokyo, Japan, October 1975, and editorially revised at the 170th Council Session, Divonne-les-Bains, France, May 2005 and the 173rd Council Session, Divonne-les-Bains, France, May 2006. Available from www.wma.net (accessed 10 Jun 2006).

    6.      Ray P. New AMA ethical policy opposes direct physician participation in interrogation. June 12, 2006. www.ama-assn.org/ama/pub/category/16446.html (accessed 14 Jun 2006).

    7.      American Psychiatric Association. Psychiatric participation in interrogation of detainees: position statement. www.psych.org/edu/other_res/lib_archives/archives/200601.pdf (accessed 19 Jun 2006).

    8.      Wynia M. Consequentialism and harsh interrogations. Am J Bioethics 2005;5(1):4-6.

    9.      Annas GJ, Grodin MA. Medicine and human rights: reflections on the 50th anniversary of the doctor’s trial. Health Hum Rights 1996;2:7-21.