Medical torture

Medical torture (also known as a medical interrogation) describes the involvement and sometimes active participation of medical professionals in acts of torture, either to judge what victims can endure, to apply treatments which will enhance torture, or as torturers in their own right. Medical torture may involve the use of their expert medical knowledge to facilitate interrogation or corporal punishment, in the conduct of torturous human experimentation or in providing professional medical sanction and approval for the torture of prisoners. The term also covers torturous scientific (or pseudo-scientific) experimentation upon unwilling human subjects.

Medical torture uses psychotropic and/or other chemicals to induce pain and cause compliance with the torturer's goals. May include the forced ingestion or injection of psychotropic drugs such as neuroleptic antipsychotics to produce the agonizing condition called akathisia, (eg., phenothiazines (such as perphenazine and chlorpromazine), thioxanthenes (such as flupenthixol and zuclopenthixol) and butyrophenones (such as haloperidol (Haldol)), newer atypical antipsychotics, dimenhydrinate, R015-4513), or being forced to ingest (or be injected with) chemicals or other products (such as broken glass, heated water, or soaps) that cause pain and internal damage. Irritating chemicals or products may be inserted into the rectum or vagina, or applied on the external genitalia.

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Medical ethics and international law

It is generally accepted that medical torture fundamentally violates medical ethics, which all medical practitioners are expected to adhere to.

• The Hippocratic Oath makes explicit statements against deliberate harm not in the patient's best interests. These statements are often translated as "I will prescribe regimens for the good of my patients according to my ability and my judgement" and "to never deliberately do harm to anyone, for anyone else's interest." (Note: these statements are formulations of the ethical principles of beneficence and non-maleficence.)
• In response to the Nazi human experimentation on prisoners, which were declared at the Nuremberg Trials to be "crimes against humanity", the World Medical Association developed the Declaration of Geneva to supplant the dated Hippocratic Oath. The Declaration of Geneva requires medical practitioners to state "[I, the medical practitioner] will maintain the utmost respect for human life from its beginning even under threat and I will not use my medical knowledge contrary to the laws of humanity".
• The Nuremberg Trials also led to the emergence of the Nuremberg code which explicitly outlines the boundaries of acceptable medical experimentation.
• Additionally in response to the Nazi atrocities, the Fourth Geneva Convention of 1949 outright prohibits the torture of prisoners of war and other protected non-combatants.
• The World Medical Association Declaration of Tokyo (1975) [1] makes a number of specific statements against torture, including "The doctor shall not countenance, condone or participate in the practice of torture".
• Also the UN Convention Against Torture, which applies not only to medical staff, prohibits the use of torture under any circumstance. The text explicitely states there is no exception to this treaty under which torture is allowed.
• The UN Principles of Medical Ethics relevant to the Role of Health Personnel, particularly Physicians, in the Protection of Prisoners and Detainees against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (UN.1982)applies specifically to medical and other health workers but it has no implementation mechanism to ensure enforcement. It is up to state, provincial, and national bodies to enforce the standards in the document.
• The development of command responsibility established criminal liability for all people, including physicians, involved in crimes against humanity.

There remains gaps in regulation relating to medical torture in many countries:

1) Government sponsored torture and organized violence, with the complicity and or participation of health personnel, is internationally prohibited yet these violations occur with impunity in a significant amount of cases. An example of this impunity is found in the Abu Ghraib prison torture and prisoner scandal as well as documented by Amnesty International.

2) A higher standard of behaviour is expected of health professionals yet the UN Principles of Medical Ethics are not enforceable when governments are complicit in violations. This higher standard is reflected in the principles of beneficence, non-maleficence (above all do no harm), autonomy, justice, dignity and informed consent and these aren’t covered comprehensively by the UN Convention Against Torture.

To fill in the gap in regulation the Victoria Coalition for the Survivors of Torture(VCST) in Canada has proposed that an International Health Professions’ Ethics Committee be established to enforce the UN Principles of Medical Ethics. A draft of the Ethics Committee has been posted on the VCST web-site: http://vcst.ca/proposal.htm

The concept is aimed at the World Health Organization and it proposes that WHO amend its structure to facilitate the idea. The proposed committee would be comprised of elected experts and will have the membership of civil society. The participation of the World Medical Association, the World Psychiatric Association, the International Council of Nurses and the World Federation for Mental Health is invited.

The Committee's purview would include medically relevant human rights violations connected with torture such as those inherent to the Geneva Conventions, the death penalty, the illegal organ trade, the abuse of women, and breaches against security detainees and prisoners.

Asserted instances of medical torture

• Between 1937 and 1945, Japanese medical personnel who were part of Unit 731 participated in the torture killings of as many as 10,000 Chinese and Korean prisoners as well as Allied POWs during the second Sino-Japanese War.
• During World War II, the Nazi regime in Germany conducted human medical experimentation on large numbers of people held in its concentration camps. In particular, Josef Mengele's experiments on prisoners at Auschwitz earned him the nicknames "the Angel of Death" and "Dr. Death".
• Japanese surgeons also performed vivisection and other medical experiments to torture American prisoners of war in several islands of the Pacific. [2] [3]
• Between 1970 and 1971, mentally disorienting interrogation techniques were used against interned prisoners captured in Northern Ireland, including white noise. The Irish government complained to the European Commission for Human Rights, who found Britain guilty of torture; however the higher European Court of Human Rights ruled that the British government's actions were "inhuman and degrading but did not constitute torture". [4]
• An Israeli medic was convicted of negligence for refusing to treat interrogated Palestinian detainee Mahmud Al-Masri for a burst ulcer, 24 hours before his death on March 6, 1989 at Gaza Prison. It was claimed by pro-Palestinian sources that this constituted medical torture, however this categorisation is disputed by pro-Israeli commentators, and those who consider it dereliction of duty rather than deliberate torture.
• In 1978, "Pisaot menuh" ("Human Experiments") were performed on seventeen political prisoners held at the infamous prison Tuol Sleng in Phnom Penh under the Khmer Rouge.
• A study called "The Aversion Project" found that gay conscripts in the South African Defense Forces (SADF) during the apartheid era had been forced to submit to "curing" their homosexuality, both by electroshock therapies and by botched sex changes.
• There have been numerous claims that electroconvulsive therapy and prefrontal lobotomies and similar psychiatric treatments have sometimes been performed not in the patient's best interests, but rather as punishment for misbehaviour or to otherwise make the patient easier to manage. A classic example of this is the Lake Alice, New Zealand atrocity which occurred in the early 1970s. Children admitted to the Lake Alice Hospital's open child and adolescent unit were routinely punished with unmodified electroconvulsive treatment. Some governments (e.g. Norway and New Zealand) have since begun paying reparations to patients who suffered such treatments. The World Health Organization has called for a ban on unmodified ECT, and states no form of it should be used on children.

Asserted instances of medical complicity in torture

• The SERE ("Survival, Evasion, Resistance and Escape") program's chief psychologist, Col. Morgan Banks, issued guidance in early 2003 for the "behavioral science consultants" who helped to devise Guantánamo's interrogation strategy although he has emphatically denied that he had advocated the use of SERE counter-resistance techniques to break down detainees. The New Yorker notes that in November, 2001 Banks was detailed to Afghanistan, where he spent four months at Bagram Air Base, "supporting combat operations against Al Qaeda and Taliban fighters".
• A 2005 report by Human Rights Watch suggested that torture was routine under the appointed Iraqi government. Human Rights Watch Report
• Dr. J.C. Carothers, British colonial Kenyan psychiatrist, has been implicated in designing interrogation of Mau Mau prisoners.
• Similarly, it has been implied that Interim Iraqi Prime Minister Dr. Ayad Allawi violated his obligation to medical ethics whilst serving as Western European chief of secret police for the Baathist government of Saddam Hussein. However, the same sources allege that Allawi had abandoned his medical education at that point and his medical degree "was conferred upon him by the Baath party." [5].

Medical torture in fiction

• Actor Michael Palin plays a medical torturer in Director Terry Gilliam's 1985 dark comedic dystopian film Brazil.
• In the film adaptation of George Orwell's 1984 the main character, Winston Smith (played by actor John Hurt), is subjected to electroconvulsive torture by the thought police.
• Actor Gregory Peck plays Nazi medical torturer Josef Mengele in Director Franklin J. Schaffner's The Boys from Brazil.
• Actor Laurence Olivier plays Nazi torturer dentist Christian Szell in Director John Schlesinger's 1976 Marathon Man.
• The film One Flew Over the Cuckoo's Nest, starring Jack Nicholson, shows abuse of psychiatric techniques including electroconvulsive therapy and lobotomy.
• In an episode of the FX series Nip/Tuck, a patient with Munchausen's syndrome has a self-inflicted wound repaired, and during her surgery the anesthesia is replaced with a paralyzing agent, possibly deliberately, which leaves her awake during the entire procedure.
• In the popular series, "24", various forms of medical torture (including hallucinogens, and injections) are utilized to obtain confessions and information from high- threat terrorists being interrogated in the fictional Counter-Terrorist Unit (CTU)of the United States

See also

• World Medical Association
• Action T4
• International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use
• Geneva Convention
• Political abuses of psychiatry
• Declaration of Geneva
• Declaration of Helsinki
• Doctors' Trial
• Duplessis Orphans
• Electroconvulsive therapy
• Nuremberg Principles
• Nuremberg Code
• Medical ethics
• Persecution of Falun Gong
• Universal Declaration of Human Rights
• Vivisection

Sources

• Dr. J.C. Carothers, M.B. D.P.M. 1954. The Psychology of the Mau Mau. Government Printer, Nairobi, Colony and Protectorate of Kenya.
• Carolina Elkins. 2005. Imperial Reckoning: The Untold Story of Britain's Gulag in Kenya. New York: Henry Holt. ISBN 0-8050-7653-0.
• Steven H. Miles, Abu Ghraib: its legacy for military medicine; The Lancet volume 364 issue 9435, page 725 (August 2004) [6]
  Related editorials:
  • The Lancet editorial staff, How complicit are doctors in abuses of detainees?; The Lancet volume 364 issue 9435, page 637 [7]
  • Harvey Rishikof and Michael Schrage, Technology vs. Torture; Slate, August 18, 2004. [8]
  • CNN editorial staff, Ethicist questions medical workers' role in abuse.; CNN.com, August 19, 2004. [9]
  • John Carvel, Abu Ghraib doctors knew of torture, says Lancet report; The Guardian, August 20, 2004. [10]
• Mikki van Zyl, Jeanelle de Gruchy, Sheila Lapinsky, Simon Lewin and Graeme Reid, The Aversion Project--psychiatric abuses in the South African Defence Force during the apartheid era.; South African Medical Journal volume 91 issue 3, page 216 (March 2001) [11] [12]
  Related editorials:
  • Paul Kirk, Apartheid army forced gay soldiers into sex change operations; Daily Mail & Guardian, July 28, 2000 [13]
  • Ana Simo, South Africa: Apartheid Military Forced Gay Troops Into Sex-Change Operations, The Gully, August 25, 2000 [14]
  • S. Predag, South African Gays Terrorized During Apartheid Era; Lesbian News, volume 26 issue 3 (October 2000)
• Ben Kiernan, The Pol Pot regime: Race, Power, and genocide in Cambodia under the Khmer Rouge, 1975-1975; Yale University Press, 2002. pp. 438-439. [15]
• Joost R. Hiltermann. "Deaths in Israeli Prisons." Journal of Palestine Studies. Spring 1990. Vol. 19: Issue 3. pp. 101-110.
• Eliott Valenstein. Great and Desperate Cures: The Rise and Decline of Psychosurgery and Other Radical Treatments for Mental Illness (Basic Books, 1986).
• Stephen N. Xenakis. "From the Medics: Unhealthy Silence." The Washington Post. Feb. 6, 2005. p. B4. [16]