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Torture and The Medical Conscience
many countries phystdans are n inVOlved. in an acrtviry that Inflj crs severe pain and suffering upon persons to punish, degrade. or extract information. The practice is torture. In a startling new report entitled Ionute in the Eighrie->, Amnesty International finds; "It is nOt uncommon in many countries that a doctor
Bill Frelick is a writer for Refugee Reports
in \fashington, D.C. 12
is present to supervise interrogation under torture or available to ensure that the victims can survive to be tortured further and that they do not 'escape' through unconsciousness or death."! For a variety of reasons, including fear of reprisals, ambition, ideology; or mere inertia, medical personnel sometimes find themselves gravitating toward ever increasing involvement with torture. Doctors serving in a military or police facility may ini-
tially assume they are treating sick or injured detainees, but as the cause of trauma becomes more apparent, these physicians may become increasingly timid about confronting reality and eventually they become active collaborators.
In Chile, for example, a man known to prisoners in the secret police interrogation center in Santiago as "the doctor" revives prisoners between
torture sessions and admlniste, .iontherapeutic drugs that enable interrogators to manipulate prisoners. Former prisoners testify that they were examined by "the doctor" after nearly all torture sessions, and that his medical knowledge indicates he is a fullytrained physician. In the case of South African Black Consciousness leader Steve Biko, the presence of doctors between torture sessions did nothing to prevent his suffering; on the contrarytheir negligence and Indifference helped [0 bring about his death. After weeks of detention, police Inrerrogators believed that Biko was shamming unconsciousness, and called for a medical examination: Although the medical notes indicated slurred speech, blood-srained cerebrospinal fluid, urinary lncontlnence and len hernlparesis with a pesitive plantar response, the atrendtng physician failed ro diagnose a possible head injury and did not recommend hospitalization. After he was declared fit fortravel, Biko was loaded, naked and chained, onto the bare floor of a Land Rover and transported a distance of 750 miles. He died several hours after arrival. The autopsy determined brain damage as the cause of death and revealed gross external injuries to the head, which had not been recorded in the earlier medical notes.s In other cases medical complicity connnues.even ':ifter death by torture .. A Brazilian physlcian, Dr. Harry Shibata, publicly admtrred signing an offlcial autopsy report in October 1977 Citing sulcide as rhe cause qf death in the case of a pnsonerhe had never exarnined.f
are frequently confined to special psychlatric hospitals administered not by the Health Ministry, but by the internal security forces. of the Ministry of Internal Affairs. Their beliefs, falling outside the norm of official acceptability, are branded as "delusions," and dubious. diagnoses, such as "sluggish schlzophrerua" are invented to confine them. They are "treated" With a variety of painful and disorienting drugs, including such antipsychotics as haloperidol, chlorpromazine and trifluoperazine. Psychiatrist') reportedly administer them in excessive quantities, disregarding
Physicians who are called in by police or military authorities to treat prisoners who have been brutalized are ltkely to face moral urnbiguiry Certainly a doctor will try [0 treat the wounds of prison inmates regardless of their cause. However; when they become aware of the probable cause of injuries, particularly those sustained during periods of inrerrogation, physicians should see chat their care of inmate patients doesnor end with the immediate rrearmenrof injuries, but rather with the.prevenrton of further torture.
.. Medical personnel sometimes find themselves gravitating toward ever increasing involvement with tort!"re."
contramdications. Vladimir Tsurikov, confined in a psychiatric hospital in 1980, described the effects of these drugs on a sane man-himself: The triftazin (stelazine) made me writhe, and my legs began to twist about in a ridiculous way. I lost the ability to walk, while simu ltaneously feel j ng very restive and also feeling sharp pains in my buttocks at any movement-a result of the sulfazin (a one percent solution of elemental sul. phur in oil) Fainting fit') began, recurring very often; I fell and hit my head on the floor and on the brick wall. The pain prevented me sleeping or eating. TI1e sulfazin made my temperature rise, and it then stayed around 40 degrees centigrade. Sometimes I experienced slight shivering and my tongue hung out.> The accoum of Hossein Dadkhah, a member of the Mojahedin opponents of Khomeinis regime in Iran, who was wounded in the course of his arrest, shows that treatment of injuries is not enough: I was taken straight to the torture chamber, but since I was bleed ing profusely and on the verge of unconsciousness, torture could not begin. So they brought in the doctor, who stitched my head wound and bandaged it. ... Torture commenced after my head was bandaged. They tied me to a bed, attacking me like wild beasts.v After his transfer from the local Revolutionary Guard headquarters the Evin Prison, 'the motivation for torture changed from extraction of Informstion to punishment, but the whippings and beatings continued, as did the involvement of the medical pro-
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In his history of the Soviet penal system, GuJ:1gArthjpeJagq~Alexander Solzhenitsyn alleges that during the Stalin era prison doctors routinely falstfied.dearh certificates. He describes Prisoners such as Tsurikov, me doctor in the notorious Lubyanka fession: branded as insane and held indefiPrison as the "interrogators and exOnce again I was strapped to a . nitely, have no legal recourse to proecutioner's right hand man." 501bed [and} whipped with avariery test abusive treatment or to win rezhenitsyn observes, "The beaten prisof electric cables on different lease.from confinement. They can not oner 'Would come [0 on me floor only parts of my body. , .. Whenever write letters without permission from to hear the doctors voice: 'You can one man became exhausted, ancontinue, the pulse is normal"! . the very· doctors who are "treating" . other took his place, ... By mid'them, Those letters permitted are Today, roles have changed and the night I was in such a critical state subject to censorship and can be writemphasis seems to be less on bruthat they took me to the hospital . ten only to relatives. Prisoners who talizing prisoners in order to extract wing. They wanted to' keep me . have succeeded in smuggling out acconfessions and information, and alive for more tortures? ' counts of their treatment and are dismore on disorienting and debasing dissidents, .. The. physicians who treated covered have been subjected to addiDadkhah, even within the torture tional punishments. Political and rellgious dissenters
chamber itself, necessarilv ha .J turn a blind eye to the proceedings in order to rationalize that they were serving the real needs of me victim.
Risks and Responsibilities
Clear codes of ethics should be instituted internationally to guide health professionals who find themselves slipping away from health care toward acceptance of practices that
however. Doctors throughout t... world have faced imprisonment, torture and death for their commitment to the highest ethical standards of their profession. Drs. Leonard 'Iernovsky,Anatoly Koryagin and Semyon Gluzman have all paid with terms of imprisonment for exposing the abuse of psychiatry for political purposes in the USSR. Ninety Syrian physicians, after joining in a resolution of the Syrian Medical Association calling
Health professionals can join Amnesty International's Urgent Action Medical Appeal Network and receive a report each month documenting one or two cases of political torture, These may involve a prisoner being tortured or denied medical care or they may identify a health professlonal in jeopardy. Thesemonthty reports include Instructions on which officials in the offending country to write or telegram to protest the treatment-it may be anyone from the head pf the country to the local police chief. AMSA and the Washington Medical Group of AI are building a system through AMSA chapters at medical schools for student participation in the Urgent Action Medical Appeal Network. The reason for going through the AMSA chapters, according to Susan Gerber AMSA liaison to AI, is to provide continuity at medical schools over the years. Interested students should contact their local AMSA chapter or Susan Gerber at AiuSA, 407 S. Dearborn, room 575, Chicago, IL. 60605. (312) 579-1269. Residents and others can contact AI directly at: AI Health Professional Group, 724 G Bt., ~.E., Washington. D.C. 20003.
"Doctors . . . have faced imprisonment, torture and deathfor their commitment to the highest ethical standards of their profession. ~
cause the very injuries they are treating. Medical professionals with knowledge of torture should report the information to appropriate authorities. If that fails to eliclt positive results, torture should be reponed to national and regional medical societies. Where a free press operates, iJ should also be reported to the media. Such actions have alreadv been successful. When protests were lodged by police surgeons in interrogation centers in Northern Ireland, for example, new procedures resulted for independent monitoring of interrogations and a significant drop occurred in prisoner allegations of brutality.~
Under totalitarian governments medical personnel have less chance for success and.greater personal risk in lodging criticisms of police and military excesses. However, the ethical obligation to report such abuses is constant. No regime, however repressive, wants to admit to torture, and most are on record as opposing it. There is therefore hope for success when a doctor goes through the channels even within highly authoritarian systems. Health professionals are still regarded as people with special skills dedicated to a humanitarian pursuit and they are generally respected regardless of the ideological systems in which they practice. They may be able to make a difference and at relatively lower risk than other sectors of sociRespect for the integrity of physicians does not always protect them, 14
upon their government to end the practice of torture, were arrested and their national congress and regional assemblies dissolved." Four years later the fate of these physicians is still unknown. However, the fate of another Syrian doctor who fled the country after his detention in 1979 suggests that arrested physicians are not immune from being tortured. His allegations of beatings, electric shocks and injections were confirmed upon medical examination by a British doctor who found inter alia between 50 and 100 scars on his back and genitals which "are not compatible with natural causes, and are the result of external trauma, which could have been electrical."lQ All of these physicians have suffered simply for following the dictates of the Hippocratic oath, a heroic act in many places in today's world. Such acts involving great personal sacriflees constitute a standard of conduct that may be too high for most doctors with families to consider. There are other less risky steps mat can be taken by those who feel unable to openly oppose and report human rights abuses, At the very least, they should refuse to participate in cruel punishment. In an effort to establish a strict adherence to Islamic law, Pakistan's President Zia-ul-Haq prescribed amputation of hands and feet for various crimes such as robbery and theft. Although many persons have been sentenced to amputation since the law was introduced in 19n,
the military courts have yet to find a surgeon willing to perform the operation. To Amnesty International's knowledge, no amputations have yet. been carried out as a result. When individual doctors' refuse to condone ill treatment, even in sodeties where such actions are wholly unexpected, evidence suggests a reasonable chance of preventing or alleviating torture. In a study of Latin American torture victims in the Canadian Journal of Psychiatry (March 1982) half of the victims were found never to have had access to a physician at all. In most cases where doctors were present, they either actively collaborated with the torturers or
failed to inquire about injurie . offer comfort. However, in ne... IY a quarter of the cases under study doctors did try to help to some degree. In one case a surgeon was able to prevent soldiers from removing a woman from her hospital bed. Although it is problematic from our vantage point of comfort"and freedom to second-guess the actions of professionals under duress, it is still worthwhile to consider how one would act under similar circumstances. Could more people have been spared the horrors of torture if health professionals in prisons and detention centers had been more assertive with guards and interrogators?
ucated about medical treatment and lish safeguards during inter rogatio ocher forms of rehabilitation for torand custody, including independent investigation of allegations of torture. ture victims. Three centers, in CopenSeveral health and scientific soci- hagen, Toronto and Paris, are cureties in the United States have begun rently devoted to rehabilitating torto take an active role in monitoring ture victims, but, as yet, no center and protesting human rights viola- provides these services for refugees tions. The recent mission to the Phil- in the United States. The entire medical community ippines sponsored by the American Association for the Advancement of . must strive to make the practice of
.. Medical associations have an important role to play in bringing about the abolition oftorture.~
Science, the American College of Physicians and the American Nurses' Association, among others, demonstrates how health organizations can assume responsibility for investigating allegations of torture and other human rights violations. Medical associations have an important role to play in bringing about the abolition of torture. Some important steps have been taken already, such as the declaration of the Wbrld Medical Associarion in 1975 forbidding doctors to "countenance, condone, or participate in the practice of torture or other forms of cruel, inhuman or degrading procedures, whatever the offence of which the victim of such procedures is suspected, accused or guilty, and whatever the victirns beliefs or motives, and in all situations, including armed conflict and civil strife." II In addition, institutional reforms are needed. For example, health professionals working in state penal institutions should be employed by those branches of government concerned with health rather than internal security. Medical cooperation with the International Committee of the Red Cross, Amnesty Intemational and other organizations that conduct investlgations of prison conditions is essential to stopping torture. In addition, physicians must be edtodays world. International solidarity
Individual initiatives to prevent torture are not enough, however. Institutional changes and the solidarity of colleagues throughout the world are also needed. The international medical community must make a conscious effort to establish itself as the guardian against torture without regard to national or ideological boundaries. Amnesty International has created one avenue for individuals throughout the world to respond as soon as reports of torture are received. Through its Urgent Action Network health professionals send letters and telegrams to security and political authorities on behalf of prisoners who may be tortured. Experience has shown that security and police authorities abuse their power less when they know they are being watched In addition to appeals on behalf of individual torture victims, efforts are underway to approach the nations of the world on a country-by-country basis to bring about institutional changes for the prevention of torture. Amnesty International's program also pressures ·every government to abolish secret and incommunicado detention, to prohibit from trials confessions extracted by torture, to make torture a punishable offense under national criminal codes, and to estab-
torture as inconceivable as slavery in
is needed from physicians both inside and outside countries where torture is practiced. Unless doctors band together to confront torture wherever it occurs, this scourge will continue as a challenge to the individual and collective medical conscience, as well as an affront to the dignity of all human beings. •
I. Tonure in the Eighties, Amnesty IniemaliorW PubUaIioos. London: 1984, p. 20.
2. Samuel Shapiro, M.B.B.ot .• "MediC21 Work Against Torture: The Case of SleW! Biko," New Engl3JIdjournal ofMedidne, \01. 303. No. 13. September 25. 1980. 3. Tot1Ure in the Eighties, p. 22. 4. A1enndr I. Solzhenits)'n. The Gulag Archipelago: An ~ menl in literary Investi~n 1918-1956, \011.• Harper and Ru.v Publishers, NY: 1973. p. ZOS. 5; Tonure in the Eighties, p. 22. 6. 1bis account was made Mihble by Amnesty InlerMliofW. but has DOl ~t been published In 2Jl AI report. 7. Hossein DadkII2h escaped from prison In Febnwy 1983 and arriI'ed In FC2IIce the foUawing month. French p~ conJirmed that his injuries \m'e consistent with the torture he described. He underwent SUI1!ery 10 repair the cbm2ge III his leer; seYenl of his toes had been Hampulaled" by whlpping.
8. A deWled account of !be actions olthe Nonhero Ireland poUce surgeons can be found In 7brture in the Eighties, pp.
9. fJl!II2 0. Nightfngale, Eric ~
Davtd A.l1ockIwt, ~ Curt ; GoerIng. "SpecbI Report Support 1JJged lOr Syrian Doc- .• IOrs," New Enghnd}ourn2l cf Medicine, \01.310, No. 12, Much 22. 1984, pp. 803-604.
"l!£forts are underway to approach nations ... to bring about institutional changes for the prevention oftorture.~
10. Report from Amnesty IntmWiorul II> !be G<werrImeDIcf/be .syri2n AnI> lIlpublJc. Amnesty Intemalio.w PublJadoos, London: N<7o'mIber 1983, pp. 28-9. . II. 7brturr In tire EIghties, pp. 47-48.· • :-. __ .' -: :'_: .'