By Derek Summerfield.
During the Middle Ages in Europe the practice of torture drew distinction from its association with confessed truth, repentance, and salvation, yet by 1874 Victor Hugo could write that “torture has ceased to exist.” However there has never been any doubt that torture would outlive its obituarists. As I record in my recent JME paper, in 2015 Amnesty International noted that 157 states had ratified the UN Convention of Torture, yet 141 states had used torture in the previous 5 years – this included Western supposedly liberal democracies.
What of doctors and torture? The World Medical Association (WMA), created after World War 2 following the outrageous ethical abuses of Japanese and German physicians, carries the membership of over 100 national medical associations – from many of the nations implicated by Amnesty. The WMA’s Declaration of Tokyo is the seminal anti-torture manifesto for doctors, forbidding not just direct involvement (“in the room”) but also mandating doctors to speak out, protest and protect the torture victim whenever encountered. There are also UN Special Rapporteurs on Torture tasked with paying particular attention to medical complicity. Yet the complicity of doctors with torture worldwide is described by Steven Miles in “The Torture Doctors” (2020) as “pandemic” and that “a complete lack of accountability is the norm”.
What is the response of a national medical association when there is credible evidence incriminating their own doctors. And do international conventions and declarations forbidding medical complicity with torture, and the organisations set up to regulate these, carry out their mandate effectively and even-handedly? These are the questions I ask with regard to the case of Israel in respect of the Palestinian populations they control. Since 1992 I have had extensive academic and human rights involvement with the region, including with Birzeit University, the Gaza Community Mental Health Programme, and with Israeli non-governmental organisations like Physicians for Human Rights and Public Committee Against Torture in Israel. From these as well as from international agencies like Amnesty or Human Rights Watch, a mountain of scarcely deniable evidence has been accumulating over many years, and this is the bedrock of my paper.
There are then two parallel stories in the paper: one concerns how far evidence counts in cases which incriminate a Western state with powerful friends; the other describes the experience of trying over years to engage the relevant parties – the national medical association in question, the WMA, UN Rapporteurs, etc. – to get them to do what they were set up to do. I give a blow-by-blow account of convening and running a principled evidence-based appeal launched in 2009, and dedicate the paper to the 725 physicians from 43 countries who gave their names to this endeavour and still do. Our conclusions have been sobering.
There is no glib answer to why doctors are prepared to collude with torture and my paper had insufficient space to address it. However I would point to a famous lecture by the sociologist Max Weber on “Politics as a Vocation”. Weber distinguished between an “ethic of responsibility” and an “ethic of conviction”. By “ethic of responsibility”, Weber meant conformity to professional standards and frameworks of accountability. In the medical profession this means a commitment to factual evidence and to standards in clinical practice determined by peer opinion, patients, general public and employers. By “ethic of conviction” Weber was identifying actions that were inspired by personally valued ideals, political or other philosophies, and identities. In my decades of anti-torture work I have witnessed how regularly, in doctors, an ethic of convention trumped an ethic of responsibility, even when it came to torture or other human rights abuses. The case of Israel bears this out clearly in my paper, with the Israeli Medical Association seeing itself as functioning in patriotic defence of state policies.
But not only Israel. Let me finish with examples from UK. As I note in the Conclusions, in 2014 the European Centre for Constitutional and Human Rights and Public Interest lawyers detailed 58 separate allegations regarding UK doctors acting in violation of the Declaration of Tokyo in Iraq in 2003-8. Only one case, the torture-murder of hotel receptionist Baha Mousa, led to sanctions against a doctor for failing to record the 93 injuries on his body. In one of the unexamined cases, from Al Shaibah Detention Centre, the victim said he told the doctor about the beatings he had suffered at the hands of British soldier but that the doctor made no comment. “He told me he thought I had a stomach ulcer. He said this without examining me. I told him that I never had anything wrong with my stomach before, until the soldier had smashed me in it with the hammer. My t-shirt and shorts were covered in blood from the beatings to my face and in particular my nose. The doctor could clearly see this and didn’t ask me about it. I told him about the injury I had received to my nose and I thought it was broken because it was so swollen but he didn’t do or say anything”. Why has there been no official enquiry into this and other well attested cases, why hasn’t the General Medical Council acted pro-actively?
Paper title: Is the international regulation of medical complicity with torture largely window dressing? The case of Israel and the lessons of a 12 year medical ethical appeal.
Author: Derek Summerfield
Affiliations: Honorary Senior Clinical Lecturer, Institute of Psychiatry, Psychology & Neuroscience, King’s College
Competing interests: None declared