{"id":2878,"date":"2015-03-03T10:20:02","date_gmt":"2015-03-03T09:20:02","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=2878"},"modified":"2015-03-03T10:20:02","modified_gmt":"2015-03-03T09:20:02","slug":"flogging-and-the-medic","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2015\/03\/03\/flogging-and-the-medic\/","title":{"rendered":"Flogging and the Medic"},"content":{"rendered":"

You must, by now, have heard of the Saudi Arabian blogger\u00a0Raif Badawi<\/a><\/span>. \u00a0Just in case you haven’t (really?), here’s a potted biography:\u00a0having set up the secularist forum Free Saudi Liberals, he was\u00a0arrested for insulting Islam and showing disobedience. \u00a0Among the formal charges he faced was one for apostasy, which carries the death penalty in Saudi. \u00a0The apostasy charge was dropped, but he was convicted on other charges and sentenced to seven years in prison and 600 lashes. \u00a0He appealed, and this sentence was changed: it became 1000 lashes and 10 years in prison. \u00a0Why? \u00a0Does it matter? \u00a0Because Saudi Arabia. \u00a0The latest update<\/a><\/span> is that the apostasy charge may be renewed, so for a second time, he faces beheading. \u00a0Part of the evidence against him is that he “Liked” a post on a Facebook page for Arab Christians. \u00a0(Remember: Saudi is one of our allies against religious extremism.)<\/p>\n

The lashes were to be administered in batches of 50, weekly, after Friday prayers. \u00a0As I write this, he has only been flogged once; doctors have attested that he is not well enough to be flogged again. \u00a0And – with thanks to Ophelia<\/a><\/span> for the link – it’s \u00a0not hard to see why<\/a><\/span>:<\/p>\n

Dr Juliet Cohen, head of doctors at Freedom from Torture, explained: “When the cane strikes, the blood is forced from the tissues beneath… Damage to the small blood vessels and individual cells causes leakage of blood and tissue fluid into the skin and underlying tissue, increasing the tension in these areas.<\/p>\n

“The more blows are inflicted on top of one another, the more chance of open wounds being caused. This is important because they are likely to be more painful and at risk of infection, which will cause further pain over a prolonged period as infection delays the wounds’ healing.”<\/p>\n

There is also the long-term damage done to the victim’s mental health caused by flogging.<\/p>\n

“Psychologically, flogging may cause feelings of fear, anxiety, humiliation and shame. Anticipation of the next scheduled flogging is likely to cause heightened emotions especially of fear, anxiety and difficulty sleeping… pain and fear together over a prolonged period have a deeply debilitating effect and recovery from such experiences may take considerable time,” said Cohen.<\/p><\/blockquote>\n

At the beginning of February, Vincent Iacopino had a post on the main BMJ blog<\/a><\/span> in which he claimed that\u00a0health professionals should play no part in Badawi’s flogging:<\/p>\n

Any form of participation by health professionals in this kind of punishment is prohibited, including assessing a prisoner\u2019s ability to withstand the punishment, observing or monitoring the practice, evaluating a prisoner\u2019s \u201cfitness\u201d for these types of harmful practices, or even being present and failing to take action and stop it. […]<\/p>\n

As doctors, we have no greater duty than to heal and prevent human suffering. The integrity of our profession and the trust that society places in us depends on the actions we take individually and collectively to ensure respect for our professional ethical standards.<\/p><\/blockquote>\n

I think Iacopino is wrong. \u00a0Wrong because the principles that his position indicates are rather naive: they appear assume that medics not being involved would mean that the flogging would not take place. \u00a0That would be the natural way to make sense of this claim:<\/p>\n

While it may appear that the doctors are assisting Badawi by delaying punishment, their participation is actually enabling the infliction of physical and mental pain.<\/p><\/blockquote>\n

I don’t see any reason to suppose that that’s true. \u00a0The evidence so far is that the involvement of medics has prevented the administration of further pain. \u00a0Of course, one can’t discount the possibility that the second, third, and\u00a0n<\/em>th round of flogging would have been deferred without medical opinion having been offered… but I’m not inclined to make that leap. \u00a0At the weakest, it’s simply not clear that medics’ participation has enabled<\/em> such infliction; but my hunch is that the claim is false. \u00a0To show that they were enabling anything would mean demonstrating that it would and could not have gone ahead without them. \u00a0And that’s nonsense.<\/p>\n

Maybe the worry is one about giving an aura of legitimacy to the procedure: maybe the Saudi government is using medical attention as a cover, to make it look as though they’re humane and moderate – and maybe, for this reason, they’d be unwilling to enforce the punishment without this cover. \u00a0On that basis, medical intervention\u00a0would<\/em>, in some sense, enable the flogging – and by standing aloof, doctors could prevent it. \u00a0But I don’t buy that, either. \u00a0If the Saudi government really did want to look moderate and humane, a much more effective way would be… oh, I don’t know: not\u00a0beheading people who don’t want to be Muslim, and not flogging people for running a blog.<\/p>\n

Besides:\u00a0inasmuch as that the government has been forced to suspend the flogging, apparently on medical advice, Iacopino’s claim would appear to be false on this reading, too. \u00a0Maybe medics’ involvement has, in a roundabout kind of way, helped keep flogging on the books; but if at the same time it’s meant that it doesn’t actually happen in reality… well, that’s not trivial.<\/p>\n

Besides: there’s always the question of what doctors are supposed to do in the context of brutal regimes. \u00a0One possibility would be to stand back and try to keep their hands clean. \u00a0But I don’t think that that’s a desirable response. \u00a0It doesn’t stop suffering, so much as waft a scent of lavender over it.<\/p>\n

A couple of years ago, I wrote about<\/a><\/span> the case of Mohammed al-Byati: he was a doctor who’d been struck off because of his involvement in torture in Ba’athist Iraq. \u00a0That sanction, I suggested, could be seen as unjust: doctors working for the Iraqi state did not notably have room to exercise their consciences; and the alternative would not have been that the torture stopped – it’d simply continue without medical intervention. \u00a0Of course, it would have been better for al-Byati not to have treated torture victims – but only on the understanding that there was none to have to treat.<\/p>\n

The same kind of consideration applies here. \u00a0How, precisely, is someone\u00a0obliged to take action to stop Badawi’s flogging? \u00a0Note that his own lawyer faced prosecution on grounds of “undermining the regime and officials”, “inciting public opinion” and “insulting the judiciary” – a charge sheet that would be hilarious if it weren’t so grotesque; so standing in the square, or trying to wrestle the guards to the ground, seems like a moral non-starter. \u00a0It wouldn’t even be heroic. \u00a0It’d be stupid.<\/p>\n

I suppose that all doctors could leave the country to protest there… but that’d leave an injured man (and everyone else) without any medical attention at all. \u00a0This is also a non-starter.<\/p>\n

Iacopino’s appeal to professional ethical standards seems to assume that they’re the be-all and end-all of moral decisionmaking; and those standards themselves, as he presents them, appear to reflect a rather naive view of the world. \u00a0Importantly, they\u00a0suggest that\u00a0we live in a world with no genuine moral dilemmas: in which things are straightforwardly right and wrong, and that’s that. \u00a0But we don’t. \u00a0Even if it turns out that medics should distance themselves from the Badawi case after all, it’s not nearly as straightforward as we might prefer. \u00a0If it were, the problem would never have arisen in the first place. \u00a0To pretend that there is no problem, as Iacopino does, is to\u00a0sacrifice real ethics on the altar of codes of practice.<\/p>\n

Keeping your hands clean because you don’t approve of the reasons why your patient is covered in blood… well, you can’t justify that by making vague statements about ethics – especially when\u00a0your view of ethics goes no further than codes of practice.<\/p>\n","protected":false},"excerpt":{"rendered":"

You must, by now, have heard of the Saudi Arabian blogger\u00a0Raif Badawi. \u00a0Just in case you haven’t (really?), here’s a potted biography:\u00a0having set up the secularist forum Free Saudi Liberals, he was\u00a0arrested for insulting Islam and showing disobedience. \u00a0Among the formal charges he faced was one for apostasy, which carries the death penalty in Saudi. […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1240,575,511,2148,328,475,2745,576],"tags":[],"class_list":["post-2878","post","type-post","status-publish","format-standard","hentry","category-blogosphere","category-bmj","category-in-the-news","category-law","category-philosophy","category-politics","category-professionalism","category-the-art-of-medicine"],"yoast_head":"\nFlogging and the Medic - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2015\/03\/03\/flogging-and-the-medic\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Flogging and the Medic - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"You must, by now, have heard of the Saudi Arabian blogger\u00a0Raif Badawi. \u00a0Just in case you haven’t (really?), here’s a potted biography:\u00a0having set up the secularist forum Free Saudi Liberals, he was\u00a0arrested for insulting Islam and showing disobedience. \u00a0Among the formal charges he faced was one for apostasy, which carries the death penalty in Saudi. 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