Right Now | Hypocritic Oaths?
The Medicalization of Torture
The revelations of torture and prisoner abuse at the Abu Ghraib facility in Iraq may not be over; the Army's Fay Report and the independent Schlesinger Report trace the underlying problems to the top of the chain of command. Some of their most troubling findings indicate the complicity of American doctors, nurses, and medics in torture and other illegal acts in Iraq, as well as in Afghanistan and at Guantanamo Bay. "In one part of our minds we know that doctors are human beings with faults, who are far from perfect," says lecturer on psychiatry Robert Jay Lifton, M.D. "But we also expect doctors to be involved primarily in a healing enterprise, helping other human beings."
Lifton, who alerted the profession to the problem in a New England Journal of Medicine article, cites three main ways in which physicians historically have been involved with atrocities. First, they have not reported injuries that are obviously consequences of abuse. For example, "Certain kinds of wounds are clearly caused by having been struck in some way," he says. Two doctors who gave a painkiller to an Abu Ghraib prisoner knew that his dislocated shoulder resulted from his having been handcuffed and forced to hold his hands above his head for a long time. Second, doctors have sometimes given medical records to interrogators, who might use knowledge of physical or psychological vulnerabilities to put extra pressure on captives. Third, physicians have been complicit in the falsification of documents that might, for example, assign an ordinary cause of death like heart disease to a decedent who actually perished from torture.
As an air force psychiatrist in the Korean War, Lifton personally experienced some of the inherent conflicts between the Hippocratic oath and the exigencies of military combat. In his 1986 book The Nazi Doctors: Medical Killing and the Psychology of Genocide, he analyzed some of the issues involved in what he calls a "reversal of healing and killing." Although Lifton stresses that the genocidal activities of Nazi doctors should in no way be equated with the abuses at Abu Ghraib, he notes that "atrocity-producing situations" can arise whenever certain conditions crop up. "Most of the Nazi doctors were not fanatics," Lifton says. "They were ordinary human beings who turned out to be corruptible, and who were socialized into the death camps." Similarly, Soviet psychiatrists locked up political dissidents in mental hospitals; white South African doctors falsified medical reports on blacks who had been killed or tortured; and Iraqi surgeons, under Saddam Hussein, cut off soldiers' ears as punishment for desertion.
In such situations, "the environment creates strong psychological pressures toward killing or harming others," Lifton explains. In Vietnam and in Iraq, these conditions have been part of a counter-insurgency war in a hostile setting, amid a largely nonwhite population, where soldiers face a dangerous enemy who is extremely hard to locate. In Vietnam, one atrocity-producing policy was "free fire zones" in which soldiers were encouraged to kill virtually anyone who stirred. In Iraq, troops in great danger are unable to ascertain even who the enemy is. In this case, Lifton explains, "The enemy can become everyone just about all Iraqis."
For doctors, these conditions create a "conflict between humane professional and legal precepts and the realities of insurgency, where there are nasty forces at play," he says. "People tend to be vulnerable to the pressures of their immediate situations. Ordinary soldiers, for example, are not supposed to carry out illegitimate orders, like killing civilians, but it's very hard for a soldier to resist an order in a combat situation. Doctors can know about the Hippocratic oath, but under certain extreme conditions, their adherence to it can give way to the pressures of the military group."
Whistle-blowing is also difficult. Lifton once interviewed a Vietnam veteran who had been present at the My Lai massacre, but had not fired at civilians and had even pointedly rested the muzzle of his rifle on the ground to make it clear that he would not shoot. "That can be dangerous," Lifton says. "There's deep resentment of someone who fails to join in the atrocity, or who raises questions that those involved can't afford to look at."
While acknowledging that very ordinary people, including medical professionals, are capable of complicity in torture, Lifton does not believe that atrocity-producing situations are powerful enough to override all of our humane instincts. "There's still a basic distinction between someone who has engaged in this behavior, and someone who might," he says. "There are people who resist these situations. But it takes a special amount of autonomy and courage."
Robert Jay Lifton e-mail address: email@example.com