The Tortured Patient: An Ethical Dilemma

The authors make a well sourced and closely argued attempt to reveal the multi layers and complexities involved when looking at members of the medical profession being complicit in torture. They do this through a number of lenses including that of assisted and shared intention (though comparing it to Catholic concepts of material and formal complicity seemed extraneous). The authors state that their use of the term "medical" encompasses psychologists and social workers. I would suggest that the arguments the authors make are more pertinent to doctors and possibly nurses than to psychologists for reasons which I hope to explain further on, and that rather than a medical dilemma, the tortured patient poses an ethical dilemma.

Contributions like this keep the torture discourse current. Although not its overall purpose, it reminds us that we cannot keep professions segregated from the murkier complexities of politics. In that liminal space between postmodernism and whatever comes next, politics is, or certainly should be, everyone's business. This paper beavers away at the interface and asks uncomfortable questions. It is informed by papers and reports rather than live research and emerges out of considerable critical reflection. Critical reflection is an example of best practice for any professional body interested in both preserving and encouraging a sense of social responsibility and accountability as well as professional responsibility to its members. Its additional usefulness is in the authors' suggestions for actions particularly involving medical associations. The medical profession needs some vehicle for those of its members caught up in the nightmare that is torture to manage a range of conflictual feelings and emotions around integrity, the role morality of physicians, guilt, shame and personal anguish that arise when a doctor not only witnesses torture but believes they have become somehow complicit in it. Where do they go for debriefing, for exoneration, for understanding so that they do not internalise the torturer? Where do they go for action so that they do not become what survivors call the silent others, those like us who know that something terrible is going on and do nothing about it? The authors' suggestion of an ethical ombudsman could go some way to meeting the concerns they raise and would be worth a significant piece of live research among members of the medical profession as serious ethical dilemmas do not just arise for those caught up in torture.

The Issue of Complicity

During my professional practice with survivors of torture, I have also treated/ debriefed a number of doctors and nurses returning from conflict zones as well as medics caught up in torture in various countries. They manifest many of the same symptoms as torture survivors. This is supported by several accounts given by torture survivors on the role of medics in the torture dynamic. They also benefit from treatment protocols similar to those used with survivors of torture. Such evidence strongly indicates they have undergone a form of torture in their medical roles. To illustrate, in parts of Africa, members of the same family have been paired off and one given a machete. They are told that if they do not kill their partner in the pair, they have to hand over the machete to the other. If both refuse to carry out the orders, they are both killed. In this torture dynamic, a father, for example, has to kill his son or make a murderer out of his son or cause the death of both of them. This type of torture is intended to invade and dismantle our values and morals. It reaches into everything held sacred to contaminate it in this life and in any belief one has in an afterlife or in the goodness of humankind. It attempts to reduce human decency to something to be ridiculed and distorted. It reaches beyond the body and mind into the very souls of those forced to participate. It is often beyond physical, emotional and psychological endurance. It is beyond humanness. The dilemmas raised for each person are beyond our normal experience. It is a torture of beyondness. This is why I have an issue with the term complicit...