- The Tortured Physician:Better to be Complicit?
This editorial focuses on the notion of justified complicity in torture as discussed in the article by Millum and Lepora in this issue. It claims that medical complicity in torture is sometimes justified and offers criteria for analysing how "other factors" may outweigh the wrongness of being complicit in torture. It also argues that a real dilemma is encountered "when the victims of torture are also patients in need of treatment" in that "to accede to the requests of the torturers" [to provide needed treatment] "may entail assisting or condoning terrible acts". Although the authors do not want to condone "the actions of physicians who assist in torture without regard for its victims", they claim that the problem of medical involvement in torture will not be resolved by blanket denunciations of complicity.
One finds in the article a clear analytical contribution to the understanding of ethical considerations facing medical professionals who get drawn into situations of torture. However, people who consider acts of torture as violations of human rights that always deserve condemnation may feel that the situations being examined by the authors in terms of complicity in torture are avoidable — and should actually have been avoided by the medical professionals — in the first place. In other words, a physician or some other healthcare professional should not have to face the type of dilemmas outlined by the authors since they could extricate themselves from those torture situations without having to be involved. A human rights advocate rejecting torture and complicity in it will probably find it very hard to accept that a physician could not just walk away from such situations and avoid not only complicity but also any form of involvement. [End Page 179]
Thus, one is left to wonder why one objection to the authors' position on justifiable complicity — that a "physician's role as healer entails that she has a special duty to refrain from actions that harm, and this includes any form of support for torture" — is quickly brushed aside by highlighting the role of the physician as involving "duties to act in the interests of their patients (even at some risk to themselves)" as if that primarily meant giving the kind of treatment that fit into the design of the torturers. Perhaps for someone sympathetic to the objectives (and methods) of the torturers to begin with, this would be easy to accept as a fair summary of the options. However, someone who rejected the humanity of the means employed to achieve the objectives of torture need not accept the inevitability of being caught in such dilemmas.
The objection that "complicity in torture could require doctors to sacrifice their personal integrity" or their "deeply held values" as individual physicians is met with the reply that someone who argues thus would have to be able to explain why he does not sacrifice his personal integrity by "abandoning a patient in need". Part of the explanation lies in that, according to the article, the importance of maintaining integrity could be outweighed by other factors, as it is "just another of the considerations that must be factored into the complex moral calculus that weighs it with the disvalue of complicity, the consequences of different courses of action, and the patient's preferences". Clearly, the authors do not accept what moral integrity could mean for others since, for them, "the appeal to integrity in the face of another's wrongdoing is neither always applicable nor decisive where it is applicable".
Those who condemn torture as human rights violations are not likely to take lightly this dismissal of the significance of moral integrity, which appears to be based on a misunderstanding of what moral integrity entails and what it signifies for a person's identity. Rather than being just one of those considerations that must be factored into an individual's moral calculus, one's moral integrity could very well be the anchor that defines one's moral identity and ensures ethical survival.
On the other hand, moral integrity appears to have nothing more than a consequentialist value for the authors. One wonders if the authors even consider torture to...