- The Torture Doctors: Human Rights Crimes and the Road to Justice by Steven H. Miles
During the Middle Ages in Europe 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." This magisterial book reminds us how much torture has outlived its obituarists, noting in the Preface that the US Office of Refugee Resettlement estimates that 500,000 torture survivors live in the United States alone. It would seem astonishing to the average citizen that a practice so noxious, the ostensible province of the barbarian—the very antithesis of the professed values and public reputation of the medical profession—should have so intimately involved doctors in so many countries, not least in Western democracies. Steven Miles sets out to exhaustively document and interrogate this role, a vital ethical task.
He starts with examples—from Haiti, Malawi, Syria, Turkmenistan, Ivory Coast, Bosnia, Rwanda—where the torturers-in-chief were physicians themselves—before going on to the Nazi doctors and their trial at Nuremburg in 1946–1947. He describes a striking aftermath—the election in 1992 of Dr. Hans Sewering of Germany to the Presidency of the World Medical Association (WMA). The WMA had been specifically created after World War II as the official watchdog of the ethical behavior of doctors worldwide. During the war Dr. Sewering had been in the SS, the Nazi organization most responsible for genocidal killings, and had dispatched over 900 disabled children to their deaths. It is telling—touching on the core question of impunity running through the whole book—that after the war Dr. Sewering experienced no challenge to his career and rose to be president of the German Medical Association. However, the WMA Presidency was exposed as a step too far and Sewering was forced to stand down. But in 2008, fifteen years later, he was awarded Germany's highest medical honor. His obituary did not mention his Nazi past.
The WMA's Declaration of Tokyo is the seminal anti-torture text for doctors. This makes it clear that the ethical duties of a doctor go well beyond not directly participating, or not being in the room where the torture is taking place. Whenever he encounters or thinks he encounters torture the doctor has a duty to protest, speak out, and protect the detainee. If he is a working member of a unit whose methods during interrogation include torture, he is in what Amnesty International has called "institutional complicity" with such practices, and this cannot be fudged.
Why do doctors collude with torture? The medical advisor in the Nazi doctors' trial concluded that a morally lazy careerism lay at the core of most physicians guilty in this way. I think it is much deeper than that, touching on matters of personal identity. In a famous lecture on "Politics as a Vocation," the sociologist Max Weber distinguished between an "ethic of responsibility" and an "ethic of [End Page 959] conviction."1 By "ethic of responsibility," Weber meant conformity to professional standards and accountability. In our profession this means the ethical standards by which doctors should practice, including a commitment to factual evidence—standards determined by peer opinion, by patients and public, employers, and the licensing authority. By "ethic of conviction," Weber was identifying actions that were inspired by personally valued ideals, political or other philosophies, or identities. In my thirty-five years of antitorture human rights work, and with an emphasis on the collusion of doctors, I have witnessed how regularly, in doctors, an ethic of conviction trumped an ethic of responsibility, even in matters of grave human rights abuse.
I will give two personal examples. First, in the early 1990s when I was principal psychiatrist at the Medical Foundation for Victims of Torture in London, we documented in the medical journal, The Lancet, accounts of the torture of Turkish Kurds (a persecuted people in that country) given to us directly after they had sought asylum in the UK. This prompted a number of...