Welcome to Ethics Consult — an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma from a true, but anonymized, patient care case, and then we provide an expert’s commentary.
Last week, you voted on whether you thought a physician was being asked to support torture.
Is it ethical for the doctor to play this indirect role in the interrogation?
Is it ethical for the doctor to decline this role?
And now, bioethicist Jacob M. Appel, MD, JD, weighs in with an excerpt adapted from his book, Who Says You’re Dead? Medical & Ethical Dilemmas for the Curious & Concerned.
The canons of medical ethics have long banned physicians from participating in torture. These proscriptions were explicitly laid out in the World Medical Association’s Declaration of Tokyo (1975), the United Nations Principles of Medical Ethics (1982), and the United Nations Convention against Torture (1984). The American Medical Association Code of Medical Ethics goes one step further, noting that “physicians must not be present when torture is used or threatened.” The AMA code also warns that “physicians may treat prisoners or detainees if doing so is in their best interest, but physicians should not treat individuals to verify their health so that torture can begin or continue.”
Whether “enhanced interrogation techniques” used by the U.S. military constitute torture has been a matter of considerable controversy. In preparing for the interrogation of detainees at Guantanamo Bay in the early 2000s, Deputy Assistant Attorney General John Yoo and Assistant Attorney General Jay Bybee advised the Bush administration that such techniques did not constitute torture.
Critics, such as Physicians for Human Rights, strongly disagree.
While the AMA and the American Psychiatric Association forbid members from participating in enhanced interrogation, the American Psychological Association once sanctioned such engagement. Two psychologists allegedly participated in guiding the examination of Al-Qaeda prisoners. They were later sued by the American Civil Liberties Union on behalf of several of these detainees; the case was settled on terms that have not been publicly disclosed.
In our hypothetical, John Banner, MD, is not being asked to participate directly in enhanced interrogations. Rather, he has been informed that such interrogation will occur with or without his presence; his sole role is to aid prisoners who suffer negative medical consequences. Yet some of those patients could theoretically be revived by him only to face more questioning. Under the circumstances, if these techniques are indeed torture, he is rendering assistance that might permit it to continue.
The scenario, in essence, asks how complicit one must be in unethical conduct before one suffers moral responsibility for that conduct. These same questions arise in a number of areas where physicians interface with law enforcement. For instance, now that most major medical organizations have prohibited physician participation in capital punishment, one must ask whether psychiatrists are permitted to certify that patients have the capacity to understand why they are being executed — a U.S. Supreme Court requirement for such executions to go forward.
Banner may legitimately feel he is helping these internees by making himself available to provide emergency care. However, he must balance those noble intentions against the harm he may do by lending his good name, and the good name of his profession, to legitimizing potentially unethical behavior.
Jacob M. Appel, MD, JD, is director of ethics education in psychiatry and a member of the institutional review board at the Icahn School of Medicine at Mount Sinai in New York City. He holds an MD from Columbia University, a JD from Harvard Law School, and a bioethics MA from Albany Medical College.
And check out some of our past Ethics Consult cases:
Report Alleged Improper Doctor-Patient Relationship?
Refuse Treatment for Dictator?
Can I Fire ‘Extremely Unpleasant’ Dialysis Patient?
Last Updated February 12, 2021