MD, Ethics and a Special Group of Prisoners
Tada Yipintsoi MB*
Affiliation : * Member of Medical Association of Thailand
A comment in the August issue of Lancet(1) forced me to consider that if I were an MD that had to look
after prisoners, how would I respond if I were commanded to mistreat them physically or if I were commanded
to “break” the prisoner by using psychological methods?
This article is titled “A stain on medical ethics”. It started by stating “: disturbing that cultural and
social factors that have seduced individual health professionals and ‘their institutions’ into participating in
abuse have ‘persisted’ and have therefore remained unchallenged” [my own ‘quotation marks’]. The article
cites exposure related to the maltreatment of prisoners at the Abu Ghraib and Guantanamo Bay detention
centers. It also suggested that what had been published was probably under-reported. It then reminds us of
the performance of some German doctors in the 1930-1940s with their active euthanasia and experiments on
Jews, gypsies and the mentally ill. At present, many nations (at war or not), have their share of such atrocities
e.g. Africa, Russia etc.
A memorandum from the US Department of Justice was cited explaining that “torture” happens
when the intensity of the pain is equivalent to“serious physical injury such as organ failure … or even
death”. Explaining torture into these words sounds horrible and disgusting particularly from an institution
dispensing justice. However, given this definition of “torture”, it is presumably implied that an MD is allowed
to mistreat lawfully his fellow human being to a level just before that limit is reached.
Now back to my first statement in introducing this subject. If I am commanded to do this horrible act,
either directly or indirectly, will I obey? If I obey, I may defend my action stating that this prisoner may be a
true enemy of my country. I may willingly participate because the tolerability to the mistreatment appeared
challenging as a research subject. I also realize that after several participating sessions, I may become
immune to what initially appeared abhorrent. Mistreatment by an MD in this case also included failure to
report or prevent torture, falsification of death certificates on those who died from maltreatment or
collaborating in psychological techniques. On the other hand, the consequence of not obeying may mean my
imprisonment, physical injury or verbal abuse. Dare I stand firm in my belief that such behavior or even
collusion is wrong for a physician?
The answer seems obvious, however, if I now extend this belief to a less extreme but still unethical act,
one that has the potential of producing more harm (or pain) than benefit to a patient (despite an informed
consent) or harm to a colleague, if I am under intense societal or peer pressure to do so. Furthermore, does
this apply to a learning curve in certain circumstances? The last seemed acceptable in several institutions(2).
Who am I to cast the first stone? Are we allowed to instill and guide? How do we nurture our young
ones? Given the highly materialistic environment that permeates our society, to dare stand up and say
“damned if I will obey and go along with such commands”(3) often seems impossible.
Keywords : MD, Ethics, Prisoner
