According to latest statistics from Amnesty International,[1] torture is systematically or episodically practised in around 65 countries with credible allegations of incidents from over 30 others. The true figures are probably much higher as many countries are closed to human rights investigators. Reports of the involvement of doctors and other health professionals in torture are frequent.[2]

Prisoners and detainees suffering from poor health after physical and mental torture are often brought for examination before doctors or other health professionals. But rather than the compassion they should be able to expect from 'healing hands', they are often met with faces turned the other way, cold detachment or wilful ignorance as to how they came to sustain such injuries. Sometimes the hand of the doctor is also the hand of the torturer.

To what extent are doctors involved in torture? How do they get involved? How can we respond as Christians?

Medical involvement

Although it is difficult to assess, doctors have been implicated in a number of ways:

• Evaluating a victim's capacity to withstand torture before it starts.
• Supervising torture through the provision of medical treatment if complications occur.
• Providing professional knowledge and skills to the torturer. For example a doctor might pass on that the victim is asthmatic, enabling the torturers to exploit this by using methods of suffocation.
• Falsifying or deliberately omitting medical information when issuing health certificates or autopsy reports. An example of this is the death of Steve Biko, the South African black rights activist.
• Providing medical assistance within the torture system without either denouncing torture or resigning from such work.
• Administering torture by directly participating in it.
• Remaining silent in spite of the knowledge that abuses have taken place.
• Using political prisoners for unethical experiments, eg the Nazi doctors.[3]
• Abuse of psychiatry for political purposes: declaring political opponents insane and subjecting them to unnecessary sedation or sectioning in mental institutions.
• Corporal punishment such as beatings and amputation of hands or feet: a growing problem in Iraq as highlighted in the last few years in the British Medical Journal.[4]
• Forced feeding of hunger strikers as carried out in the UK in the 1970s.5

How do doctors get involved?

• The available evidence suggests that those who participate in torture, including doctors, are not exceptional or uniquely evil persons.[6] An interplay of psychosocial, cultural and political factors is involved. However, a number of mechanisms by which a person becomes able to carry out terrible acts have been suggested[7]
• Discrimination and labelling or devaluing of a victim group such as occurred in South Africa and continues in Israeli occupied territories.
• Military training that encourages unquestioning obedience to orders. Doctors in the military or young conscripted doctors are particularly vulnerable.
• A tendency to blame the victim for their fate.
• Identification on the part of the doctor with the cause of the torturers, seeing their participation as part of the 'fight against the enemy'.
• Fear of the consequences of refusing to co-operate (see later).
• Career advancement as a reward for participation.
• Lack of a moral framework and a tendency to see the job as a technical process.
• Inadequate understanding of medical ethics.

One often asked question is how doctors who participate in torture can reconcile it with their role as healers and comforters, husbands and fathers. In his study of the Nazi doctors,[6] Lifton identified the psychological process of 'doubling' whereby the doctor manages to split his psyche into two functioning wholes, each with its own mutually contradictory value system. Primo Levi, an Italian Jew who survived Auschwitz, deals with this subject particularly well.[9] He suggests that the lies torturers use to excuse their actions are internally rehearsed until in their minds they become truth.

It is a great mistake for us to see doctors who torture as very different from ourselves. Given the right circumstances, many of us could be enticed to commit acts of barbarism. Just reflect a moment on our attitudes to the patients we come across. Are we not tempted to discriminate against certain groups? Do we go along with what the boss says even when it compromises our moral beliefs? Do we blame the victims, seeing patients as somehow responsible for their illnesses? Do we think of the ventilated ITU patient as a reckless young fool who deserved to crash his motorbike or the cancer patient as only having himself to blame? We must all be vigilant, not only about our ethical standards but also our emotional and psychological responses to those we care for.

Doctors as victims

Doctors, however, are not only involved in the torture process. Often they are the victims. Throughout the world there are many courageous doctors who have campaigned for human rights issues, drawn media attention to abuses or refused to participate in corporal punishment and torture. A recent Amnesty International document[10] outlines the risks that doctors face. In countries such as Turkey, Kenya and Pakistan medical workers have been killed, imprisoned and tortured as a direct result of refusing to co-operate.

Ethical codes

What do international codes of medical ethics say about the involvement of doctors in torture? Underlying all ethical codes that relate to torture lies the principle of primum non nocere, above all do no harm.

The World Medical Association's Declaration of Tokyo, adopted in 1975, states:

The doctor shall not countenance, condone or participate in the practice of torture or other forms of cruel, inhuman or degrading procedures, whatever the offence of which the victim of such procedures is suspected, accused or guilty, and whatever the victim's beliefs or motives, and in all situations, including armed conflict and civil strife.

It is noteworthy that the declaration also prohibits forced feeding where the prisoner can make a rational choice to continue a hunger strike.

In 1982 the United Nations General Assembly adopted the 'Principles of Medical Ethics' which prohibit health personnel from being involved in certification of fitness for prisoners or detainees to undergo any form of treatment or punishment that may adversely affect their mental or physical health.

The British Medical Association (BMA) has published guidance on a doctor's ethical response to torture;[11] in particular that:

Doctors having knowledge of any activities covered by the Declaration of Tokyo have a positive obligation to make those activities publicly known.

The medical profession has a responsibility to support any practitioner who refuses to keep silent about abuses of human rights...Doctors in countries where torture does not occur have a responsibility to assist colleagues in countries where it does.

A Christian response

How should we respond as Christian doctors?

The Bible clearly states that every man, woman and child bears the image of God (Gn 1:26-27) and that consequently human life is very precious (Gn 9:5-6).

Furthermore, God has always had a special concern for vulnerable and oppressed groups in society (Ex 22:21-22; Jas 1:27), including those who belong to a different nation or racial group (Dt 10:18-19; Ps 146:9).

Jesus Christ himself showed us how much he values human life by dying on the cross in our place, setting us free from the penalty of our rebellion against God (Rom 5:8). He taught us the true meaning of love (Jn 15:13) through the example of his own life. The love that Jesus showed and talked about extended across racial and national boundaries (Jn 4:4-43). He commanded us to love our enemies, do good to those who hate us, bless those who curse us and pray for those who treat us badly (Lk 6:27-28). Those of us who follow Christ must obey his commands, rejecting political ideology and rhetoric if it enjoins us to do otherwise. Although as Christians we are encouraged to submit to governing authorities (Rom 13:1-6), our loyalty to Christ and his commands comes first (Acts 4:19, 5:29).

More than this, our Saviour is able to identify deeply with the sufferings of the victims of torture. He was betrayed (Lk 22:47-48), abused (Jn 18:22), beaten and mocked (Lk 22:63). He suffered the final torture and ignoble death of the cross. To this day he still bears those scars (Jn 20:27). Yet he is also the one who overcame death to bring healing, wholeness and new life to all those who trust in his name. One day he will come again and put an end to all suffering, including torture (Rev 21:4).

From the life and teaching of Christ it is clear that Christian doctors should not have any part in torture. In fact our attitude should be one of active prevention rather than turning a blind eye, even if this means costly sacrifice on our part (Jn 15:12-13). For many the issue of torture may seem far away. However, human rights groups have been critical of the UK's treatment of asylum seekers and prisoners.[12] Treating the victims of political violence is a reality for many British doctors working in developing countries.

As Christians we are called to care for our neighbours. 'Who is my neighbour?' an expert in the law once asked Jesus, wanting to justify himself (Lk 10:29). In reply Jesus told the parable of the Good Samaritan, indicating that our neighbour is anyone we see who is in need of our assistance, regardless of religious or racial barriers (Lk 10:30-37). What might loving our 'tortured neighbour' involve? Here are some suggestions:

• Being aware of the ethical issues involved and the international ethical codes which doctors are to abide by. We should uphold these in all situations.
• Being aware of Christ's teaching in regard to the love we should show towards disadvantaged groups and 'enemies'. We must set our heart, mind, soul and body to obey him.
• Being aware of human rights issues and what is happening around the world. There are many groups that organise campaigns for the release of prisoners of conscience and an end to torture. Amnesty International[13] is the best known but there are others that do a similar job such as Christians Against Torture,[14] Physicians for Human Rights[15] and the Jubilee Campaign.[16]
• Remembering in prayer the victims of torture, the governments and doctors involved. Information received from human rights groups can help guide us as we pray.
• Getting involved. All of the groups mentioned above run campaigns lobbying governments to end torture and demanding the release of prisoners of conscience. Some also organise letter writing to individual prisoners as a means of encouragement and hope.

Jesus taught us that we have a special responsibility to care for our Christian brothers and sisters who are in need (Mt 25:31-46). If we turn our faces from them we risk rejecting Christ (Mt 25:41-46). However, this does not mean that we can neglect those who are outside the fellowship of believers. We also have a responsibility towards them (Rom 12:20-21; Gal 6:10). It is a real challenge: we need his strength and mercy. Yet, having compassion for those around us is worship that God loves to receive:

Is not this the kind of fasting that I have chosen: to loose the chains of injustice and untie the cords of the yoke, to set the oppressed free and break every yoke? Is it not to share your food with the hungry and to provide the poor wanderer with shelter - when you see the naked, to clothe him, and not to turn away from your own flesh and blood? Then your light will break forth like the dawn, and your healing will quickly appear.(Is 58:6-8)