{"id":2377,"date":"2013-03-12T10:11:18","date_gmt":"2013-03-12T09:11:18","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/medical-ethics\/?p=2377"},"modified":"2013-03-12T10:11:18","modified_gmt":"2013-03-12T09:11:18","slug":"torture-and-fitness-to-practise","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/medical-ethics\/2013\/03\/12\/torture-and-fitness-to-practise\/","title":{"rendered":"Torture and Fitness to Practise"},"content":{"rendered":"

I’m running a bit late with this, but the BMJ<\/em> reported last week<\/span><\/a><\/span><\/span> that Mohammed Al-Byati had been suspended from the medical register for 12 months for complicity in torture.\u00a0 So far, the decision hasn’t been uploaded to the list of Fitness to Practise decisions<\/span><\/a><\/span><\/span>, but the outline of the case is available here,\u00a0on the “upcoming hearings” calendar<\/span><\/a><\/span><\/span>:<\/p>\n

The Panel will inquire into the allegation that between December 1992 and March 1994, Dr Al-Byati visited camps and prisons in his capacity as a doctor in Iraq. \u00a0It is alleged that during these visits and whilst administering treatment, Dr Al-Byati knew that some prisoners he treated had sustained injuries as a result of torture, and it was likely that the prisoners would be tortured again. \u00a0It is also alleged that as a consequence of Dr Al-Byati\u2019s engagement in these events, he was complicit in acts of torture.<\/p><\/blockquote>\n

The BMJ <\/em>report relates that<\/p>\n

the panel decided not to end his career by erasing him from the medical register, after accepting that he played no part in the torture and had effectively no choice but to carry out orders.\u00a0 He told the panel that he had been \u201cterrified\u201d of what would happen to him and his family if he did not do as he was told.\u00a0 \u00a0The panel\u2019s chairman, Michael Whitehouse, said, \u201cHe was a junior doctor whose behaviour was being controlled by a dictatorial, totalitarian regime which used systematic, widespread, and extremely grave violations of human rights to control the population.\u00a0 Dissent from orders was not tolerated.<\/p><\/blockquote>\n

There’s a couple of things that’re perplexing about this.<\/p>\n

The first is that it’s not clear how close to the torture process Al-Byati actually was. \u00a0The FtP outline simply alleges that he knew the people he was treating had been tortured, and that they probably would be again. \u00a0The BMJ<\/em>\u00a0repeats this.\u00a0 Al-Byati appears to have denied knowing it<\/span><\/a><\/span><\/span>, but it’s not clear to me that it’d’ve mattered if he had known:\u00a0treating someone in those circumstances doesn’t amount to endorsement of the torture.<\/p>\n

I mean: imagine that you’re working in A&E and someone is admitted whom you suspect strongly (strongly enough for it to count as knowledge in the common-or-garden sense)\u00a0to have been injured as a result of domestic violence.\u00a0 You patch up the patient, who then goes home – to face, you suspect almost as strongly, more violence.\u00a0 It’d be nuts to suppose that you could be criticised as complicit in or even supportive of that violence, though, or that there might be something problematic about treating the patient in the knowledge of what had happened and may happen again.\u00a0 At most, you might be criticised for not contacting the police or social servives; but that’s a question of confidentiality, and of a totally different stripe – and, anyway, to whom would Al-Byati have reported his concerns?<\/p>\n

The other thing that’s perplexing is that noone claims that Al-Byati had any real choice in the matter.\u00a0 It doesn’t seem\u00a0unreasonable for a twentysomething medic to\u00a0agree to provide medical treatment to those who need it, especially when it’s at the request of the state and that state is\u00a0Ba’athist Iraq.\u00a0\u00a0Maybe he could have refused in principle – but in practice, that\u00a0kind of refusal may well have been heroic, and it’s odd to criticise someone for\u00a0not being sufficiently heroic.<\/p>\n

In both cases, consider the alternative. \u00a0The alternative for the patient is not being treated. \u00a0The alternative for the doctor is… well, who can say? \u00a0I doubt that there was much scope for conscientious objection. \u00a0And remember that the complaint is not that he assisted in the torture, but that he\u00a0knew<\/em> about it.<\/p>\n

So why apply sanction?\u00a0 Here’s Michael Whitehouse, the panel chairman, quoted in the BMJ<\/em>:<\/p>\n

\n

He said that the suspension, for the maximum period allowed, was necessary \u201cto demonstrate clearly to him, the profession, and the public that even though his involvement as an accessory to torture was outside his control<\/strong>, such conduct is unacceptable.\u201d<\/p>\n<\/blockquote>\n

Ummm…\u00a0Really<\/em>? \u00a0The emphasis is mine, because this is a very, very odd thing to say. \u00a0Treating people for the effects of torture is not to be an accessory in any meaningful sense – especially if you didn’t have a realistic choice.\u00a0 And the pour encourager les autres<\/em> claim in this context stinks.\u00a0 I mean, as a principle of justice, my inclination is to think that it’s iffy at best in any circumstance.\u00a0 But it’s not really as if anyone needs to have it demonstrated that state-sponsored torture is a bad thing to begin with.\u00a0 And if, mirabile dictu<\/em>, someone does<\/em> need to be reminded of that, it’s not clear that they’re going to be swayed by demonstrations of foot-stamping like this.<\/p>\n

Note that this case seems to raise questions similar to those raised in respect of medical involvement in capital or corporal punishment.\u00a0 However, it’s also significantly different from what I can tell.\u00a0 For one thing, in regimes in which capital or corporal punishment is used and the presence of a medic is mandated as an integral part of that process (for example, if the law demands that a lethal injection be administered by a medical professional), it seems to me that it’d be conceivable that minimally decent doctors would refuse participation, thereby bringing the whole process to a halt.\u00a0 One might even imagine doctors refusing to be involved as a means<\/em> of bringing the process to a halt – though you could, alternatively, make a rule-of-law case to insist that medics ought not to aim to undermine valid laws from valid sources, and draw a distinction between conscientious objection that makes the execution of a sentence (and a prisoner) impossible as a side-effect, and more activistic attempts to exert moral pressure on a notionally unjust law.<\/p>\n

Whatever.\u00a0 There’s a debate to be had there, but it doesn’t really speak to this case, because Ba’athist Iraq was not a rule-of-law regime, and (perhaps more importantly) non-participation wouldn’t – on the face of it – have made any real difference, because from the way the story is reported, the presence of a medic like Al-Byati wasn’t a part of the process.\u00a0 That is: even if Iraq had been a rule-of-law regime, there’s a difference between treating someone who has been tortured and may be tortured again, and treating that person as a part of the torture framework<\/em>. \u00a0There’s no reason to believe that the law required that the torture be overseen by a medic: only that he happened to be the guy closest to hand when the prisoners needed patching up. \u00a0Had he not been there, it’s all-too-easy to believe that the torture would’ve happened anyway.<\/p>\n

Maybe I’ve missed something about the case.\u00a0 But from the way it’s reported, it seems possible that the decision has been at least partially determined by the idea that Al-Byati is contaminated by association with bad people.\u00a0 Either that, or because of PR concerns about the public perception of the matter should the “news”paper to which I do not link<\/span><\/a><\/span><\/span> get wind of it.<\/p>\n

I think that there’s more to be said. \u00a0There must be, mustn’t there?<\/p>\n","protected":false},"excerpt":{"rendered":"

I’m running a bit late with this, but the BMJ reported last week that Mohammed Al-Byati had been suspended from the medical register for 12 months for complicity in torture.\u00a0 So far, the decision hasn’t been uploaded to the list of Fitness to Practise decisions, but the outline of the case is available here,\u00a0on the […]<\/p>\n

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