Angst and Moral Courage

The Hippocratic Oath is a tradition that physicians have participated in since the 5th Century B.C.E.  Although no one version is referenced by all doctors, the same basic premise resounds throughout: medical doctors possess an obligation to act justly, whether they are alleviating the suffering of the sick, to the best of their ability, or simply remembering to respect the dignity of all persons, sick and well.

A recent article in The Guardian describes former-President George W. Bush's admission in his memoir, Decision Points, to allowing--or rather giving a "Damn right" to--the use of torture, including waterboarding, by the CIA. Bush's justification for this decision relied on the presence of doctors, who no doubt have taken some version of the above mentioned oath, during the procedures. In fact, according to Bush, the doctors gave their assurance that the procedures did no lasting harm.

There is, however, something missing here. Since waterboarding and other forms of torture are illegal, there is a shortage of credible medical studies on the health effects to people undergoing them. It seems that the CIA under the Bush-Cheney administration took advantage of the opportunity the wars they started provided to conduct the studies themselves.

The participation of the doctors in all of this goes against physician codes of ethics for several reason. It is unethical for a doctor to conduct a study on a human subject without the subject's permission. It is also a clear violation of basic human rights to participate in torture. That last reason is not something which is exclusive to medical doctors either.

On a more fundamental level, there is also something a bit dubious about the studies. Doctors were brought in for torture procedures in order for them to make observations and calibrate the boundaries for where the procedures begin to produce "severe pain" in the prisoners. The production of "severe pain" is an important legal threshold, demarcating the difference between torture and non-torture. Yet a problem arises whenever a study requires an observer to make an objective quantitative assessment of the pain another party is subjectively experiencing. This is the same problem that arises when doctors are brought in to determine whether or not a patient's pain has become "unbearable", therefore making the patient a candidate for euthanasia in Denmark.  

As Keller and Allen put it in their article, "The circular reasoning of legally requiring medical participation in torture – and then arguing that this is what makes the torture legal – is palpable and brazen." Since the justification of the procedures is logically flawed, and the conductance of the studies is scientifically and morally flawed, the presence of doctors during torture procedures was unnecessary and grossly irreverent.

I do not want to play the blame-game. While I do not doubt that there are doctors out there who would have voluntarily participated in this out of a skewed sense of patriotic duty, I also would not be surprised if any of the doctors that did this were coerced into participating, whether with threats of losing their job or the temptation of cash. I've been given the concept of moral courage much thought lately. I think that it is necessary  present in large quantities in every great leader, but also must be a characteristic of every good citizen. Reading about the role doctors played during the CIA's torture of prisoners makes me realize that moral courage is not something people are born with. It is something that must be worked towards and requires a great deal of thought and reflection.

I started this blog so that I may have a way to organize my thoughts, while I reflect on my own actions, in light of my future aspiration to be a physician, and the role moral courage plays in my decision-making.