Recent revelations about post-9/11 practice remind us that doctors’ ethical guidelines are only as good the society that has allowed a variety of shocking human experimentation.Originally published in The Guardian, 22 June, 2015.
New documents released by the Guardian have shown the CIA may have broken its own internal ethics policies during their controversial torture programme following 9/11. In particular the CIA breached its guidelines for “human experimentation”, which specifically state that research should not occur without a subject’s informed consent.
While these breaches may not be surprising to the cynical, the involvement of medical doctors and psychologists in the programme still has the capacity to shock. Doctors from the Office of Medical Services (OMS) were active throughout the torture programme – with some even being present and participating in the interrogations themselves. This, according to many medical professionals, it a major breach of medical ethics – procedures based at their heart on the principle of “do no harm”.
But is this really such a shock? Unfortunately, probably not. Look at the history of medical science and these breaches are more common than we’d like to admit.
The controversy over the CIA torture is very similar to another debate raging within the US medical community – that over doctor involvement in the death penalty. With the growing use of the lethal injection, doctors have been increasingly involved in this form of punishment, developing and implementing drugs for the purpose of killing. As Jonathan Groner explains (PDF):
“Even without physician participation, the lethal injection process so closely mimics medical practice that the entire medical community is tied to the death chamber.”
This is highly problematic. As we’ve seen recently, the lethal injection has at times been akin to torture. In 2014 in Oklahoma for example, convicted rapist and murderer Clayton Lockett was submitted to what was called a “botched execution”. In what was the state’s first attempt at using a new three-drug cocktail, Lockett ended up living for 43 minutes after he was injected, writhing in pain as he was strapped to the gurney.
Even if lethal injections can be more “humane” approach, they represent a significant threat to the medical profession. Jonathan Groner argues:
“Not only does lethal injection induce physicians to perform unethical activities, but lethal injection also ‘medicalises’ executions, meaning that its veneer of medical respectability allows the imagery of healing to be used to justify killing.”
It is the “imagery of healing” that has often been used for some of the other worst examples of medical practice. The most obvious example relates to sexuality. Up until 1973 the American Psychiatric Association – and similar associations around the world – considered homosexuality a mental illness. This is part of what Michel Foucault described as “scientia sexualis”, or the scientification of sexuality. Within this ideology “divergent” sexualities were identified scientifically, with doctors then conducting ‘conversion therapy’ to cure people of these illnesses. Techniques included forced hospitalisation, electro-shock therapy, castration, torture drugs and lobotomies.
Perhaps the most famous case of this is the treatment of Alan Turing – the father of computing. After it was discovered that Turing had a homosexual lover in the 1950s he was punished through chemical castration, given hormones to suppress his sexual urges. Turing died of cyanide poisoning only two years later in 1954 at the age of 41. It was at the time put down to a suicide, although recent evidence has suggested that may not have been the case. Either way the story represents potentially the most high-profile unethical medical treatment of homosexuals to date.
And while this may sound like old news, unfortunately that’s not the case. A committee of the Australian Senate for example recently heard evidence from the Organisation Intersex International Australia (OII), who stated that every member of their organisation had at some point experienced a form on non-consensual medical intervention. One story from OII was particularly shocking — a person who agreed to hormone therapy after his doctor insisted that it would “turn him into a real man”:
“It was insinuated, even blatantly stated on occasions, that my life would be worthless; that I would be a freak; that I would never achieve my potential, and that I would never have any self-esteem … So, eventually, from the age of 28, after about six years of constant threats and ‘counselling’ by my medical specialists, I began testosterone therapy. And I found it to be a horrifying experience.”
All of these cases have been based on a desire to do some form of good, but have resulted in what has often been the traumatic and horrible treatment of people against their will. This does not just relate to the treatment of medical patients, but to medical research as well.
For example, from 1951 to 1974 Dr Albert Kligman conducted a range of medical experiments at the Holmesburg Prison in Pennsylvania in the United States on behalf of the Dow Chemical Company, the US Army and Johnson & Johnson. In one study Kligman injected dioxin – a highly toxic and carcinogenic compound found in Agent Orange – into 70 prisoners. He did so because Dow Chemical employees were being exposed to the chemical and the company wanted to know what effect it had on the skin. Prisoners developed severe lesions, with many being left untreated for months.
In another example, from 1946-48 American public health officials conducted a range of unethical medical experiments in Guatemala, infecting soldiers, prostitutes, prisoners, and mental health patients with syphilis and other sexually transmitted diseases without their knowledge or consent. Researchers wanted to test the effectiveness of penicillin in both preventing, and curing syphilis, something they were struggling to do in the laboratory. In doing so they infected people without their consent, with a number dying as a result.
What’s shocking about these examples is they came so closely after the discovery of Nazi medical abuses during the second world war. Throughout the war Nazi doctors conducted a range of horrible medical experiments on people in concentration camps. Perhaps the most notorious of these were conducted by Josef Mengele – known as the Angel of Death. Mengele was particularly fascinated in twins and conducted a range of brutal experiments including injecting dyes into people’s eyes, amputating limbs, intentionally infecting one twin with a disease to test the impact, and transferring blood from one twin to another. In a particularly gruesome example, he sewed two children together in an attempt to create conjoined twins. They both died several days later after developing gangrene.
It was these atrocities that lead to the development of the Nuremberg Code of human experimentation, which outlines the research ethics principles for human experimentation. The code has similar principles to broader ethical guidelines for medical practice — primarily based on the ideal of “do no harm”. This is how we all see medical practice — it is primarily a healer, and helper. Yet unfortunately what we’re finding is this isn’t always the case. Often, medicine is used for other ends.
Of course this is the exception to the broader rule. Medical practitioners around the world are overwhelmingly focused on the treatment of illness, the finding of cures of diseases, and ensuring people live long and happy lives. The Nuremberg Code, along with other medical ethical guidelines, have become central to medical practice.
Yet, what the CIA examples highlights is that we must remain wary. While of course these crimes do not match those of the Nazi era, they still highlight a major breach in medical practice. The CIA’s policies were in line with best practice medical ethics. Yet the organisation, and the doctors involved, continued anyway. They crossed the boundaries and clearly thought that was an acceptable thing to do.
There are two things we need to learn from this. First, ethics are only useful when they are actually understood and enforced. While the CIA clearly had good guidelines, they were not followed. In that instance, what is the point?
But secondly, and more importantly, these examples highlight that while we often treat the medical profession as if it is an inherent “good”, in reality it is only as good as the society and organisation that builds it. Of course many breaches of medical ethics are due to rogue practitioners acting outside the boundaries, but each of the examples above were allowed to happen because of the values of the society at the time — from governments turning a blind eye to unethical medical experiments, to a society that supports torture and the death penalty.
Our society is built within particular power structures and whether we like it or not, medicine – and the broader sciences – have been developed, and act, within these structures. That does not mean that all medical practitioners are destined towards breaching their ethics, but rather that, just like with any other profession, we have to keep a constant check on how medicine operates. Medicine is just as likely to be used as a method of implementing power as any other profession.
We see medicine in our society as an inherent good. But as these examples show, it is often only as good as the society that uses it. It is our job as a society therefore to make sure these sorts of breaches do not occur again.