Some of my idols have feet of clay?

A few weeks ago I wrote enthusiastically and gratefully about the doctors in Bhopal Medical Hospital and Research Centre and how they stood up against corruption and fought off the deadly meddling fingers of bureaucracy. Indeed the personification of selfless service and definitely to be idolised. But that doesn't mean that all doctors are so. This week, I came across an article in the New England Journal of Medicine which left me with a bitter aftertaste.. The article was about various evidence which has emerged that some American doctors, nurses, and medics have been complicit in torture and other illegal procedures in Iraq, Afghanistan, and Guantanamo Bay. I certainly don’t want to throw all doctors into the same pot, because obviously most still put their patients (regardless of who or what they are) first. After reading that article I thought about the Hippocratic Oath, one of the oldest (400 BC) binding documents in history. Though it was written way back in the mists of antiquity its principles are still held by most doctors to this very day.

So what makes some doctors think that the Hippocratic Oath has become irrelevant and that there is no need for them to adhere to it any longer? The fact that medicine has changed so much since the days of Hippocrates, and has gone through major scientific, economic, political and social changes, and has inevitable had to include pestilences unknown to the physicians then and had to deal with issues such as legalised abortion, euthanasia and research on human guinea pigs is not enough reason. After all, at end of the day, doctor's first principle is, "first, do no harm" and its rather sad that we see evidence that this core principle is violated.

After reading that article I thought about doctors and what would motivate them or cause them to commit such hideous acts against their fellow human beings, when they are supposed to alleviate their pains. I googled “breach of ethics of Hippocratic oath” and to my amazement I got a very long list which I will share with you here. I shall not go into much detail of the happenings (alleged or proven) in Iraq, Afghanistan and Guantanamo Bay, but what struck me the most was the paragraphs dealing with the allegation that medical personnel have overlooked to report wounds on prisoners that were very clearly caused by torture. Not only that, but they have been said to have participated in covering up some of the gravest human right abuses by falsifying the death certificates of prisoners who have been killed by torture. An article in the New York Times about Abu Ghraib stated that: "much of the evidence of abuse at the prison came from medical documents" and that records and statements "showed doctors and medics reporting to the area of the prison where the abuse occurred several times to stitch wounds, tend to collapsed prisoners or see patients with bruised or reddened genitals." Why didn’t they report the abuse? What made them remain silent? Why did they wait for months and months before reporting what they had seen? Doesn’t the Hippocratic Oath declare, "I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrongdoing."?

It is understandable that being a military physician is more conducive to the creation of an internal moral conflict between the commitment to the healing of individuals on one hand and the responsibility to the military hierarchy and the command structure on the other. Nazi Germany provided the most extreme examples of doctors becoming tools for atrocity instead of healing. In addition to the cruel medical experiments, many Nazi doctors were directly involved in killing.

Unethical medical experimentation carried out during the Third Reich can be divided into three categories. The first category consists of experiments aimed at facilitating the survival of soldiers. In Dachau, physicians from the German Luftwaffe and from the German Experimental Institution for Aviation conducted high-altitude experiments, using low-pressure chambers, to determine the maximum altitude from which crews of damaged aircrafts could parachute to safety. They also carried out “freezing experiments” using prisoners to find an effective treatment for hypothermia.

The second category of experiments aimed at developing and testing drugs, pharmaceuticals and treatment methods for injuries and illnesses encountered in the field. At the German concentration camps of Sachsenhausen, Dachau, Natzweiler, Buchenwald, and Neuengamme, scientists tested immunization compounds and sera for the prevention and treatment of contagious diseases, including malaria, typhus, tuberculosis, typhoid fever, yellow fever, and infectious hepatitis. The Ravensbrueck camp was the site of experiments for bone-grafting and to test the effectiveness of newly developed sulfa drugs. At Natzweiler and Sachsenhausen, prisoners were subjected to phosgene and mustard gas in order to test possible antidotes. The third category of medical experimentation and the most hideous of them all sought to advance the racial and ideological tenets of the Nazi worldview. The most infamous were the experiments of Josef Mengele at Auschwitz and Werner Fischer at Sachsenhausen. Modern medicine has had little difficulty condemning the Nazi doctors as evil men. But what is being said of the continued use of the Nazi doctors' medical research today?

But sadly it was not only the Nazis who made use of doctors and their medical knowledge, but various other regimes have exploited that knowledge to their own despotic ends. Physicians have served as actual torturers in Chile; others have surgically removed ears as punishment for desertion in Saddam Hussein's Iraq. In the Soviet Union some have incarcerated political dissenters in mental hospitals. In South Africa some have falsified medical reports on blacks who were tortured or killed. Doctors associated with the CIA have conducted harmful (sometimes even fatal) experiments involving drugs and mind control and the list can be continued. But that was not the only thing that emerged. The other items struck me even more, namely some of the practices of civilian doctors in “normal” times and not in times of wars and conflict. I was shocked reading about this bizarre new ‘mental’ illness called "Body Integrity Identity Disorder," or what I would term "amputee wannabe." Yes, you read right, we are talking about ‘disturbed’ people who want their arms, legs or other parts cut off. What is even worse is that there appear to be at least a few doctors whose "conscience" allows them to amputate these patients' healthy limbs, most notably Dr. Robert Smith of Scotland, who has admitted to consenting to the desires of his amputation-obsessed patients. According to the report there are even psychiatrists willing to prescribe amputation as the "only" available therapy to their patients' obsessions. even though no formal research studies on treatments for these people has ever been undertaken. This naturally leads to the mention of the scandal at Alder Hey Children's hospital, where hearts and other organs from hundreds of children who died at the hospital between 1988-1996 were removed and stored without permission. And the scandal about the hospital around the north west of England, where hospital staff kept and stored hundreds of foetuses. In Sweden, there was even a law which forcibly sterilised insane or criminals though doctors. While the law was enacted in 1934, it wasn’t removed from the rolls till 1977. Nobody was released from a prison, orphanage or mental hospital without "agreeing" to be sterilised. One can’t help but wonder.

Furthermore I just do not understand how some doctors could refuse medical treatment to patients, any patients at all. I have read about evidence of some American doctors refusing medical treatment to lawyers, their families and employees except in emergencies. Not just that but these doctors are urging the American Medical Association to endorse that view. Could the anger over malpractice lawsuits go as far as to go contrary to the Hippocratic oath, in which doctors acknowledge "special obligations to all my fellow human beings." Although there are jokes galore about lawyers and it is indeed true that because of the fear of malpractise suits, several states are now seeing serious shortage of practising doctors, but does that mean that the doctors wont treat lawyers? Recently, in the UK, there was a report in the UK press that some Muslim doctors refusing to treat patients with sexually transmitted diseases and Aids because they believe that such ailments are result of sinful behaviour and punishments from God. I hesitate to include the news about the appearance in England of the "lunch time" abortion, a 10-minute "walk-in, walk out" service now available at centres in London, Leeds and Manchester. Umm, in the immortal words of Homer Simpson, "D'Oh".

Fearing that the ethical standards of medicine might be slipping, the British Medical Association recently issued a wake-up call by renewing the commitment to the ancient tradition of the Hippocratic Oath whereby all medical graduates are again expected to swear adherence to it. To improve and perhaps even reaffirm respect for human dignity, to make medicine more than just a hard but lucrative job, to again turn it to being a calling, to remind physicians that their first duty is to their patients, not to government or army or what have you, will require more help than the mere memory of Hippocrates alone can give us. We do not want the judgment of history, a century or more from now, to say that medicine had become more pagan than that of the pagan ‘Father of Medicine’, Hippocrates. Perhaps these errant doctors need to visit Bhopal Memorial Hospital to relearn what doctors should be like and why they are respected enough to worship the ground they walk on.

All this to be taken with a grain of salt!