International Library of Ethics, Law, and the New Medicine 80 Wanda Teays Doctors and Torture Medicine at the Crossroads International Library of Ethics, Law, and the New Medicine Volume 80 Series editors David N. Weisstub, Faculty of Medicine, University of Montreal, Montreal, QC,  Canada Dennis R. Cooley, History, Philosophy, and Religious Studies, North Dakota State University, Fargo, ND, USA Founded by Thomasine Kimbrough Kushner, Berkely, USA David C. Thomasma, Dordrecht, The Netherlands David N. Weisstub, Montreal, Canada The book series International Library of Ethics, Law and the New Medicine comprises volumes with an international and interdisciplinary focus. The aim of the Series is to publish books on foundational issues in (bio) ethics, law, international health care and medicine. The volumes that have already appeared in this series address aspects of aging, mental health, AIDS, preventive medicine, bioethics and many other current topics. 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More information about this series at http://www.springer.com/series/6224 Wanda Teays Doctors and Torture Medicine at the Crossroads Wanda Teays Philosophy Department Mount Saint Mary’s University Los Angeles, CA, USA ISSN 1567-8008 ISSN 2351-955X (electronic) International Library of Ethics, Law, and the New Medicine ISBN 978-3-030-22516-2 ISBN 978-3-030-22517-9 (eBook) https://doi.org/10.1007/978-3-030-22517-9 © Springer Nature Switzerland AG 2019 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. 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The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland To the memory of Woodrow C. Teays Geronimo navigator and atomic vet Foreword1 Wanda Teays presents in her book Doctors and Torture: Medicine at the Crossroads key ethical and practical issues that are at the center of this public debate. On the one hand, countries sometimes feel threatened, such as the United States, in the wake of the terrorist attack of 9/11/01. No country wants to feel threatened in this way. The “fight or flight” response kicks in and safety may be given so much prece- dence in the political triage that citizens will support any policy that promises to alleviate such a threat. No country should feel threatened in this way. All of this Teays concedes. But, on the other hand, the question that comes next is as follows: What should we do about it? This refers both to solve the question of who were the perpetrators (essentially a police action) and how should we act to protect ourselves against future immoral reactions to the same. In Chaps. 2 and 3, Teays creates a scenario of double consciousness where the response of torture to these events is compared to lying: everyone is uncomfortable with it, but maybe it is necessary. This may be a common civic attitude, but what about the physicians? Do they have a professional duty to rise above this popular reaction? Do doctors have a duty not only to refrain from participating in torture but also to report it when they see it and to protect the evidence? This is the ground of Teays’ book. When we think of the global considerations, one barrier for complete analysis is all the secrecy surrounding torture. It is hard to assess the cause of the moral failure if we do not have all the facts. So what should our reaction be to all this secrecy? Either we double down and investigate (as Italy and the United Kingdom have done) or we resign ourselves and quit. This latter reaction will metastasize the tumor of torture as public policy. In Chap. 4, Teays helps us visualize torture through six examples. From these, we find certain common features: disregard for the suspect’s dignity and reinforce- ment of the power dynamic (might makes right). This latter result becomes a driving 1 An example of covering up wrongdoing that enabled crimes to continue is in the oversight by bishops and archbishops in the Roman Catholic Church concerning pedophile activity by members of the clergy. Unless there is vigorous oversight, the problem just continues. vii viii Foreword force that influences the rules of engagement: various methods of inflicting pain as a way to gather information. This is done naively without empirical backing on whether it is even an efficient method. Instead, the power dynamic creates a com- munity worldview of inflicting long-term brutality. In Chap. 5, one of the critical chapters of the book, there is an exploration of the effects of torture. Following some distinctions set out by Nel Noddings on evil, Teays applies this to torture, showing that as a result of these crimes, pain, separa- tion, and helplessness occur. These are medical symptoms that our healthcare pro- fessionals should respond to with care. Physicians (and all healthcare professionals) need to take the side of the patient and not of the “disease” (the interrogators). But, instead, many physicians took the government’s side to assist in the design of the torture. They used their knowledge of mind and body to help create a program of maximum pain, separation, and helplessness. Sometimes, these methods even resulted in death. But the physicians justified their collaboration by placing “loyalty to country above their care for detainees.” This is a direct repudiation of their pro- fessional duty as physicians. In Chap. 6, we are presented with factual details of the methods used in these “enhanced interrogations.” These methods included forced shaving, prolonged dia- pering, sexual humiliation, etc. These go against Kant’s second form of the categori- cal imperative that commands that we recognize the dignity of all people (treat them as ends) and never lower them to mere instruments of some social or practical design (treating them as means only). This chapter connects specific activities of torture to the general moral duty that applies to all people regardless of their profes- sion. Thus, medical personnel who support torture are immoral people as well as bad doctors. In Chap. 7, we explore solitary confinement. This is a very controversial form of imprisonment, in general. Even within our civilian population, it is thought by most that solitary confinement constitutes cruel and unusual punishment. The source of this is that biologically, we are social animals, so taking this away amounts to attack the detainee at his roots as a human. As Teays points out, there is no instrumental value in treating prisoners of war in this manner. It is done merely to create pain and suffering. Teays notes that Britain and Norway have moved away from the solitary confinement even in their domestic corrections facilities. Teays suggests the cre- ation of independent citizen boards will stop this practice. I agree. Chapters 8 and 9 move toward general ethical theory and professional ethics, respectively. Now, in the realm of personal and social/political ethics, there are vari- ous normative theories that generate their imperatives for action on different grounds. Teays set these out as teleological theories, deontological theories (along with Kantian theories), virtue ethics, and feminist ethics. Sometimes, this leads to arguments on the details and can derail the overall discussion. Teays wisely avoids this quagmire by pointing out the areas of agreement among most moral theories against degradation and dehumanization (sometimes resulting in permanent inca- pacity or even death). By following up each theory presented with application, the reader is clear on Teays’ take on each. (For those considering using this book in the classroom, this is especially useful.) Foreword ix However, there is one theory that leaves the door ajar here: utilitarianism. If the majority considers the outcome to be worth it, some practitioners of utilitarianism will allow torture. These practitioners often bring up the ticking time bomb thought experiment. In this thought experiment, there is a bomb that will kill a large number of people— many thousands or more. Since the death of one causes less negative happiness than the death of thousands, it seems permissible to kill one to save thousands. And since torture is less extreme than killing, the proponent says that if torture will bring the desired information, then it is ethically permissible. Teays emphasizes the fact that brutality casts a long shadow. This long shadow confronts those who try to bring forward such examples. In the long run, the choice of torture poisons a society that allows it. Therefore, the utilitarian will have to demur. That only leaves ethical egoists and ethical relativists as proponents. But they, also, fall by extending the time frame of consequences. Teays, again, makes the right call here. With the temporal parameter in play, no ethical theory will con- done torture. Then, there is the issue of professional ethics. The classic code of professional medical ethics goes back to Hippocrates. There are two main tenets: do no harm, and promote the good of the patient. Torture—especially when assisted by medical personnel—violates both of these tenets. It is grounds for losing one’s medical license; therefore, physicians may not be involved in any way in the torture of human beings—period. Teays brings this essential point of professional ethics home with vigor. She recommends that, first, physicians be held accountable for acts of com- plicity in torture and, second, that covering up records of malfeasance should be viewed as crime as well. This second point is very important because covering up immoral, criminal activity enables the continuation of that activity. The convergence of general ethics with professional ethics is a cornerstone of the book and will make this tome valuable for those doing research on this subject and for those looking for a powerful addition to classes in global ethics, just war theory, and global medical ethics (among others). Teays says it best when she argues that professional standards supersede political ideology. This is often difficult in a politics-driven world, but it is a caution we must accept if we are to escape the fate of a “might makes right” world that accepts no values aside from power. Dr. Wanda Teays’ presentation is one crucial argument to help us avoid this fate. Thank you, Wanda. Marymount University Michael Boylan Arlington, VA, USA Acknowledgments Thank you Floor Oosting, executive editor of Social Sciences; Christopher Wilby, assistant editor; and the project coordinators for seeing this book from proposal through production. I am most grateful for your encouragement, your patience, and all you did to make Doctors and Torture happen. Thank you Mount Saint Mary’s University for my sabbatical to work on this book. Thanks also to Michael Boylan for writing a foreword to this text and to Willow Bunu for her reference and research skills. Both of you have been a source of support and encouragement. I am so very appreciative. And thank you dear reader. We have more work ahead, as this book makes clear. Your commitment to examine the concerns around torture and to effect change makes all the difference. xi