Sentences to ponder

by on November 5, 2013 at 7:56 am in Law, Medicine, Philosophy | Permalink

Medical professionals were in effect told that their ethical mantra “first do no harm” did not apply, because they were not treating people who were ill.

That concerns doctor involvement in the U.S. torture of prisoners.  The pointer is from Ted Gioia.

1 Dumont November 5, 2013 at 9:50 am

… “ill-treatment of prisoners” is a well established “War Crime”, under formal International Law and specifications of the (U.S. led) Nuremberg Trials. The formal Nuremberg legal Principles also specified that :

Principle I
Any person who commits an act which constitutes a crime under international law is responsible therefore and liable to punishment.

Principle II
The fact that internal law does not impose a penalty for an act which constitutes a crime under international law does not relieve the person who committed the act from responsibility under international law.

Principles III
The fact that a person who committed an act which constitutes a crime under international law acted as Head of State or responsible Government official does not relieve him from responsibility under international law.

Principle IV
The fact that a person acted pursuant to order of his government or of a superior does not relieve him from responsibility under international law, provided a moral choice was in fact possible to him.


2 Jack Sparrow November 5, 2013 at 9:58 am

“first do no harm” – this principle is violated a lot by all doctors though a few may fool themselves into thinking that they don’t! Just need to think a little broadly into what harm means. Doctors are as self-interested as all humans and such non-sense principles which doesn’t cater to human incentives in the medical profession is itself harmful.

3 TallDave November 5, 2013 at 11:04 am
4 Silas Barta November 5, 2013 at 2:24 pm

What about the asterisk that says “unless it would allow you to bill more to the government or insurer”?

5 Mogden November 5, 2013 at 10:07 am

Everyone involved in this grotesque abomination, from the lowliest guard to the loftiest politician, deserves the harshest punishment.

6 Dan Weber November 5, 2013 at 11:12 am

Even torture?

7 albatross November 5, 2013 at 11:34 am

No, just a blindfold and a cigarette.

8 That Jim November 5, 2013 at 11:58 am

Yes. The USA waterboarded three people eleven years ago.

Let’s stay laser-focused on this grotesque abomination.

9 Craig November 5, 2013 at 12:48 pm

We executed enemy combatants for water boarding US soldiers in WWII.

10 TMC November 5, 2013 at 1:10 pm

They were enemy soldiers, we’re supposed to shoot them.

11 JWatts November 5, 2013 at 6:12 pm


12 Ronald Brak November 6, 2013 at 1:57 am

Page 1,059 of the Judgement of the International Millitary Tribunal for the Far East lists locatios where the Japanese military conducted water torture:

As you can see it was quite extensive but was only one of many forms of torture for which members of the Japanese military were sentenced.

13 Marie November 5, 2013 at 10:17 am

Anyone else find it interesting that an “oath” is not characterized as a “mantra”?

This ship sailed long, long, long ago. . . . .. .

14 Marie November 5, 2013 at 10:18 am

Sorry — now, not not.

15 mike November 5, 2013 at 10:23 am

A handful of known terrorists getting water poured over their heads while under the supervision of doctors: war crime/atrocity/inexcusable approach to preventing terrorism

Every single completely innocent American traveler getting their genitals groped by TSA apes: correct approach to preventing terrorism

16 mike November 5, 2013 at 10:28 am

Oh and also,

firing missiles from unmanned drones in foreign countries at people whose names are unknown, but who fit the demographic profile of terrorists: Nobel Peace Prize Worthy

killing children as collateral damage in aforementioned attacks: still somehow not as bad as pouring water over the head of known terrorists

17 Rahul November 5, 2013 at 11:39 am

It puzzled me why drones are singled out? In good old pre-drone eras weren’t missiles fired in foreign countries? Did old school bombardiers know names of the people they were killing? Was pre-drone warfare less likely to cause collateral casualties? Are drones more likely to kill children than would conventional manned missions?

18 mike November 5, 2013 at 12:39 pm

I personally agree with you on this subject, but drones seem scarier to some people so I put that in.

19 mike November 5, 2013 at 12:51 pm

Also drones are the signature Obama weapon.

20 mavery November 5, 2013 at 12:41 pm

It’s easier to paint drones as some monolithic source for evil and destruction in the world if you ignore the alternatives.

21 JWatts November 5, 2013 at 6:16 pm

It puzzled me why drones are singled out?

Replace drone with cruise missile and it really doesn’t change the significance.

22 albatross November 5, 2013 at 11:46 am

If only it were possible to disagree with torturing prisoners, groping genitals, *and* incinerating Pakistani wedding parties all at the same time.

The people tortured were suspected terrorists, not in general known terrorists. There are a bunch of cases where we seem to have gotten the wrong people. And that is what you’d expect–the police often get the wrong people, working in a country where they’re natives and speak the language and have substantial support and trust from the surrounding population. It would be incredible if soldiers and spies working in foreign countries, in foreign languages, with little trust and much hostility from the locals, didn’t have a higher rate of getting the wrong man. So we tortured a bunch of people, some of whom were really bad folks, some of whom just had the wrong friends, or were in the wrong place at the wrong time.

The really damning thing, though, is that this wasn’t a couple soldiers trying to beat answers out of a captive somewhere. That’s nasty, but that kind of thing happens in any war. But the US government set up one or more *formal programs* for torturing prisoners, with techniques, analysis, medical support, etc. And then, the whole ruling class of the country pretty much closed ranks and decreed that the people who set up those formal programs must never face any consequences at all for it. Disposable enlisted men from West Virginia, sure, but not anyone *important*.

23 mike November 5, 2013 at 12:50 pm

Are you disputing my position, which is that an ongoing campaign of blowing up people we aren’t sure about in a country we aren’t at war with is more outrageous than pouring water over a few terrorists’ heads a decade ago?

24 albatross November 5, 2013 at 1:43 pm

If you are going to discuss torturing prisoners, at least have the balls to call it what it is. Not “pouring water over a few terrorists’ heads”–we tortured prisoners we thought might have useful information. We tortured many of them to death. We tortured innocent people who didn’t know anything, because we thought they might know something. We built a formal program to torture people, including formal protocols for how to do it, and medical supervision to decrease the chances that they would die before we got all the information out of them. It’s quite likely we tortured some American citizens, including Jose Padilla.

If you want to defend it, then go ahead, but call it by its right name.

25 mike November 5, 2013 at 3:30 pm

I did call it what it is. You’re the one advocating for the imprecise term “torture” which apparently includes everything from solitary confinement to putting someone’s balls in a vise.

26 JWatts November 5, 2013 at 6:18 pm

We tortured many of them to death.


27 albatross November 5, 2013 at 9:44 pm

This article summarizes a FOIAed document that reported on 44 prisoners who died under interrogation or soon after. Of those, 21 were ruled homicides by the military. This is one released document; I don’t know what fraction of our torture program is encompassed in this document–I’m pretty sure it does not include the CIA’s secret prisons, for example.

28 Michal November 5, 2013 at 10:33 am

+1 It so nicely shows what is wrong with this civilization.

29 Rahul November 5, 2013 at 11:35 am

Can’t one take the position that all three of those are atrocities? Why must it be one or the other?

30 mike November 5, 2013 at 12:37 pm

You can water down the meaning of “atrocity” all you want, so long as you come up with some other words to distinguish blowing up children from pouring water on terrorists’ heads.

31 Michael B Sullivan November 5, 2013 at 1:06 pm

Okay, let’s take this piece by piece:

1. Mike appears to be trying to imply that there is a broad swath of people who are against torture, but for drone attacks and TSA nonsense. I’m sure that somewhere out there, some such person exists, but it seems clear that the constituency of people who are incensed about torture overwhelmingly overlaps with the constituency of people who are against drone strikes and think that security theatre is ridiculous.

It is mike’s co-religionists who want to minimize the US torture who are also pro-drone strikes and pro-security theatre. By and large.

2. The whole meme of “water boarding is just pouring water on people’s heads” is idiotic even by its own lights. If water boarding is so innocuous, why does anyone actually do it? Is it mike’s contention that the reason these terrorists were water boarded is that they just really needed a shampoo? The only reason that you would bother to water board someone is if you thought that the experience was so deeply horrible that your subject would betray their most deeply held principles rather than go through the experience again.

Perhaps we could imagine a world in which some people just didn’t mind being water boarded. Okay! Those people would never be water boarded more than once! The only point of the procedure is torture. It’s not even like sleep deprivation in which you might argue that the horribleness experienced by the subject is a byproduct, and what you’re trying to do is simply reduce their capacity to make judgment. Nobody argues that being nearly-drowned produces an altered state of consciousness, except the altered state of consciousness of thinking that they want to do anything in their power to prevent something that terrible from happening to them again.

32 Michael B Sullivan November 5, 2013 at 1:10 pm

Sorry, awkward phrasing. Where I wrote “want to minimize US torture,” what I meant was, “minimize outrage over or repercussions from US torture.”

33 mike November 5, 2013 at 1:36 pm

By the way, I don’t know who my “co-religionists” are meant to be but this sort of hysterical partisan-selective moral outrage was exactly what I was ridiculing in my original comment.

34 Rahul November 5, 2013 at 1:15 pm

Personally, I’m against the torture and water-boarding yet totally ok with the drone strikes.

I’d love to hear a good argument as to why the drone strikes are worse than any of the other ways we conventionally prosecute such warfare. e.g. dumb bombs, missiles, mortars, artillery etc.

35 mike November 5, 2013 at 1:19 pm

I would love to hear the argument for why killing people is worse than waterboarding people. I can think of some arguments, but I do not think they’re persuasive. And in terms of sheer numbers, we do a lot more killing than we ever did waterboarding.

36 mike November 5, 2013 at 3:22 pm

I’m sorry, I meant “I would love to hear the argument for why WATERBOARDING people is WORSE than KILLING people.”

37 Marie November 5, 2013 at 6:33 pm

Lots of arguments of that nature have been reasonably made.

Using silly extremes, many moral systems would say that if I walk up to a stranger and, for no reason at all, spit in his face, that’s much worse than if I’m shooting at someone attacking me and the bullet goes through the attacker and kills a bystander that I didn’t know what in the area.

The severity of the injury isn’t always what determines the morality of the act.

But I agree with others, there’s plenty of wrong in all of your examples; and I agree with what I think you’re saying, that it’s really bizarre sometimes what gets and doesn’t get people outraged.

38 albatross November 6, 2013 at 10:26 am

Most of us aren’t interested in your attempt to change the subject from US torture policies to US drone strike policies. That’s a worthwhile topic, but it has nothing to do with the formal policies of torture the US enacted as part of the war on terror, nor with the role ethics-free doctors played in helping keep the victims alive for more torture.

39 Nigel November 5, 2013 at 2:40 pm

Maybe because you’re not at war (with, eg, Pakistan or the Yemen) and drone strikes make it possible to assassinate selected individuals / randomly kill individuals who happen to be in the wrong place, without having to send in troops to another country ?

40 Anonzmous November 5, 2013 at 2:56 pm

We’ve always been at war with Eastasia.

41 TW November 6, 2013 at 11:57 am

That’s a fair point. It used to be that when our leaders contemplated military action they had to worry about the loss of lives of US personnel and whether these actions would be worth the loss of US lives. By being able to kill people remotely, we remove that cost and make it easier for superpowers to take military action than we would have been if we had to see the sight of flag-draped coffins. I’m in favor of taking steps to protect our own people from harm and agree that sometimes military action like the use of drones is preferable but I can also see that the more we use this method, the greater the danger that as a society we will become more detached from the very real consequences of our actions.

42 mike November 5, 2013 at 1:17 pm

There is a spectrum of interrogation techniques that are all intended to get people to talk. They vary in unpleasantness to the subject. They’re not all torture.

43 Nigel November 5, 2013 at 2:43 pm

But water boarding is.
And conducting torture is illegal in the US, so for the government to sanction it is a big deal.

44 albatross November 5, 2013 at 9:47 pm

Well, waterboarding was torture when done by the Spanish
inquisition, the Japanese Army in WW2, and the Khmer Rouge. But when done by US personnel against suspected terrorists, it is enhanced interrogation, or perhaps splashing a little water in someone’s face.

45 Finch November 5, 2013 at 10:32 am

Are doctors ever involved in the design of weapons? Surely chemical weapons? Bomb effects design? Do they work on body armor for soldiers? It would have been awfully hard to conduct the Iraq war without field hospitals.

This is hardly the only place “do no harm” is tested. I think the argument that “do no harm” is meant to describe your relationship with your patient is not a crazy one. You don’t get your medical license revoked for divorcing your wife, for example. The ethics of torture ought to be judged on its own merits – this is just adding confusion.

46 FE November 5, 2013 at 10:33 am

With all due respect to our host, Prof. Cowen does not consistently excel at close reading of news articles. The incendiary sentence he quoted is qualified by the phrase “in effect.” This seems to be the author’s way of implying that she is paraphrasing a quote, but there’s no follow up in the article elaborating on what the doctors were actually told. If a reviewer of Average
Is Over had written “Tyler Cowen in effect states [something outrageous],” I think he would have noticed the ambiguity.

47 TallDave November 5, 2013 at 11:03 am

Doesn’t a prison system by definition operate under the opposite premise (i.e. it is intended to do harm)?

48 Dan Weber November 5, 2013 at 11:14 am

Apparently you can’t get any doctors to supervise state executions.

49 Rahul November 5, 2013 at 11:33 am

Some of the stuff raises interesting ethical questions. Take force-feeding. Apparently the AMA opposes it on ethical grounds.

Maybe not in this case, but say a regular prisoner went on hunger strike, is less harm done by medically force feeding him or by letting him starve?

50 Dan Weber November 5, 2013 at 11:37 am

FWIW, starvation is pretty painless after the first day. If humans became debilitated by hunger pains we would never have survived evolution.

It comes down to allowing them to kill themselves. And “should we stop prisoners from killing themselves?” is different from “should we force them to do something that would keep them alive” the same way different versions of the trolley problem are different.

51 Rahul November 5, 2013 at 11:41 am

Forget prisoners, what’s the legal position on civilian hunger strikes? Does the state machinery watch you die or does it intervene? Can protective custody / intervention be authorized?

52 Nikki November 5, 2013 at 11:06 pm

No documentary proof at hand, but according to a source working at a nursing home, in the US you are free to willingly starve yourself to death unless you’ve been declared legally incompetent. Relatives sometimes demand force-feeding when residents refuse food, and those requests are turned down. They may be senile, but they are still American citizens with all the rights and freedoms attached to the status, unless a competent authority has decided otherwise.

53 GiT November 5, 2013 at 1:08 pm

Prisons aren’t necessarily or essentially punitive and retributive.

54 Aaron Street November 5, 2013 at 11:32 am

Dr. Steve Miles, a professor at the University of Minnesota Medical School (who, incidentally, ran for the US Senate in 2000), wrote a book about this in 2006, titled “Oath Betrayed”:

55 albatross November 5, 2013 at 11:55 am

If the US torture and kidnapping program had been done by some other country, say Mexico or Russia or India, nobody in the US media and government would have any trouble figuring out the morality involved. There would be no difficulty with whether to call waterboarding “enhanced interrogation,” or whether this was okay because it was done to bad people who had it coming.

But because it’s our team, a shocking number of people can find ways to justify it, or at least minimize it. This is, of course, *totally different* from what, say, good Germans told themselves about what was happening to the folks who got put on those one-way train rides. Only a damned America-hating liberal could think otherwise.

56 wm13 November 5, 2013 at 12:28 pm

I don’t follow the argument of the panel. How could a private oath override the command of a sovereign? The government, as President Obama has to keep reminding people, is us. If the people’s elected representatives, and their Constitutionally-appointed subordinates, decide on a policy, a citizen is not excused from obedience to that policy on the grounds that he previously took an oath to the contrary, or that he belongs to a private organization which prohibits its members from such conduct.

Now if a government official ordered someone to do something illegal, he might have an excuse for refusing obedience, but that consideration applies to all citizens, with no special rule for doctors.

57 GiT November 5, 2013 at 1:11 pm

Why couldn’t a private organization make its membership contingent on refusing to do things that one may be ordered to do, by the state or anyone else?

58 wm13 November 5, 2013 at 10:36 pm

You mean like the Mafia? You can have such an organization, but such organizations are commonly called “criminal conspiracies.”

59 TMC November 5, 2013 at 1:13 pm

Resistance is futile.

60 Brian Donohue November 5, 2013 at 6:34 pm

+1. LOL. Literally.

61 albatross November 5, 2013 at 1:47 pm

Say, wasn’t there some kind of big decision once on the question of whether following the orders of your government was a complete defense against charges of crimes against humanity?

62 mike November 5, 2013 at 3:38 pm

Why would anyone care what a small group of dead old white guys thought on the subject?

63 wm13 November 5, 2013 at 10:38 pm

You are not reading very closely, are you? Obviously, as I said, if the government orders you to do something illegal, you might have grounds to refuse, but not if the government orders you to do something that violates the rules of your club.

64 albatross November 6, 2013 at 7:22 am

I’m not sure this is quite right. Can a Catholic priest who is also a
Army chaplain be ordered to report on what someone told him in confession? I would expect a priest to refuse such an order.

At any rate, torture was and is illegal, both by US law and by international law.

65 Ray Lopez November 5, 2013 at 12:46 pm

Well you folk don’t know much about this issue, so let me educate you. Back in the 1990s a Mexican doctor that worked for the Mexican drug cartel ended up keeping a US DEA undercover cop alive longer so he could be tortured more before he died. (Google this). The USA retaliated by kidnapping the doctor, while the doctor was in Mexico, and extraditing him to the USA to face trial. Eventually the case went before the Rehnquist Supreme Court, which held such extraditions *were* legal. The doctor, btw, was released by the trial judge after the Sup. Ct. decision on evidentiary / technical grounds, but this Rehnqust decision was the legal basis for Gitmo. Ironic the the US doctors are doing–in a milder way of course–what the Mexican doctor was chastised for.

66 mike November 5, 2013 at 1:04 pm

Was the Mexican drug cartel waterboarding the guy?

67 bluto November 5, 2013 at 1:52 pm

No, their methods were pretty simple. They generally beat people to death, then had the doctor resuccitate them for further beatings.

68 mike November 5, 2013 at 6:23 pm

now THAT’s what I call torture!

69 Nigel November 5, 2013 at 2:49 pm

Medical professionals were in effect told that their ethical mantra “first do no harm” did not apply, because they were not treating people who were ill.

Does Google have a similar rider to its ‘don’t be evil’ motto ?

70 edeast November 5, 2013 at 3:38 pm

Youtube won’t let me get all the way through this video, but I assume it’s pertinent.

Brigadier general (retired) Stephen Xenakis MD, on omar khadr.

71 Peldrigal November 8, 2013 at 7:48 pm

I just feel dumb having to assert again such things in the XXI century, but…

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