Physicians' justification for participation in human rights abuses

Medical personnel participate in 20% of torture sessions worldwide. Recent evidence of U.S. physician participation in interrogations of terrorism suspects at Guantanamo Bay has highlighted the continuing problem of complicity of medical personnel in human rights abuses. The purpose of this study was to determine why physicians abrogate their ethical responsibilities to patients, and how they justify participation in human rights abuses.

During two weeks in June and July 2003, 98 practicing physicians in two Southern Iraq cities were administered a survey and interviewed about physician complicity in human rights abuses under the Saddam Hussein regime. Participants were recruited from major hospitals through snowball sampling. Free-text responses on written surveys, and transcripts of interviews, were coded for themes.

The cognitive and psychological mechanisms employed by physicians to justify participation in human rights abuses included denial, dehumanization of victims, identification with the government, displacement of responsibility, bureaucratization of their jobs, and the “lesser evil” rationalization. Additionally, some physicians stated that they were coerced into committing abuses.

The justifications of physicians for participation in human rights abuses included many of those that were given by physicians who participated in abuses under other regimes, including in Nazi Germany. A multi-level approach to the prevention of health professional participation in human rights abuses is necessary, including training in professional ethics, policies of professional organizations against member participation in abuse, and transparency and oversight of medical practice in situations most likely to be sites of abuse, including detention facilities, prisons, and other closed institutions.