This Letter to the Editor was published in THE LANCET in September 2007. It was also reported on the Canadian Medicine Editors' blog. They note that only one Canadian signature was amongst the signatories of the Letter. The Letter draws parallels between the conduct of doctors in the case of the torture and eventual murder of South African anti- apartheid activist Steve Biko and the treatment of prisoners on Guantanamo.
The irony of the letter, of which I am a signatory, is that its instigators (David Nicholl, Trefor Jenkins and Steve Miles) chose THE LANCET as the outlet for the Letter. THE LANCET, of course, is at the receiving end of an international boycott aiming at its owner, Elsevier. Elsevier is heavily involved in facilitating international arms trade, a profit driven mission that doesn't gel too well with its academic publishing activities.
From Steve Biko to Guantanamo - 30 years of medical involvement in torture
This week marks the 30th anniversary of the death of anti-apartheid activist Steve Biko while being detained by security police. Initially, the South African Minister of Justice suggested Biko had died of a hunger strike. The inquest revealed that he had died of the consequences of head injuries sustained during police interrogation, and identified gross inadequacies in the medical treatment from the two doctors responsible for his care including the falsification of records. The regulatory authorities failed to take firm action, and it was only grass-roots action by doctors that led, almost 8 years later to Dr Benjamin Tucker being found guilty of improper and disgraceful conduct and being struck off, whilst Dr Ivor Lang was found guilty of improper conduct and was given a caution and a reprimand1.
There are strong parallels with the Biko case and the ongoing role of US military doctors in Guantanamo and the War on Terror. Last year, we suggested that the physicians in Guantanamo force-feeding hunger strikers should be referred to their professional bodies for breaching internationally accepted ethical guidelines2. One of us (DJN) lodged formal complaints with the Medical Boards for Georgia and California as well as pointing out to the American Medical Association (AMA) that the former hospital commander at Guantanamo, Dr John Edmondson, was a member3. After eighteen months, there has still been no reply from the AMA, the Californian authorities have stated that “they do not have the jurisdiction to investigate incidents that occurred on a federal facility/military base”, the Georgian authorities stated that the “complaint was thoroughly investigated” but “the Board concluded that there was not sufficient evidence to support prosecution”, yet an analysis of the same affidavit by the Royal College of Physicians concluded that “in England, this would be a criminal act” (Personal communications to DJN).
The UK government has refused a request from the British Medical Association for a group of independent doctors to assess the detainees4 and, to date, there has been no formal report on the 3 alleged suicides in Guantanamo that took place in June 2006.
The resolution of the Biko case was instrumental in the rehabilitation of the South African Medical and Dental Council and the Medical Association of South Africa which had been subject to boycotts during the apartheid years. The failure of the US regulatory authorities to act is quite simply damaging the reputation of US military medicine. No healthcare worker in the War on Terror has been charged or convicted of any significant offence despite numerous instances documented including fraudulent record keeping in detainees who have died as result of failed interrogations5. We suspect that the doctors in Guantanamo and elsewhere have made the same mistake as Dr Tucker who in 1991, in expressing remorse and seeking re-instatement said “I had gradually lost the fearless independence …and become too closely identified with the organs of the State, especially the Police force…I have come to realise that a medical practitioner’s first responsibility is the well-being of his patient, and that a medical practitioner cannot subordinate his patient’s interest to extraneous considerations.” (cited in1)
The attitude of the US medical establishment appears to be one of ‘See no evil, hear no evil, speak no evil’.
1. Jenkins T McLean GR. The Steve Biko affair: a case study in Medical Ethics. Developing World Bioethics 2003; 3(1): 77-102.
2. Nicholl DJ and 262 other doctors. Forcefeeding and restraint of Guantanamo Bay hunger strikers. Lancet 2006; 367:811.
3. Nicholl DJ. Guantanamo- a call for action. Good men need to do something. BMJ 2006; 332:854-855.
4. Nicholl DJ and 119 other doctors. Doctors at Guantanamo. The Times 18th September, 2006.http://www.timesonline.co.uk/tol/comment/debate/letters/article642161.ece
5. Miles, SH (2006) Oath Betrayed: Torture, Medical Complicity and the War on Terror. Random House, New York