Article Categories

Take the Physicians out of the System and it Will Cease to Exist

 

Articles - Torture

By Hadas Ziv and Ze’ev Weiner*

Following the Israeli Supreme Court’s ruling in 1999 prohibiting torture, it seemed – or at least we hoped – that the era of torture in Israel was over, and with it the shameful complicity of medical personnel who served as a safety net for torture and as collaborators whose silence constituted consent. One might have assumed, then, that the various institutions that failed to extricate medical personnel from this terrible practice would follow the Supreme Court's ruling and recognize their failure. However, the reaction of the Ministry of Health was typical. For ministry officials, the ruling resolves the dilemma: if torture has ended, physicians are also no longer participating in torture. Therefore, it is of no surprise that none of those involved – chief medical officers or physicians who examined the prisoners – was summoned for review or punished. Everyone heaved a sigh of relief and left the past behind them.

In recent years, there is growing testimony that torture, albeit in a different form, has returned and is again being supported by the familiar “ticking bomb” argument. This argument should not affect the perspective of medical personnel, however, because even if one considers torture to be justified – and it is not – medical personnel are prohibited from participating in it in any shape or form. Yet it is impossible to ignore the fact that the prevalent environment has an impact on the willingness of physicians to turn a blind eye to torture and even participate in it in a monitoring role, such as by examining the prisoner before, during and after interrogation. Some will ask why we focus on medical personnel; shouldn’t torture itself be the focal point of the struggle? The answer is: Of course it should. However, we should not downplay the importance of removing physicians from the system as the most effective step toward eradicating torture entirely. Medical personnel are a central tool or a kind of fig leaf that enables others within the system to continue to carry out this prohibited activity under a veil. Try to imagine an execution taking place in the United States without an anesthesiologist to enable the execution to be conducted without pain. Or try to imagine the Shin Bet (GSS) designing methods of torture without seeking medical consultation, or an interrogator working without a medical safety net to treat those who are injured. In addition, the mere existence of torture harms the whole of society and the involvement of physicians in torture destroys the ethical cornerstone of the medical profession. Its ramifications extend to medical activity in general beyond the walls of the prison and interrogation facilities.

Since the medical establishment failed to confront its past, our situation today, when confronted against with the challenge, is no better. All that we can hope is that the memory of the failure of the past will enable our complaints and struggle to respond more rapidly today with a sweeping, unequivocal directive to immediately remove medical personnel from the system of torture in the short term, and to initiate ethical and disciplinary proceedings against implicated medical personnel and stripping them of their license to engage in the profession. Ostensibly, the way to deal with this should have been totally obvious. If organizations such as the Shin Bet and the Ministry of Defense lack ethical codes, then the involvement of physicians in torture, in knowing, in acting, in failing to report or issue warnings, is prohibited under every ethical code, and in the most explicit manner. The most prominent of these codes, the Declaration of Tokyo by the World Medical Association, which was also ratified and adopted by the Israeli Medical Association, notes, among other things, that:

• The physician shall not countenance, condone or participate in the practice of torture or other forms of cruel, inhuman or degrading procedures, whatever the offense of which the victim of such procedures is suspected, accused or guilty, and whatever the victim’s beliefs or motives, and in all situations, including armed conflict and civil strife.
• The physician shall not provide any premises, instruments, substances or knowledge to facilitate the practice of torture or other forms of cruel, inhuman or degrading treatment or to diminish the ability of the victim to resist such treatment.
• When providing medical assistance to detainees or prisoners who are, or who could later be, under interrogation, physicians should be particularly careful to ensure the confidentiality of all personal medical information. A breach of the Geneva Conventions shall in any case be reported by the physician to relevant authorities. The physician shall not use nor allow to be used, as far as he or she can, medical knowledge or skills, or health information specific to individuals, to facilitate or otherwise aid any interrogation, legal or illegal, of those individuals.
• The physician shall not be present during any procedure during which torture or any other forms of cruel, inhuman or degrading treatment is used or threatened.1

Collaboration in torture in Israel was and still is mainly conducted through the examinations performed before, during and after the interrogation, with medical personnel disregarding complaints made by detainees in one or more of the following ways:

• a failure to demonstrate awareness of the existence of the problem;
• a failure to diagnose it;
• a failure to treat it appropriately;
• a failure to document it;
• a failure to report it;
• a failure to actively protect the victim;
• a failure to act to stop torture in general, including engaging in a struggle against the system.

In addition to the physicians and medics at the interrogation facility, who are actually employed by the Israel Prisons Service (IPS) and provide medical services for the Shin Bet’s interrogation facilities located within the prisons, the detainee also meets, in cases of serious torture, medical teams in the emergency rooms of general and psychiatric hospitals. These teams should have been expected to act more resolutely to protect interrogated detainees. Unlike the physicians and medics of the IPS, they are not part of the overall system and are therefore freer to act in accordance with their medical conscience. However, we have also been disappointed here. It is enough to mention several detainees who arrived at hospital with signs of torture on their body or mind but were returned immediately or several days later to the interrogation facilities, to their torturers, a return that clearly runs counter to the interests of the detainee-patients.

We should take into consideration here the fact that there exists a comprehensive system in Israel that de-humanizes the victim and places security considerations over the interests of the detainee-patient. The climate within the political system and the courts is part of the overall system that justifies torture under the pretext of it being an effective measure in cases of “ticking bombs”.

Professor Daniel Statman2 emphasizes that the violent and humiliating treatment of Palestinian detainees deviates sharply from any acceptable interpretation of the concept of the “ticking bomb”. The fact that this treatment is reserved solely for Palestinians and not Jews confirms to a certain extent, he writes, Edward Peter’s statement that, “It is not primarily the victim’s information, but the victim that torture seeks to win – to reduce [him] to powerlessness.”3 This approach is designed first and foremost to gain control over a population that is perceived as a threat, to intimidate it and restrain it, and not to obtain information about a “ticking bomb”.

Physicians who operate within detention facilities and prisons are part of an atmosphere that condones torture. They operate within a paramilitary system (in which obedience is rewarded) that diminishes their independence and ability to act according to their medical conscience. In order to encourage physicians to fight against torture, or to extricate themselves from it, we cannot merely rely on the individual’s strength of spirit, though such strength is highly valued. We must act so that all medical personnel have a firm source of professional, legal and financial support outside of the system in which they work. Such support must not only serve as an address for complaints by physicians, but should also constitute a foundation to ensure them legal protection from dismissal and abuse by the system that wants them to maintain the bond of silence. A bill is needed to reinforce that protection, in the same spirit of the legal protection now being proposed in a Knesset bill for those who expose corruption.

The fact that the physicians working for the IPS are not members of the Israeli Medical Association, or the argument that they are not subject to the Ministry of Health should not prevent these organizations from waging a determined battle to apply the rules of ethical conduct to these physicians, and even to end their subordinate status to an entity that ignores, facilitates and/or encourages such excesses.

In light of the above, Physicians for Human Rights-Israel again recommends that:

• Medical personnel should not cooperate in any way in interrogations involving torture and/or cruel, inhuman or degrading treatment and punishment (hereinafter interrogation involving torture).4
• Medical personnel should not examine a prisoner prior to interrogation involving torture. (Until the Shin Bet declares that it will refrain from using such means, medical personnel should not examine people detained by the Shin Bet.)
• In case of a detainee who claims that he was tortured or a detainee and was examined by medical personnel (in prison or hospital) and whose examination raised suspicion that he or she was tortured, the medical personnel should:

1. treat the detainee as required, after receiving his or her consent;
2. categorically prevent the detainee’s return to interrogation and/or the facility in which he or she was being held;
3. report to an authorized official within the system and outside of it;
4. document in the detainee’s medical file the details of the torture and its medical ramifications, as reflected in the examination.

• Medical personnel who receive information on torture (including from oral testimony) should report this information to the authorized bodies.

Only a categorical prohibition on any collaboration with the Shin Bet, together with intensive educational and informational activity by the government and professional authorities, will guard against the participation of physicians in torture, which represents, after all, the ethical collapse of the medical profession at large.

Physicians for Human Rights-Israel (PHR-Israel), the Ministry of Health and the Israeli Medical Association (IMA) must set out the strongest ethical standards to oppose this dangerous practice. PHR-Israel is lobbying the Ministry of Health to adopt these recommendations and urging its general director to issue a directive in this regard to all physicians and medical personnel in Israel.

For the IMA’s support center (in Hebrew), see: http://www.ima.org.il/imahebnew/T1.asp?p=2&n=7957

Medical teams are welcome to contact Physicians for Human Rights-Israel via email ( This e-mail address is being protected from spambots, you need JavaScript enabled to view it ) or at telephone (054-6623232). Confidentiality is assured.

* Hadas Ziv is the executive director of Physicians for Human Rights-Israel. Dr. Ze’ev Weiner is a psychiatrist and member of the Ethics Committee of Physicians for Human Rights – Israel

 

References:

1. See: http://www.wma.net/e/policy/c18.htm.

2. Prof. Daniel Statman, “The Question of Moral Absolutism and the Prohibition on Torture,” Law and Government, Vol. D, No.1 (Faculty of Law: Haifa University, July 1997) (Hebrew).

3. Edward Peters, Torture (Oxford, 1985), p. 164 as quoted in Statman, p. 181.

4. The definition of torture according to the Declaration of Tokyo is as follows: “For the purpose of this Declaration, torture is defined as the deliberate, systematic or wanton infliction of physical or mental suffering by one or more persons acting alone or on the orders of any authority, to force another person to yield information, to make a confession, or any other reason.”