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A chilling subplot in the twentieth-century saga of state-sponsored mass murder, torture, and other atrocities was the widespread incidence of medical complicity. Nazi doctors’ human “experiments” and assistance in genocidal killing are the most oft-cited exemplar, but wartime Japanese physicians’ human vivisection and other grotesque practices rivaled the Nazi medical horrors. Measured by these standards, Soviet psychiatrists’ role in repressing dissent, Latin American and Turkish military doctors’ complicity in torture, and even the South African medical profession’s systematic involvement in apartheid may seem, to some, almost prosaic. Yet these and other reported cases of medical complicity in human rights abuse compel an inquiry into medicine’s vulnerability to becoming an adjunct to illicit state purposes.

To many practicing physicians, the idea of such vulnerability may seem anathema. The Hippocratic Oath’s pledge of undivided loyalty—“[i]n every house where I come, I will enter only for the good of my patients” — and the oft-quoted maxim, “first do no harm,” express the profession’s ethical commitment to the sick people it primarily serves. Well-meaning practitioners might reasonably presume that this commitment safeguards the profession against involvement in illicit purposes and that physicians who collude in human rights abuses are a rogue element, not evidence of a deeper problem. But I shall argue here that the Hippocratic commitment of undivided loyalty to patients tells only part of the story of medicine’s purposes, that clinical work in contemporary societies serves myriad state and social ends, and that physician complicity in state-sanctioned human rights abuse is a perverse corollary of this seldom- acknowledged reality. Were the ethic of undivided loyalty and the maxim, “first do no harm,” the inviolate precepts many take them to be, then efforts to prevent such complicity could concentrate on the conceptually simple tasks of dissuading physicians from doing anything that serves state purposes at their patients’ expense and pressing governments to respect the profession’s adherence to these precepts. But the pervasive links between clinical work and state purposes — in the industrialized democracies no less than in repressive regimes — complicate the work of prevention and put physicians at risk for becoming collaborators when state purposes turn illicit. This risk is heightened by the near-absence of ethical guidance as to how to distinguish between acceptable and intolerable furtherance of state objectives.


Copyright © 2001 Cambridge University Press;

Publication Citation

10 Cambridge Q. Healthcare Ethics 275-284 (2001)