The letter is a response to an earlier article in the BMJ, which discussed how and why doctors become agents of state human rights violations. Ethical pitfalls can be hard to avoid
BMJ 2004;329:1103 (6 November)
Medical education should include human rights component
EDITOR—Two important issues emerge from the article by Forrest and Barrett on humanitarian medicine.1
Firstly, the use of the terms "moderate physical pressure" or "torture lite" risks euphemising torture into acceptability. In 1976 the European Commission on Human Rights held that certain techniques used by the British security forces in Northern Ireland constituted torture.2 These included forcing detainees to remain for some hours in a "stress position" and subjecting the detainee to continuous noise. The United Kingdom undertook not to use the techniques again. Doctors can see from this that the standards of international law regarding the prohibition of torture have been upheld even during a public emergency. The prohibition on states using torture is absolute, non-derogable, and unqualified.
Secondly, the international human right to the highest attainable standard of health is a measure which, by placing the patient's health as a doctor's prime concern, provides a legal justification to resist coercion to discriminate against individual patients, much less be complicit in torture.3 The right to health is part of human rights law. Although states are ultimately accountable, health professionals have responsibilities regarding the realisation of the right to health.
Doctors should call governments to account for policies or practices that lead to torture, including those situations where medical staff are employed; but they need to do something further. They must demand that medical education include a human rights component. Unlike ethics, human rights codify universally accepted standards that are enforceable by law. Tomorrow's doctors deserve to be taught this.
Helen Bygrave, general practitioner
Abbots Langley, Hertfordshire WD5 0BE firstname.lastname@example.org
Competing interests: None declared.
1. Forrest D, Barrett J. Ethical pitfalls can be hard to avoid. BMJ 2004;329: 399-400 (14 August.)
2. Ireland v UK (5310/71) Report: 25 January 1976.
3. United Nations. General comment No 14. New York: UN, 2000. www.unhchr.ch/tbs/doc.nsf/(symbol)/E.C.12.2000.4En?OpenDocument