Physicians for Human Rights - UK (PHR-UK)
A stain on medical ethics

The Lancet 2005; 366:1263


A stain on medical ethics

Peter Hall a

Michael Wilks' criticism of the failure of medical organisations to prevent and deal with medical participation in the torture of detainees (Aug 6, p 429)1 is well aimed and appropriately timed for the World Medical Association General Assembly on Oct 12–15, 2005, in Chile—a country currently confronting the collusion of its national institutions in the torture of more than 35?000 citizens.

However, although it is clearly proper to condemn doctors' participation or complicity in torture, the medical world must appreciate that torture is more than an unethical practice. It is a heinous international crime which is prohibited under international human rights law, the laws of armed conflict, and customary international law. The prohibition is a non-derogable right under global and regional treaties and a jus cogens norm. If the analyses are accurate, the conflation of the former UN Special Rapporteur on Torture's assessment that “what we know is only the tip of an iceberg” with Amnesty International's 70?000 figure for detainees held outside the USA during its so-called war on terror could compute into a massive crime perpetrated on an industrial scale across continents.2 Each victim is entitled to restorative justice, an essential part of which entails seeing the perpetrators punished.

Doctors who have been complicit might be comforted by a perception that they are loyal soldiers, and by a sense of impunity encouraged by the bilateral agreements with which the US government has sought to immunise its forces and leaders from prosecution by the International Criminal Court. They might not have taken into account the fear and loathing felt by many for a practice whose patron saint is Josef Mengele, nor that torture is an international crime to which a universal jurisdiction applies.

In the absence of any serious attempt to establish accountability by the USA, every one of the 139 countries that ratified the UN Convention against Torture is obligated to either prosecute suspects entering its territory or extradite them to a country that will.3 Crucially, the US executive's creative interpretation of what defines torture will hold no sway over the courts of other sovereign nations. In 1997, a Sudanese doctor working for the UK National Health Service was arrested in Scotland on charges of participation in torture while acting in an official capacity in Sudan. A year later, the former Chilean dictator Augusto Pinochet was arrested and faced extradition to Spain on charges of torture until assessed as having dementia. So important does the current British Attorney General consider this legislation, that he personally led the recent successful prosecution of a former Afghan warlord living in London, using video-linked witness participation in the court from a specially prepared room in the British Embassy in Kabul.4

National medical organisations have a responsibility to ensure that doctors who have participated in torture, whether as a human rights violation, a war crime, or crime against humanity, are denied licence to practise and are reported to the authorities.5 If doctors against whom exists prima facie evidence travel to countries prepared to meet their obligations under the Convention against Torture, national medical organisations should liaise internationally over their identities to facilitate their prosecution.

I declare that I have no conflict of interest.


1. Wilks M. A stain on medical ethics. Lancet 2005; 366: 429-431. Full Text | PDF (156 KB) | CrossRef

2. Amnesty International. United States of America: Guantánamo and beyond—the continuing pursuit of unchecked executive power. London: Amnesty International, 2005:

(accessed Aug 6, 2005).

3. United Nations. Convention against torture and other cruel, inhuman or degrading treatment or punishment. Geneva: UN, 1987:

(accessed Aug 6, 2005).

4. BBC. Afghan Zardad jailed for 20 years

(accessed Aug 6, 2005).

5. World Medical Association. World Medical Association Statement on the licensing of physicians fleeing prosecution for serious criminal offences. Ferney-Voltaire: WMA, 1997:

(accessed Aug 6, 2005).