The field of bioethics within the medical profession, more prominently among physicians from poverty-stricken countries, has grown little resistance to the violation of international human rights due to intentional oversight on behalf of doctors and a lack of government sponsored regulation. Although the medical profession strives to guard and advocate human rights both on a domestic and international scale, certain actions undertaken by personnel within the health field, including medical experimentation, torture, and participation within the organ trade illustrate their ability to violate global civil liberties. This demonstrates that current domestic and international standards are not sufficient to the task of regulating physician ethics.
Medicine holds physicians accountable for their actions and thus requires certain bioethics to be established prior to beginning practice. Concepts such as beneficence, non-maleficence, and autonomy are taught in order to ensure that justice and dignity are exercised while treating patients. However, more than often, medical ethics are ignored by medical personnel, thus resulting in an array of human rights being violated during the process. While some may argue that it is morally permissible for physicians to perform actions considered unethical in order to improve scientific research and knowledge pertaining to certain diseases, the fact that patients are harmed during the process indicates otherwise. Furthermore, it is recognized to be the physician’s duty to improve health quality both domestically and internationally; any deviation from such direction would be violating civil liberties by physicians.
While the concept of torture is dependent upon individual cultures, medical professionals globally remain persistent in safeguarding individual rights from abuse and mistreatment in order to uphold ethical obligations (Nowak 2006). Yet the imprisonment and torture of homosexual men inEgyptperformed by both police officers and physicians exemplifies the legally-enforced and accepted abuse of human rights within an international scale. AlthoughEgypthas acknowledged their citizens’ right to “body integrity, freedom of torture, arbitrary arrest, and right to fair trial,” there have been over 179 reported documents of prosecuted men solely based on their sexual orientation (De Gruchy and Fish 2004). It has been observed that physicians have undertaken “unnecessary forensic anal examinations” to confirm men’s homosexual orientation; thus, doctors are putting the ideological “interests of the state above ethical obligations” by aiding in the imprisonment of men based exclusively on their sexual identity (De Gruchy and Fish 2004). Rather than using their medical knowledge to address global diseases and find innovative solutions to improve upon health, physicians within Egypt are using their comprehension of medicine to support an oppressive state ideology that chooses to prosecute individuals for the “habitual practice of debauchery” (De Gruchy and Fish 2004).
In addition to harming those in relation to their sexual identity, research has shown that surgeons use their medical knowledge to kill the fetus of unborn females to enhance the number of male births (Nehauuddin 2011). While abortions can be morally allowed under certain circumstances, the implication of limitations upon the lives of a specific gender contrast an individual’s inherent right to life. A deterioration of safeguards occurs as surgeons perform actions that do not preserve life but promote the onset of illness and death (Oldfield 1901). The actions undertaken by doctors inEgyptprove a stark violation of international human rights by neglecting the patient’s right to wellness and instead justify both prejudice and discrimination.
Although it has been recorded that medical knowledge has been used wrongfully to imprison people based on their sexuality (De Gruchy and Fish 2004), physicians have also been observed to issue false medical findings after examinations of torture performed by the police (Kumar 1999). Regardless of efforts exhausted to prevent torture both domestically and internationally, “millions of victims in more than half the countries of the world” are still subjected to such abuse, even by the police, demonstrating an increased demand to improve upon the quality of human rights globally (Kumar 1999). The fact that doctors are “overlooking police torture” illustrates not only the need for medical investigation guidelines, but also a change in bioethics in order to prevent future torture accounts from occurring (Kumar 1999). Withdrawing torture accounts from the evidence during investigations promotes inaction against human rights violations and validates the morality of physicians who violate civil liberties. As stated by Prem Agarwal, Secretary General of the Indian Medical Association, “they [physicians] act as silent spectators in torture” (Kumar 1999). From an ethical perspective, doctors are obligated to take a formal Hippocratic Oath prior to serve their community, ensuring the safety and wellness of patients; unfortunately, physicians in this study act in a way to exemplify conflict between the government and medical ethics, in which case the latter is often disregarded.
The need to better recognize torture and punishment performed by state governments has only just been advocated (Arie 2011). While it would appear understandable to prevent crimes against humanity within any given country, the lack of action undertaken by people to do so reveals a disturbing side of medicine. Physicians are regarded as respectable, selfless people in many states, but they are also viewed as citizens capable of aiding others during physical turmoil. Under such circumstances, doctors become an individual’s last resort to restore their health (Downie 1993). The fact that many state governments actually abuse their citizens portrays their negligence and disrespect towards human rights and highlights the increased need for new statues to be legislated in order for doctors to better recognize torture. Arie (2011) studied cases in which doctors “facilitated a torture or failed to report an incident” inSri Lanka,Israel, and theU.S., which therefore “violates the medical ethics and the Geneva convention.” Choosing to not submit a misconduct report, even if directed towards the government, prevents any action towards future protecting individuals’ rights. Additionally, a physician partaking in the action of torture clearly violates their oath to assist others, and instead uses his or her medical knowledge to inflict harm. Regardless of the circumstances present, physicians should not part from their goal to guard and advocate human rights. New standards are needed to regulate physician ethics.
Furthermore, the role doctors are expected to acquire during military circumstances exemplifies the conflicts physicians encounter between ethics and loyalty to their nation. For instance, coercive conditions inGuantanamoBayinfluenced doctors to “help cover up or remain silent during prisoner abuse,” even when supposedly “bound by medical ethics” (Younbyoung 2004). In another case, under the policy of President George Bush for treating “suspected terrorists” detained in Iraq and Afghanistan, military medical physicians “collaborated with the abuse” and failed to “report injuries or deaths”, demonstrating a lack of sufficient ethical training for doctors (Miles 2004). While the safety of a nation remains a priority for governments, it is crucial to remain active supporters of human rights and health, no matter what the environment. Medical personnel who are involved in such torture against civilians make it admissible to abuse patients and show the lack of developed ethics on part of physicians (Haque 2007). Even if military situations promote the mistreatment of prisoners in order to attain national security, physicians should not become involved due to their inherent responsibility as who they are.
While the use of torture during extraordinary rendition circumstances differs significantly in comparison to physician medical experiments, the same principle of ethics are involved: physicians are performing the acts of abuse against patients, not terrorist suspects, making the mistreatment more unacceptable. The court case of Mohamed v. Jeppesen Dutaplan exemplifies the alleged torture involved after governments force the disappearance of certain individuals during extraordinary rendition “torture flights” to CIA “black site” prisons (Jensen 2010). Even during the War on Terror, the Ninth Circuit examined the treatment Mohamed experienced to be intolerable according to United States standards, signifying that torture during threats to national security should not be permissible. On the other hand, physicians perform medical experiments in order to explore inquiries on certain subjects, making their research on torture—even during wartime circumstances—more insupportable compared to those experiments to protect national security.
Aside from partaking in torture, medical physicians have also been involved in violating human rights through medical experimentation, portraying that existing domestic and international standards are inadequate to the task of regulating physicians. Internationally, the number of medical experiments documented illustrates a lack of ethics acquired by physicians, especially against those citizens with medical conditions or who are prisoners of war. By targeting individual groups, medical personnel acknowledge the immorality of performing such experiments. Medical experimentation results in the destruction of human rights, as demonstrated in the case of the 426 children infected with HIV in al-Fateh Children’s Hospital in Libyaby six Bulgarian nurses and a Palestinian doctor (Burns 2005). Though doctors were able to learn more about the HIV diseases stages by infecting patients within the hospital, they are justified in risking the lives of other individuals (Blustein 2007). Rather than promoting actions that would benefit the well-being of others, medical experiments merely violate a physician’s duty to practice non-maleficence. Even during wartime circumstances, physicians perform inhuman trials on captured enemies. The Japanese medical experiments during the 1940’s inChinaare such an example (Nie 2002). Despite their status as licensed physicians, doctors engage in activities that result in the maltreatment of individuals against their will in order to fulfill governmental obligations.
Evidently, there is a strong disregard for the profession and neglect for patient rights. Reverby (2011) studied the medical ethics involved in the Tuskegee syphilis experiments on male African Americans and compared them to the U.S. Public Health Service experiments conducted in Guatemala during the late 1940’s, in witch the former was denied penicillin treatment. Additionally, Siegel-Itzkovich (2006) reported the investigation of four doctors inIsraelwho were found conducting illegal medical experiments on elderly patients diagnosed with dementia, exposing the physicians’ lack of concern towards their patients’ rights as humans. Doctors abuse their patients by performing experiments on vulnerable people and withdrawing medical treatment in order to prolong the prognosis of certain diseases. Also, Rabello (2004) documents the abuse people of Jewish decent endured during World War II and compares the mistreatment caused by medical experimentation against Israeli Law standards. While any nation would view such experiments as an exploitation of humanity, the fact that physicians are partaking in such actions reveals a misconstrued concept of bioethics taught during medical school. Experiments performed with the intent of harming another individual without his or her consent portrays an inadequate level of justice; not only are the patients’ right to autonomy ignored, but doctors are abusing their medical knowledge.
Not to mention that physicians also have partaken in the organ trade, violating global civil liberties both domestically and internationally. Targeting individuals from lower income countries, the organ trade uses an individual’s poverty in order to obtain an organ, regardless of the physical and psychological implications that result (Khalili 2007). Even with anti-organ trade legislation, physicians “hunt potential organ sellers” due to its fiscal advantages; it appears there is a thin layer supporting medical ethics that can easily be ignored by physicians whenever desired. Ahmad (2000) details an instance in which three doctors and a hospital administrator declared “patients brain-dead” and falsified documents “to make it easier to use their organs” for illegal transplant trading inThailand. During organ transplants, either the individual willingly offers their organs in exchange for monetary compensation, or they are stolen from patients who are unable to defend themselves. Even though doctors are fully aware of the negative consequences that result after harvesting organs, they still participate in the illegal trading of human organs in order to make additional money. Additionally, Sanal (2004) studied the organ trafficking occurring in theMiddle East, in which it was observed that “organ mafia doctors” were referred to as “Robin Hoods” by taking “organs from the poor to give to the rich”. While a small percentage of individuals do receive compensation for their organs, it cannot be argued that such reciprocation equivocates to a respect for their human rights. The lower classes are subject to the standards of the wealthy and are obliged to perform drastic measures, such as the selling of organs, in order to survive. This coercion of less fortunate individuals unveils a stark violation in human rights in the sense that physicians are neglecting their duty to heal. Obviously, there is an increased demand of new regulations to be placed on an international-scale for the organ-trade. Without effective laws to control the trade or a government sponsored regulation program, physicians are easily able to ignore medical ethics and instead place their own personal desires above the lives of patients.
Thankfully, several nations are striving to reduce the number of illegal organ trades (Watts 2007). For instance, measures such as implementing “new penalties for doctors and hospitals” have been legislated inChinain order to end the profits that result from the sale of organs, of which “99 percent…come from executed prisoners” (Watts 2007). Extremes such as executing individuals in order to collect their organs shows the devastating turn medicine has taken; not only are physicians betraying their oath to protect humanity, but also human lives are viewed quantitatively rather than qualitatively. Physicians need to abide by ethical implications to allow the field of medicine to evolve and improve upon itself, properly promoting the general welfare of human rights. Otherwise, physicians will become too focused on finding alternative methods to grow financially. Bernard (1990), under The National Organ Transplant Act of 1984, outlines different procedures and processes as to how an organ transplant should be conducted properly within the United States in order to respect human rights while also reducing risk factors associated with the patient’s health.
While there are currently different existing domestic and international standards enacted to regulate physicians, the literature demonstrates that these policies are far from sufficient in achieving their goals. Lewis (2011) explains that the UN passed the Convention Against Transnational Organized Crime during the year 2007 with the protocol to Prevent, Suppress, and Punish Trafficking in Person, Especially Women and Children in order to end organ sales; however, under the guidance of medical professionals, many individuals still have been able to participate within organ trafficking. Furthermore, non-governmental organizations including Organ Watch and personal statements such as the Hippocratic Oath are designed to promote the dignity and well-being of individuals within society. It would appear that current measures designed to regulate physicians, both domestically and internationally, rely steadily on the honesty of physicians. New policy measures should rather be undertaken in order to improve the quality of life for patients and to ensure that physicians are aware of the consequences of such actions.
Likewise, in a report submitted by the Special Rapporteur on torture and other cruel, inhuman, or degrading treatment, Juan E. Mendez outlines that it is the “states’ obligation to prevent and punish violations” under Article 4 of the Convention Against Torture (Mendez 2011). By including measures to ensure that each state is responsible for violators of human rights, there would be more action to regulate the performance of physicians. Government organized programs that supervise the actions of its citizens would only improve the standards established currently to avoid human rights violations, and a government-sponsored regulation program needs to be established within each state to provide better oversight and safeguards for patients. For example, Article 4 of the International Tribunal forRwandaexplicitly states that prosecution may result for “persons committing…serious violations of Article3” of the Geneva Conventions, which includes the participation in cruel treatment such as ‘torture, mutilation, or any form of corporal punishment” (Obote-Odora 2002). Additionally, under Article 3 of the International Tribunal forRwanda, people are eligible to be prosecuted for “torture…and other inhumane acts” committed against other individuals (Obote-Odora 2002). Even with these current measures directed to deter crimes against humanity, physicians are still able to use their medical knowledge to inflict harm upon patients due to a lack of government intervention. In order to target the issues on a primary level, education on bioethics should be stressed during medical school to aspiring physicians.
All in all, despite its attempts to guard global civil liberties, the medical profession has violated human rights through torture, medical experiments, and organ trafficking, thereby increasing the demand for new global policy development and legislation in order to regulate physician ethics.
Endnotes:
1 Jing-Bao Nie. “Japanese Doctors’ Experimentation In WartimeChina.” Lancet 36 (2002), 5. The Japanese doctors’ experimentation on war detainees inChinawas similar to the Nazi experimentation during World War II; however, due to complex political history, the Japanese torture experiments were less publicized. Furthermore, unlike the Nazi wartime doctors who were subjected to penalty under the Nuremberg Trials, the Japanese doctors were protect by Japanese and US Governments and remained respected medical researchers.
2 Juan E. Mendez. Report Submitted by the Special Rapporteur on Torture and Other Cruel, Inhuman or Degrading Treatment. Rep. no. 52. United Nations General Assembly, 2011, 5-7. Juan E. Mendez also urges the Human Rights Council to adopt protocols established under the Committee Against Torture, the subcommittee on Prevention of Torture, and the Human Rights Committee. Furthermore, it was noted that support for UN Funds for Victims of Torture and other non-governmental organizations working for rehabilitation of victims were addressed.
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