Iraqi doctors acknowledge rights abuses

Forced to sever ears, remove patients' organs

March 24, 2004|By Erika Niedowski | Erika Niedowski,SUN STAFF

About half of the doctors surveyed in southern Iraq last summer said their peers had participated in an array of human rights abuses - including cutting off ears, falsifying death certificates and even removing patients' organs without their consent.

Of the nearly 100 physicians interviewed at three civilian hospitals, the majority reported that doctors were forced to participate in the abuses under threats from various groups that ranged from losing their jobs to outright execution.

"This goes completely against what physicians normally do, which is to `do no harm,' " said Dr. Lynn L. Amowitz, senior medical researcher for the Boston-based Physicians for Human Rights, which conducted the study. "They were completely unable to protect themselves - and to protect the patients that they were supposed to protect - because of what was happening [politically] at the time."

The researchers, reporting in today's issue of the Journal of the American Medical Association, caution that their findings don't suggest the extent to which doctors may have participated in abuses in the rest of Iraq under Baathist rule. They also note that few physicians said they committed abuses themselves.

"It's an incredibly difficult thing to admit," Amowitz said. "But at least saying that it happens, that's a step forward."

Dr. Robert Lawrence, a professor of preventive medicine at the Johns Hopkins Bloomberg School of Public Health and founding member of Physicians for Human Rights, said it doesn't matter if the abuses were more widespread than the doctors reported.

"I think physician participation in torture and in falsification of medical records is such a gross violation of professional ethics and human rights," he said, "[that] if you have fairly good evidence that it happened in one instance, that's enough to use as a reason to remind people of the importance of the rule of law, the importance of strengthening professional [medical] societies and the importance of having an international tribunal where these kinds of abuses can be fairly adjudicated."

The Fedayeen Saddam - a paramilitary group once run by Uday Hussein, son of former Iraqi President Saddam Hussein - initiated the majority of abuses in which physicians were complicit, according to the doctors surveyed. But they implicated other groups, too, including other paramilitary forces, the Republican Guard, security and intelligence forces, Iraqi police and the Ministry of Health.

Physicians for Human Rights conducted the survey over two weeks in June and July at three hospitals in Najaf and Nasiriyah. Most of the 98 doctors interviewed were male. Nearly all identified themselves as Shiite Muslims, who represent the majority of Iraqis but were generally shut out of power under Hussein's rule.

About half said that physicians were "extremely" or "quite a bit" involved in the amputation of ears as a means of punishment and the falsification of reports involving torture victims. Nearly a third said the same regarding falsifying death certificates and releasing medical records to government officials without a patient's permission.

Other abuses, which physicians said occurred less frequently, included removing the organs of a patient - dead or alive - without consent, participating in torture and administering "mercy" bullets to kill people who had survived torture or ill treatment.

Most doctors who participated in the study provided some justification for their involvement in the abuses. "In many of the cases, it was a Fedayeen standing there with a gun threatening them or threatening their family," Amowitz said.

"What would you have done," the study quoted one physician as saying, "if you knew that if you refused, your ear would be cut, or you or your family might be killed? Tell me honestly, what would you do?"

Explained a surgeon who performed ear amputations on army deserters between 1994 and 1996: "I couldn't refuse the decision, it came from Saddam Hussein, but I refused the way it was being done in public."

In an accompanying JAMA editorial, Dr. Edmund D. Pellegrino of the Center for Clinical Bioethics at Georgetown University Medical Center said the study reveals "how often ruthlessly tyrannical regimes suborn the uses of medical knowledge for execrable ends."

"The central problem in the case of Iraqi physicians who have engaged in torture and other abuses," he wrote, "is the active and passive collusion of the profession with patriotic and defensive measures justified in the interest of the nation, one's career, or personal safety."

Pellegrino compared the ethical violations and the justifications physicians offered to those of Nazi doctors during World War II. The Germans conducted barbaric experiments on concentration camp prisoners, including castrating them or placing them in vats of ice-cold water for hours at a time. Many patients died or were maimed as a result.

Dr. Michael VanRooyen, director of the Center for International Emergency, Disaster and Refugee Studies at the Hopkins public health school, said that the JAMA study should serve as a spark for doctors around the world to engage in a constructive dialogue about medical ethics and human rights.

The authors also suggest that ethics education for physicians could play a pivotal role in preventing future abuses.

But Pellegrino notes in his editorial that education should not be seen as a panacea.

"More than education is needed," he wrote. "Character formation is, in the end, the surest way to inculcate the virtues. This cannot occur unless the culture of the profession is itself ethically rigorous. Even the most virtuous physicians need a supportive culture to remain virtuous."

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