Should doctors apologise for their role in torture?

Doctors have been involved in inhumane treatment of people throughout history.¹ They have harmed patients by being either obstinate believers in flawed medical theories or instruments of corrupt political regimes. Notorious examples include the inhumane treatment of mentally ill patients in medieval “asylums,”² torture by Nazi doctors on thousands of prisoners in German concentration camps,³ and the unethical radiation experiments on prisoners conducted by American doctors during the cold war.⁴ Recently, US military doctors were alleged to be complicit in prisoner abuse in the notorious Abu Ghraib prison in Iraq, collaborating in designing and implementing psychologically and physically coercive interrogations, and falsifying or delaying death records of detainees to cover up for abuses.^{5 6}

Some of these practices may have ended decades or centuries ago, others are still going on or are likely to recur in the future, but in every case the ramifications outlive the actual incident. Guilt may linger in the collective conscience of the medical profession, continually raising an important question: should we apologise for these wrongdoings against humanity? Although such public apologies are usually symbolic, they are very powerful stimuli for healing and for reform.⁴ Apologies can also draw media attention and lobby political power necessary to take action, develop policies, and devise ethical codes to prevent similar incidents from occurring in the future.

To meet those ends, apologies must come from bodies that can officially represent doctors, thereby lending credibility to the gesture.⁴ For example, in 1997, the then US president, Bill Clinton, formally apologised on behalf of the US government for the Tuskegee syphilis study, in which poor African-Americans were denied treatment for syphilis and deceived by US government doctors for 40 years.4 7 8 The experiment was brought to an end in 1972 while the apology came two decades later. However, it was hailed by the survivors of the experiment saying “it is never too late to work to restore trust and faith.”⁸

Perhaps the most important value of such apologies is to highlight unethical behaviour to doctors themselves, especially those who are still in training. The lessons we gain are invaluable; we will learn we are not as detached from such mistakes as we may think, simply because our colleagues have made them over and over again. These examples will always remind us how much power we have over patients' lives and how easy it is to slip off the path of ethical behaviour and abuse this power. Even when we act in the patients' best interests, we will realise that medical theories we hold today as absolutes may turn out to be inaccuracies for which we will have to apologise in the future. Hopefully, we will learn to be careful not to burden future generations of doctors with mistakes for which they will have to apologise on our behalf.

1. Maio G. History of medical involvement in torture—then and now. Lancet 2001;357:1609-11.
2. Mental health history timeline. http://www.mdx.ac.uk/www/study/mhhtim.htm (accessed 27 Aug 2004)
3. Nathanson V. Doctors and torture BMJ 1999; 319:397-8.
4. Kahn J, The new politics of apology, Bioethics examiner 1997; 1, (Issue 2):1-2
5. Yahoo News. US medics implicated in prisoner abuse at Iraqi prison: Lancet. http://sg.news.yahoo.com/040820/1/3mk95.html (accessed 20 Aug 2004).
6. Miles SH, Abu Ghraib: its legacy for military medicine Lancet 2004;364:725-9.
7. Jones JH. Bad blood: the Tuskegee syphilis experiment. New York: Free Press, 1993.
8. The presidential apology. www.med.virginia.edu/hs-library/historical/apology/whouse.html (accessed 27 Aug 2004).