{"id":968,"date":"2022-03-30T23:36:11","date_gmt":"2022-03-31T03:36:11","guid":{"rendered":"http:\/\/wordpress.forensicpath.us\/?p=968"},"modified":"2022-03-30T23:54:26","modified_gmt":"2022-03-31T03:54:26","slug":"dual-loyalty-and-physician-torture-in-the-name-of-lgbtq-ideology","status":"publish","type":"post","link":"https:\/\/wordpress.forensicpath.us\/index.php\/2022\/03\/30\/dual-loyalty-and-physician-torture-in-the-name-of-lgbtq-ideology\/","title":{"rendered":"Dual loyalty and physician torture in the name of LGBTQ+ ideology"},"content":{"rendered":"

A young physician at Wake Forest recently posted to her Twitter feed that she tortured a patient because he made a comment about her pronoun pin:<\/p>\n

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To be clear, there is some ambiguity here — it may be that she did not deliberately miss the vein, but was simply pleased that she did.\u00a0 To me, however, that’s a distinction without a difference from an ethical point of view. There are likely those who would claim that this is not “torture” per se, but in fact it is — it is the intentional infliction of pain because of the victim’s ideology.\u00a0 By a physician.\u00a0 Not a lot of pain.\u00a0 And not quite a physician.\u00a0 But close enough for government work, in my personal opinion.<\/p>\n

A poster in a discussion group of physicians I belong to was appalled by this and could not understand how a physician would do this, since it is in direct contradiction to traditional medical ethics.\u00a0 But, in fact, it makes perfect sense, and it is a well-documented phenomenon in the torture literature.\u00a0 Those who know me well know that while I was in the military, I did image analysis in cases of forensic pathology interest, and some of those were instances of executions and torture by Islamic jihadists.\u00a0 I became interested in this literature during this time.<\/p>\n

The key here is the concept of “dual loyalty.”\u00a0 Jasper Sonntag wrote a great article about this in the journal “Torture” in 2008 (Sonntag J.\u00a0 Doctor’s involvement in torture.\u00a0 Torture 2008 18(3):161-175<\/a>).\u00a0 He writes:<\/p>\n

Physicians for Human Rights (PHR) has defined dual loyalty as: \u201cClinical role conflict between professional duties to a patient and obligations, express or implied, real or perceived, to the interests of a third party such as an employer, insurer or the state.\u201d Various cases of doctors in dual loyalty conflicts have been described, such as doctors in Iraq under the Baathist regime, police doctors in Germany, U.S. military medical personnel in Iraq, Afghanistan and <\/em>Guantanamo Bay, prison doctors in Denmark and Canadian military physicians in Afghanistan.<\/em><\/p>\n

He continues:<\/p>\n

The ethical dilemma of dual loyalty in the war on terror is discussed by Singh:\u201c If the detainee is being subjected to poor detention conditions or \u2018robust interrogation\u2019 by the detaining power, state physicians could experience a conflict of interest between: a) their duty to care for and protect a … detainee … against abusive treatment<\/em>…; and b) their patriotic duty to protect and serve the interests of their country (which might arguably require the physician to remain silent about such treatment).\u201d<\/em><\/p>\n

He also describes how \u201csocial cicumstances and particular factors\u201d might influence some physicians to lose moral <\/em>perspective and to facilitate abuse of detainees. These \u201ccircumstances and factors\u201d are \u201cideological totalitarianism\u201d, \u201cmoral disengagement\u201d and \u201cvictim-blame\u201d. \u201cIdeological totalitarianism\u201d can result from \u201cthe negative <\/strong><\/em>labeling or devaluing of a group by influential forces\u201d<\/em>.\u00a0<\/strong> (emphasis mine)<\/p>\n

The Physicians for Human Rights Working Group white paper<\/a> that Sonntag refers to is also valuable.\u00a0 They write:<\/p>\n

Since ancient times, many societies have held healthcare professionals to an ethic of <\/em>undivided loyalty to the welfare of the patient. Current international codes of ethics <\/em>generally mandate complete loyalty to patients. The World Medical Association <\/em>(WMA) Declaration of Geneva, the modern equivalent of the Hippocratic Oath, asks <\/em>physicians to pledge that \u201cthe health of my patient shall be my first consideration\u201d <\/em>and to provide medical services in \u201cfull technical and moral independence.\u201d The <\/em>WMA International Code of Medical Ethics states that \u201ca physician shall owe his <\/em>patients complete loyalty and all the resources of his science.\u201d<\/em><\/p>\n

In practice, however, health professionals often have obligations to other parties besides their patients \u2013 such as family members, employers, insurance companies and governments \u2013 that may conflict with undivided devotion to the patient. This phenomenon is dual loyalty, which may be defined as clinical role conflict between professional duties to a patient and obligations, express or implied, real or perceived, to the interests of a third party such as an employer, an insurer or the state.<\/em><\/p>\n

They continue:<\/p>\n

How might a health professional become complicit in a human rights violation? First, <\/em>when employed by or acting on behalf of the state, health professionals may become <\/em>agents through which the state commits a violation, for example, by participating in <\/em>torture of an individual at the behest of state interrogators.<\/em><\/p>\n

Second, even in private doctor-patient encounters, health professionals can become <\/em>complicit in violations by adhering to \u2013 and thus furthering \u2013 state health policies and <\/em>practices that unjustly discriminate on the basis of race, sex, class, or other <\/em>prohibited grounds, or that deny equitable access to health care. Where the state <\/em>has failed to take necessary steps to establish a health system that affords equitable <\/em>access to health services, the health professional participating in that system has an <\/em>obligation to press for alternative policies designed to end the violations.<\/em><\/p>\n

Third, even where no explicit state policy is involved, in circumstances where the <\/em>health professional engages in cultural or social practices that violate human rights, <\/em>for example, \u201cvirginity examinations\u201d or genital mutilation of women, he or she <\/em>becomes the vehicle by which the violation is accomplished.<\/em><\/p>\n

What happened here, in my opinion, is of the third kind — where the medical student performed her act of torture on the basis of her cultural perspective.<\/p>\n

This is not really very surprising.\u00a0 Medical practice in the United States has largely embraced dual loyalty in the name of “manged care” and “public health,” and the slippery slope remains as slippery today as it was during the eugenics craze of the early and mid 20th century.\u00a0 Many years ago, when I was in the Army, we had a “bioethicist” come an talk to us.\u00a0 He told us that all us folk who were trained before “modern” medical practice had been trained that we were the patient’s advocate.\u00a0 It was our job to do whatever we could to act in the best interest of our patient and provide him or her the best possible care.<\/p>\n

No more, he said.\u00a0 Modern medicine recognized the responsibility of the physician for the “greater good.”\u00a0 In other words, when considering treatment for a patient, we should also consider its impact on society as a whole.\u00a0 Thus, for instance, if an older patient with cancer needed expensive chemotherapy, but that money would be better spend for vaccines (or today, I suppose, gender reassignment surgery) for children, then we should not tell the older patient about that option and deny that care.\u00a0 instead, we should allow our patient to die in order to provide better care for others.\u00a0 This is the fundamental ethic of so-called “managed care.”<\/p>\n

And this idea of programmed care with an eye to the utilitarian greater good has, in fact, become the norm, which means that the medical establishment in the United States has put an enthusiastic blessing on divided loyalty in physicians, and is teaching young physicians to place individual patients second to social needs.<\/p>\n

Nor should it be surprising that these actions seem so justified to the medical student that she brags about it on social media.\u00a0 Utilitarian ethics commonly devolve into atrocity — the common good justifies anything.\u00a0 \u00a0As Claudia Card notes in “The Atrocity Paradigm: A Theory of Evil”<\/a><\/p>\n

The \u201cgreater good\u201d justification for harm sets no upper limit to the extremity of harm that any individual might be made to suffer in order to produce benefits for others. This is why the slavery example is so powerful. The problem is not just that slave labor is stolen. People who are enslaved too often have no effective protection against such things as torture, murder, malnutrition, the breakup of their families through sale, and, of course, no freedom to determine the course of their own lives. The utilitarian rationale appealing simply to benefits that outweigh <\/em>harms seems compatible with letting a few die (or killing them outright) to spare many others a significant but nonfatal hardship…<\/em><\/p>\n

Contrary to initial appearances, Bentham\u2019s utilitarianism does not clearly give prominence to sufferers. Rather, it gives prominence to suffering, abstracted from the lives of sufferers. Both utilitarian justifications\u2014the \u201cgreater <\/em>good\u201d argument and the \u201cno better alternative\u201d argument\u2014invite us to treat harms and goods as fungible, like money, as though we could interchange their forms with no serious change in value simply by making appropriate adjustments in quantity. Bentham\u2019s calculus, directing one to sum up the harms and benefits done to everyone affected and see where the balance lies, does not distinguish atrocities from lesser harms. By the process he advocates for estimating overall harm, an enormous number of minor harms appear to add up to an <\/em>atrocity. But often they do not. Robbing millions of people of five dollars each is not worse than conning a retired couple out of their modest life savings. The point is not that numbers don\u2019t matter for an atrocity. Murdering millions is worse than murdering a few. The point is that the concepts \u201cbeneficial on the whole\u201d and \u201cleast harmful on the whole\u201d are too ambiguous to enable us to identify or rule out atrocities.<\/em><\/p>\n

Card would not consider what this medical student did an “atrocity” because it was a small evil.\u00a0 However, the process of utilitarian dual-loyalty thinking leading to these kinds of acts is the same.\u00a0 And like most evil, it starts small and grows over time.\u00a0 \u00a0I cannot understand why anybody is surprised that a modern medical student would take these lessons to heart, or why she would have difficulty in trying to “identify or rule out atrocities.” <\/em>\u00a0 And, really, you are seeing, in a microcosm, exactly that ethic.\u00a0 The same ethic that has led to “real” substantial medical atrocities repeatedly in the past.<\/p>\n

This is a small thing.\u00a0 But great evil in individuals tends to start small.\u00a0 Serial killers start by harming animals.\u00a0 The problem may or may not be with this one student, but it is certainly inherent in the ethic she’s been taught.<\/p>\n

Wake Forest has put out a statement that this does not represent its values.\u00a0 But, in my opinion, it does.\u00a0 Precisely, in fact — because that *is* the modern medical ethic.<\/p>\n

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