The Lancet, Sept. 8, 2007
David J Nicholl a, Trefor Jenkins b, Steven H Miles c, William Hopkins d, Adnan Siddiqui e, and Frank Boulton f, on behalf of 260 other signatories
This week marks the 30th anniversary of the death of anti-apartheid activist Steve Biko while being detained by South African security police. Initially, the Minister of Justice suggested Biko had died of a hunger strike; however, the inquest revealed that he had died of the consequences of head injuries sustained during police interrogation, and identified gross inadequacies in the medical treatment from the two doctors responsible for his care, including the falsification of records. The regulatory authorities failed to take firm action, and it was only grass-roots efforts by doctors that led, almost 8 years later, to Benjamin Tucker being found guilty of improper and disgraceful conduct and being struck off the medical register; Ivor Lang was found guilty of improper conduct and was given a caution and a reprimand.1
There are strong parallels between the Biko case and the ongoing role of US military doctors in Guantanamo Bay and the War on Terror. Last year,2 we suggested that the physicians in Guantanamo force-feeding hunger strikers should be referred to their professional bodies for breaching internationally accepted ethical guidelines. One of us (DJN) lodged formal complaints with the medical boards for Georgia and California as well as pointing out to the American Medical Association (AMA) that the former hospital commander at Guantanamo, John Edmondson, was a member.3 After 18 months, there had been no reply from the AMA, the Californian authorities stated that they “do not have the jurisdiction to investigate incidents that occurred on a federal facility/military base”, and the authorities in Georgia stated that the “complaint was thoroughly investigated” but “the Board concluded that there was not sufficient evidence to support prosecution”. Yet an analysis of the same affidavit by the Royal College of Physicians concluded that “in England, this would be a criminal act”.
The UK government has refused a request from the British Medical Association for a group of independent doctors to assess the detainees4 and, to date, there has been no formal report on the three alleged suicides in Guantanamo that took place in June, 2006.
The resolution of the Biko case was instrumental in the rehabilitation of the South African Medical and Dental Council and the Medical Association of South Africa, which had been subject to boycotts during the apartheid years. The failure of the US regulatory authorities to act is damaging the reputation of US military medicine. No health-care worker in the War on Terror has been charged or convicted of any significant offence despite numerous instances documented including fraudulent record keeping on detainees who have died as a result of failed interrogations.5 We suspect that the doctors in Guantanamo and elsewhere have made the same mistake as Tucker who, in 1991, in expressing remorse and seeking reinstatement, said “I had gradually lost the fearless independence…and become too closely identified with the organs of the State, especially the Police force…I have come to realise that a medical practitioner's first responsibility is the wellbeing of his patient, and that a medical practitioner cannot subordinate his patient's interest to extraneous considerations.”1
The attitude of the US medical establishment appears to be one of “See no evil, hear no evil, speak no evil”.
DJN reviewed the legal record of a detainee who had allegedly been denied medical treatment, at the request of his attorney, and wrote an affidavit pro bono based on this review. There was no compensation for this work.
Web Extra Material
1. McLean GR, Jenkins T. The Steve Biko affair: a case study in Medical Ethics. Dev World Bioethics 2003; 3: 77-102.
2. Nicholl DJ, Atkinson HG, Kalk J, et alon behalf of 255 other doctors. Forcefeeding and restraint of Guantanamo Bay hunger strikers. Lancet 2006; 367: 811. Full Text | Full-Text PDF (39 KB) | CrossRef
3. Nicholl DJ. Guantanamo: a call for action. Good men need to do something. BMJ 2006; 332: 854-855.
4. Nicholl DJ and 119 other doctors, Doctors at Guantanamo. The Times Sept 18, 2006
(accessed Aug 10, 2007)..
5. Miles SH. Oath betrayed: torture, medical complicity and the War on Terror. New York: Random House, 2006:.
a. Department of Neurology, City Hospital, Birmingham B18 7QH, UK
b. Division of Human Genetics, National Health Laboratory Service and University of the Witwatersrand, Johannesburg, South Africa
c. Center for Bioethics, University of Minnesota, Minneapolis, MN, USA
d. Medical Foundation for the Care of Victims of Torture, London, UK
e. CAGE Prisoners, London, UK
f. MEDACT, The Grayston Centre, London, UK