Dr. Chiara Lepora worked with Médecins sans Frontiéres (Doctors Without Borders) for eight years before joining the Josef Korbel School of International Studies as a visiting professor in Global Health and Humanitarian Assistance. In this piece, she reflects on how torture affects a doctor's code of ethics.

I think so-- under specific circumstances.

Torture is unethical and usually counter-productive; it is prohibited by international and national laws, and by a panoply of professional codes. Clearly, engaging in torture is wrong. Yet it persists, and is widespread in more than a third of the world.

Physicians and other medical professionals working in these countries are frequently asked to assist with torture; they might provide expertise in rendering torture methods more effective, help in covering up consequences of torture (as in modifying a forensic certificate), or they might be called in to provide medical care to a patient who has been tortured.

Any of these roles breach legal and moral codes, both nationally and internationally. Any of those ways of being complicit with the wrong of torture are themselves wrong. Nonetheless, physicians also hold a duty to provide necessary treatment to a patient, and torture undoubtedly inflicts physical and mental suffering that requires care.

Blank prohibition of medical complicity with torture, in contexts where torture occurs regardless of the physicians' stance, might well serve the purpose of preserving the moral integrity of the profession. But it does so at the cost of brutally disregarding the needs of the tortured patient. If a tortured patient demands medical care, the physician should accept some form and degree of complicity in torture in order to assist the tortured patient.

Three main factors should guide a doctor's decision in such circumstances: the expected consequences of the doctor's actions, the wishes of the patient, and the extent of the doctor's complicity with wrongdoing.

First, doctors should assess the consequences of the different options open to them, including for themselves, for the patient, and the possible wider social effects (e.g., encouraging or discouraging policies that permit torture). If a doctor's refusal of complicity might actually stop torture from taking place, and does not endanger their own -- or someone else's -- life doctors ought to refuse. Unfortunately, cases like that are rare.

Second, doctors should attempt to discern and follow the requests of a patient regarding his or her care. To provide care without the patient's explicit consent might indeed just amount to patching them up for further torture. But to refuse treatment, without taking into account the patient's wishes, amounts to that patient's abandonment.

Finally, doctors should weigh the degree to which the act would make them complicit in torture, and minimize the complicity in any possible ways, even when complicity is, all things considered, justifiable. This can be achieved by assessing and minimizing the two component parts of complicity: shared intentions and assistance. If a doctors accepts to be complicit in torture, he does so because of the expressed patient's interest. The physician and torturers may then share some of the same subsidiary goals, such as keeping the patient/prisoner alive, but will have quite different ultimate goals -- the moral evaluations of which are diametrically opposed. Assistance may be reduced by maintaining the same focus on the patient's interest, and thus complying with actions if and only if they are in the patient's interest while sabotaging other requests as far as possible. A physician can further reduce her complicity if, while complicit, she carries out acts that mitigate, prevent or help redress acts of torture. For instance, data secretly collected may be used for reporting occurrences of torture in international tribunals pursuing justice.

Careful judgment must be used, both by individual doctors and medical associations, in weighing these moral factors in various situations. Still, the main point is clear: since complicity is a matter of degree, and other moral factors may have great weight, sometimes the right action involves medical complicity in torture.

For more on this subject, read this paper Dr. Lepora co-authored with her colleague at the National Institute for Health Joseph Millum. The article is a forthcoming publication from The Hastings Center.