The Times is reporting that health care workers actively assisted in the torture of CIA detainees overseas. This, as you might imagine, sickens me.

Many of us have seen movies or read spy novels where a doctor stands by as someone is tortured, monitoring their condition and telling the interrogator when they need to back off. It turns out this really happens.

I don’t have that much to say about this that isn’t obvious, i.e., it’s never acceptable for health care workers (HCWs) to participate in activities designed to cause their patients intentional discomfort or injury. That’s a no-brainer. But what justifications do health care workers use to allow themselves to participate in these activities?

One obvious one is that they may fear for their own physical safety or that of their families. In that case, no one should render judgment to quickly; this is a powerful inducement. This is probably not the case with American HCWs or those hired by Americans. A related issue is the fear of loss of gainful employment. This doesn’t change the “wrongness” of the act, but it does help explain why someone would choose to participate. Economic coercion, whether real or perceived, is a powerful inducement.

Another reason HCWs might participate in unethical activities is a sense of duty. An Army medic, for example, may be ordered to participate, and may feel a duty to his superiors and to his nation. This also does not change the immoral nature of the action, but does present a difficult conflict for an individual HCW to navigate.

The final reason a health care worker may agree to participate is more subtle and more heinous—they may believe they are helping the victim. Their inner dialog may go something like this: “The prisoner will be tortured no matter what I do, so I might as well use my expertise to protect them in any little way I can.”

This paternalistic and narcissistic view is nothing more than a way to make yourself feel good about doing a bad thing. The act of dressing a wound does not make up for having inflicted it. A doctor’s participation may in fact lead to prolonging torture, allowing interrogators to “push it to the limit”.

There is no justification for health care workers participating in torture. None. It is always wrong. It violates the dignity and autonomy of your patient, and allows them to experience more discomfort than they might have without the help of a health care worker. If the CIA wants to torture people that’s their problem—health care workers cannot be there to help them turn the screw a little further, or to soothe the conscience of the interrogator. You chose your profession—you must either hold to its ethics or step away from the job.