Is Torture Ever Acceptable?

This quarter, I am taking a class called Public Health Ethics, in which we discuss the moral and ethical justifications of actions taken by public health professionals, governments, or any other entity in the name of protecting society as a whole. During our first class, the professor posed an interesting question. He handed us the Universal Declaration of Human Rights (compiled by the United Nations) and asked us this: Which one of these rights would you be willing to put boots on the ground and fight for? Which one of these would you think are ideal to have, but maybe not worth fighting for? He proceeded by reading some of these ‘rights’ outlined in the handout. All was well until we got to the part about torture. The comments made by a woman in class have been forever embedded in my memory.

Article 5 of the Universal Declaration of Human Rights reads:

No one shall be subjugated to torture or to cruel, inhumane or degrading treatment or punishment.

He asked again: Is this something that you would advocate for? No one should be tortured no matter what? What about prisoners of war?

At this point, a woman in her 40s, dressed in a nurse’s uniform, raised her hand. She said that she had a son who was fighting in the United States Army and that the topic of torture by the American soldiers has been on the news quite often. She was referring to the torture of prisoners at Abu Ghraib. The justification she used for the torture of the prisoners was what bothered me. Her conclusion was that the American soldiers were justified because if they had been the ones captured, the “others” would have inflicted a more cruel form of torture on them.

I know where she is coming from in her thinking. She has a son that has been through a lot with the military service and obviously she will be more sympathetic to the soldiers. However, I think this notion of “they” is problematic. When we start differentiating in this way, it is easy to justify inhumane actions on others, whether it’s killing, torture, or something else. Her answer prompted me to think about this subject more and I decided to do my presentation on “War and Public Health”. My partner is talking about the needs of those that are stuck in the middle of a war (and after the war) in terms of food, water, shelter, mental health, and the like. I will be focusing more on the subject of torture and if this is something that we can justify as public health professionals.

Unfortunately, the U.S. Department of Justice sanctions torture to an extent that it deems appropriate. The Bybee Memo redefined torture and concluded (among other things) that there needs to be a ‘ specific intent’ for torture to be considered as such (1).  It is easy to justify these actions when they are being done to terror suspects, but the reality is that many of these suspects are actually innocent. Over 80% of the prisoners at Abu Ghraib were innocent (2). Furthermore, the confessions taken from these prisoners (even from those that were rightly detained) have been incorrect or fabricated, which has led to even more drastic and unnecessary measures by the U.S. government (1).

The next issue that arises is the role of the public health professionals, including nurses and medical doctors. Do they have a moral responsibility to protest against this? Unfortunately, a loyalty conflict arises where a physician is torn between providing care for the patient and working for the military (3). In this case, should the physician ensure that the prisoner’s medical needs are being met, or be a silent observer? It’s known that clinicians have been complacent in these activities and they have reached to the point that they are aiding in the exact science of the torture techniques. For example, physicians might fabricate reports that state that the detainee is healthy enough to go through the ‘interrogation’ process or not treat the appropriate medical conditions of the detainees(3).

I feel that it is an obligation for public health professionals to advocate that governments provide a torture-free environment for the detainees. Torture is plain bad policy, with few (if any) positive outcomes. It would send a strong message to governments if public health workers united against the atrocity of torture, wherever it may happen.

References:

1.    Iacopino V, Allen SA, Keller AS. Bad Science Used to Support Torture and Human Experimentation. Science. 2011;331(6013):34-5.

2.    Lenzer J. Oath Betrayed: Torture, Medical Complicity, and the War on Terror. BMJ: British Medical Journal (International Edition). [Book Review]. 2006;333(7564):401-.

3.    Singh JA. Treating War Detainees and Terror Suspects: Legal and Ethical Responsibilities of Military Physicians. Military Medicine. [Article]. 2007;172:15-21.

Side Note: Here’s a video that I found, but I haven’t watched all of it. It goes into the details of how medical complicity is present in many cases of torture:

Technorati Tags: public health,torture,ethics,graduate school,health

In Simple Terms: Alzheimer’s Disease

Alzheimer’s Disease occurs when there is an increase in neuronal cell death in the hippocampus. The hippocampus is the part of the brain that is involved in learning, memory, as well as with emotional responses. If you are going to lose neurons in this part of the brain, this will obviously have an effect on your learning and memory. Brain imaging from Alzheimer’s patients shows atrophy (or degeneration) of the brain in areas that are involved in learning and memory.

Risk factors of Alzheimer’s include:

1. Age- risk increases after the age of 6o and doubles every decade after that

2. Genetics- if your relative has the disease, your chances of having it increase

3. Cholesterol-high levels of cholesterol are related to an increased risk

4. Injury- a head injury will likely increase the risk

5. Gender- this disease is more common in females than in males

6. Lack of mental stimulation

The critical and toxic molecule in Alzheimer’s disease patients is beta-amyloid, a protein that forms plaques in the brain. Beta-amyloid is formed when an Amyloid Precursor Protein (APP) is cleaved into Ab-40 and Ab-42 (both beta-amyloids) by an enzyme called gamma-secretase. Of the two, Ab-42 is the toxic substance that forms plaques in the brain. An increase in Ab-42 causes degeneration of neurons in the brain. Drugs that inhibit gamma-secretase activity have been found to be effective in reducing the progression of Alzheimer’s.

The mechanism by which beta-amyloid induces death of neurons is through its interference with the reuptake of glutamate. Glutamate binds to the NMDA receptor in the brain, which in turn lets calcium ions flow into the channel. However, if too much calcium comes in, it induces activation of calcium-activated proteases, which leads to cell death. Drugs that inhibit NMDA activity (like Memantine) are also used as treatment for Alzheimer’s.

DNA damage within neuronal cells is also prevalent during the course of the disease.
Even though the Alzheimer’s brain increases DNA repair enzymes as well as BCL-2 ( a component that protects against cell death), the battle between damage and repair is ultimately won by the degenerative neuronal cells. Thus, there is more damage than repair occurring in the brain of these patients.

Here’s what YOU can do to slow this degenerative process:

1. Crossword puzzles. Sudoku. Anything that keeps your mind alive.

Learning and mental stimulation enhances BDNF (brain derived neurotrophic factor), a neurotrophin that supports the cells and makes them ‘feel better’.

2. Take a hike.

Physical activity increases BDNF.

3. Eat healthy

Diets high in fats and sugars decrease BDNF activity.

4. SLEEP

Sleep enhances the activity of BDNF.

5. Quit stressing

6. Get your Vitamin E

Vitamin E slows the progression of Alzheimer’s.

Other interesting facts:

-Patients with rheumatoid arthritis that take Ibuprofen do not get Alzheimer’s because Ibuprofen affects the activity of gamma-secretase in such a way that it reduces the production of beta-amyloid.

-Bilinugals have a lower chance of getting Alzheimer’s

Reference Websites:
http://www.cmj.org/Periodical/paperlist.asp?id=LW7347&linkintype=pubmed
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2772133/?tool=pmcentrez

*Lecture at University of California, Irvine