A new medical ethic: Physicians and the fight for human rights

LEONARD S. RUBENSTEIN is Executive Director of Physicians for Human Rights. Professionals have played a uniquely important role in the movement for human rights. Lawyers, steeped in the rule of law, actively promote codes and covenants articulating human rights and design institutions to enforce them. Journalists, who witness violations of human rights and the martyrdom of colleagues for exposing the truth, use their media platform to urge protection of free expression. Physicians, too, play a critical role in the protection of human rights. For centuries, the medical profession has sworn fealty to principles that affirm the dignity of the individual and demand intervention to end human suffering. Physicians understand better than most the impact of gross human rights violations on the body and mind. As human rights investigations proliferated in the last quarter-century, it became clear that physicians could contribute unique and essential skills to those investigations. Pathologists can establish the cause of death in an extra-judicial killing and expose the truth behind claims by state-sponsored thugs that the victim died of natural causes or by accident. Psychiatrists can assess the trauma of displacement in refugee populations or the impact of forced prostitution on young women. Epidemiologists can assess the health conditions in refugee camps and prisons and gauge the impact of economic sanctions on populations. Physicians for Human Rights, along with other organizations, has become a home for physicians who apply their skills to human rights. At an institutional level, professional societies as well as prestigious institutions like the Institute of Medicine have established human rights committees. Still, the embrace of human rights by the medical profession as a whole has been slow in coming. Over the past two decades, however, some of the barriers to wider physician participation in human rights gradually have been falling, now making room for the emergence of a new medical ethic of human rights. Barriers to Wider Participation Three principal barriers must be overcome before this ethic can firmly be established. The first is that the very nature of the physician's role focuses on the world of the doctor and patient, the world of individual medical diagnosis and intervention to cure or relieve suffering. It is a very private role, played out in the examining room or in the research laboratory. The relationship of the doctor and patient takes place behind closed doors and is almost always hidden from the view of people outside the room. The popular image of the physician, in literature and on television, is of the tireless, skilled doctor working furiously in a hospital to save a life or hunched over the lab in search of a cure for some dread disease. The work is intense, but narrowly focused. It is a role that does not easily lend itself to advocacy. These roles are more than social images. As historian David Rothman explains in Strangers at the Bedside, the intensity of physicians' work with patients and their separation from social and political life during their long period of training has led them to live a professional life of relative isolation, accompanied by a notoriously low level of political involvement. Engagement in human rights advocacy hardly comes naturally. By contrast, the roles of lawyers and journalists are often played out in a very public arena. The lawyer, like the physician, may have a private relationship with his client and share confidences as intimate as those a physician receives, but the lawyer's forum also includes a courtroom or hearing room. Few images of physicians in the political and social realms can match that of Clarence Darrow defending the right to teach evolution in the public schools or Thurgood Marshall thundering before the US Supreme Court against the evils of racial segregation. Similarly, the journalist's work appears in a very public forum, and the tradition of muckraking has enshrined the journalist's role in exposing wrongs. …