The Medical Exam as Political Humiliation
by Jonathan D. Moreno
2004. The American Journal of Bioethics 4(2):W20

Like millions around the world, including the Iraqi people themselves, I was shocked when I saw the despised and feared “Lion of Mesopotamia” looking like nothing so much as an unkempt, bedraggled street person. In that moment of triumph against evil it took me some days to identify a nagging feeling that apart from the raw symbolism of a cruel tyrant brought low, there was a critical element that was obvious yet barely visible, one that was a critical factor in the scene’s power. Those first images depicted a medical examination of a person who had for some time lived in squalor, whose hair needed to be checked for lice and whose mouth had to be inspected for infection.

These were pictures of a patient being attended to by a doctor.

Whoever made the decision to let these be the first images the world would see of the captured Saddam Hussein gets credit for a brilliant insight: Far more humiliating than simply displaying him in a disgusting physical condition would be exhibiting him in a truly vulnerable position, as a filthy beggar having his orifices inspected by a physician. Thus would be evoked Saddam in all his mortality and finitude, just like the rest of us.

Viewing those pictures we could almost imagine how he smelled. When our hygiene is inadequate the normal excretions we work hard to hide and mask produce a particular stench, the most public mark of our connection to the lower animals.

The message intentionally sent to the Iraqi people was loud and clear: You have nothing to fear from a street bum. Perhaps certain other leaders also got the message, like the chic Qadhafi: Mess with us and you, too, can be reduced to this. As political propaganda, these first images were surely a great success, for the point they made was immediate and universal.

Human rights groups were among the few voices of protest. They observed that the humiliation of a prisoner of war is prohibited by the Geneva Convention. Americans of a certain age remember the chilling parade of prisoners by the North Vietnamese government, including Senator John McCain. But these complaints about the Saddam images were dismissed as so much carping in the flush of a triumphal capture. What was not taken into account, by either side, was the specifically medical context.

For all its effectiveness as a piece of political theater, the use of a medical exam to demean and humiliate could set us on a dangerous course, one that, so far as I know, has no precedent. An important principle of medical ethics in wartime is that, if at all possible, the enemy receives the same treatment as our own injured. Medical matters go to the heart of our common humanity, so distortions or manipulations of medical values imperil us all. There are very few ways to preserve humanity in wartime but this is one. Therefore when medical procedures are exploited to make a political point it is not only that the rules have changed but that there may no longer be any rules at all.

Of all people, Americans understand the importance of respecting medical privacy. Today our society is in open rebellion against HMOs and insurance companies that, many fear, might play fast and loose with our personal health information. Many of us are concerned that, in the wrong hands, information about our genetic endowment will cause us to lose our insurance or our jobs. Has managed care caused us to be so skeptical of medical privacy that we are prepared to abandon it when its violation can be used as an instrument of foreign policy?

The military physicians who participated in the taped exam may not have known it was to be used for general consumption. If they had known they would, or at least should, have protested that medical ethics does not permit them to be part of such an exercise. Doctors aren’t required to like their patients but they are required to respect and if necessary protect their humanness. Nothing in the Uniform Code of Military Justice sanctions humiliating patients. Medical personnel have the right to decline to obey an illegal order, and humiliating a patient is illegal under the rules of war.

Under the historical circumstances and considering the magnitude of the event, it may seem odd to take exception to the way Saddam was first seen in captivity. Few human beings in our time more richly deserve utter contempt for the evil he has done and the suffering he has caused. But Saddam himself abused the medical profession, as should become evident in the coming war crimes trials. The rest of us should take care that we do not let slide the civilized standards against which we judge those whose violations are far more grave but no less ominous.