Doctors who kill

Doctors who kill
By Regina Dwyer
Copyright by The International Herald Tribune
Published: July 6, 2007


SEATTLE:

'Until yesterday," London surgeon Abhay Chopada told the International Herald Tribune last week, "if anyone had said that doctors were involved in terrorism, I would have said that was completely impossible."

Actually, it's not only possible but more common than Dr. Chopada realizes. And, as a physician myself, while I find it repulsive, it's not all that surprising.

Within the Arab terror world alone, Ayman al-Zawahiri, Al Qaeda's No. 2, trained as pediatrician. George Habash of the Popular Front for the Liberation of Palestine and the Hamas leader in Gaza, Mahmoud Zahar, also trained as medical doctors. So of course did the Nazi "angel of death," Josef Mengele.

In addition, there have been dozens of doctors convicted of murder and mass murder in famous public trials, including classic crimes of passion (Harvey Crippen in Britain and Jeffrey MacDonald in the United States) as well as various questionable "mercy" killings (Harold Shipman in Britain and America's "Dr. Death," Jack Kevorkian).

It's hard to find statistics on the occupations of murderers, so it's difficult to know exactly where doctors rank. The U.S. Department of Justice, for example, keeps tabs on thousands of aspects of the prison population and their victims, but they do not break out killers by occupation.

Doctors are no doubt far outnumbered as murderers by career criminals. But the wonder for most people is that a profession dedicated to life saving produces any killers at all.

Why do they do it? How can they do it? After all, the Hippocratic Oath - which most every physician is taught, if no longer sworn to - commands "first do no harm."

Can there be any greater harm than murder? Well, yes, some doctors would say. Endless, torturous suffering is worse than death. And the deaths of many are worse than the death of one. And the death of a culture or a country is worse than the death of a crowd at a nightclub.

In truth, doctors are taught that while death is the enemy, it is also natural and inevitable, and not necessarily evil per se. Death quite literally can't be stopped, so the goal instead is to minimize suffering and the amount of "needless" or "premature" death.

For the overwhelming majority of nurses and physicians, death remains a nasty adversary. But for the handful of practitioners who are inclined to turn homicidal, this familiarity with the Reaper, plus their training and practice, may make it easier, not harder, to kill.

Consider our training. On the first day of class at almost every medical school in the world, new students are presented a reeking cadaver to dissect.

Part of it is their first lesson in anatomy; most of it is their first lesson in getting used to death. Vomiting and fainting are not unusual first day reactions. But three months later they will be quite used to the sights and smells of death.

Consider our practice experience. Like the first day at medical school, a doctor's daily dealing with disease and death compels us to learn how to disregard death for our mental survival, and in part, at least, inures us to the suffering that comes with any illness, injury or surgery. We literally get used to it. If we don't, we quit or go mad.

Similarly, because experimentation is an essential element of medical science and progress, the regular killing of animals and the testing of potentially lethal drugs and procedures on humans is common practice. You get accustomed to seeing some very bad stuff.

Consider our ethics. They're quite real, but they are also very situational. We quite properly don't employ the same extreme measures to prolong the life of a terminal 95-year-old as we do when faced with a gravely ill child. When resources are limited, we try to get the most bang for the buck by focusing first on those who can be saved.

This is the philosophical basis for triage, the standard emergency room and battlefield crisis practice of separating patients who can be saved from those who, to save the salvageable, must be "sacrificed" by neglect. Triage has saved countless lives over the centuries, but it's a relatively small leap from sacrifice by neglect to just sacrifice.

For the homicidally inclined, "triage ethics" provide a handy rationalization for mere murder. Pretty soon, people who are suffering or merely inconvenient become unsalvageable.

Finally, consider our personalities. Most of us are grounded, normal people. But messianic and visionary delusions come naturally with the medical territory.

The everyday business of medicine creates a god complex in some practitioners that first blinds them, and then seduces them to view their deviltry as noble work toward higher purposes.

My guess is that at least some of the current doctor terrorists, when interviewed, will gamely defend the higher purpose of their attempted carnage.

In the end, we doctors are no different than the rest of you. We probably turn killer less often than most other occupations. But our ranks have and will always include the deeply flawed, the greedy, the delusional, bunglers, rationalizers and just plain sociopaths - like every other population.

Dr. Regina Dwyer is a retired physician living in Seattle.