Unit 731 and moral repair.

Unit 731, a biological warfare research organisation that operated under the authority of the Imperial Japanese Army in the 1930s and 1940s, conducted brutal experiments on thousands of unconsenting subjects. Because of the US interest in the data from these experiments, the perpetrators were not prosecuted and the atrocities are still relatively undiscussed. What counts as meaningful moral repair in this case-what should perpetrators and collaborator communities do decades later? We argue for three non-ideal but realistic forms of moral repair: (1) a national policy in Japan against human experimentation without appropriate informed and voluntary consent; (2) the establishment of a memorial to the victims of Unit 731; and (3) US disclosure about its use of Unit 731 data and an apology for failing to hold the perpetrators accountable.

Stratified reproduction, family planning care and the double edge of history.

PURPOSE OF REVIEW: There is a growing clinical consensus that Medicaid sterilization consent protections should be revisited because they impede desired care for many women. Here, we consider the broad social and ideological contexts for past sterilization abuses, beyond informed consent. RECENT FINDINGS: Throughout the US history, the fertility and childbearing of poor women and women of color were not valued equally to those of affluent white women. This is evident in a range of practices and policies, including black women's treatment during slavery, removal of Native children to off-reservation boarding schools and coercive sterilizations of poor white women and women of color. Thus, reproductive experiences throughout the US history were stratified. This ideology of stratified reproduction persists today in social welfare programs, drug policy and programs promoting long-acting reversible contraception. SUMMARY: At their core, sterilization abuses reflected an ideology of stratified reproduction, in which some women's fertility was devalued compared to other women's fertility. Revisiting Medicaid sterilization regulations must therefore put issues of race, ethnicity, class, power and resources - not just informed consent - at the center of analyses.

[Doctors of the dictatorship: physicians and human rights violations in Brazil (1964-1985)]. / Doutores da ditadura: médicos e violação dos direitos humanos no Brasil (1964-1985).

The article discusses the participation of doctors in the Brazilian military dictatorship (1964-1985). It identifies the main ways in which these doctors contributed with their technical and scientific knowledge and their institutional positions to the repression of the regime's opponents. The authors argue that this collaboration was not casual but strategic, organized, and systematic in assisting interrogations and practices of physical and psychological torture, as well as in covering up human rights violations. The article points out that this collaboration between doctors and the authoritarian regime violated all professional codes of ethics and international conventions for the protection and promotion of human rights, as well as the Hippocratic Oath. The primary historical sources on which the article is based are documents from the Brasil Nunca Mais Project, the final report of the National Truth Commission (CNV), and reports from states truth commissions. It concludes that the scant civil, criminal, and professional punishment of doctors involved in the regime's violence, protected by the 1979 Amnesty Law and other legal provisions, characterizes an incomplete rupture with the authoritarian legacies of the past, with consequences for the present and future of Brazilian democracy.

O artigo aborda a participação de médicos na ditadura civil militar brasileira (1964-1985) e identifica as principais formas pelas quais esses médicos contribuíram com seus conhecimentos técnicos e científicos e suas posições institucionais para a repressão aos opositores do regime. Os autores argumentam que essa colaboração não foi eventual, mas estratégica, organizada e sistemática na assessoria a interrogatórios e práticas de tortura física e psicológicas, assim como no encobrimento de violações de direitos humanos. O artigo chama a atenção para que essa colaboração de médicos com o regime autoritário transgrediu códigos de ética profissionais e as convenções internacionais de proteção e promoção dos direitos humanos, assim como o Juramento de Hipócrates. As principais fontes históricas que embasam o artigo são os documentos do Projeto Brasil Nunca Mais e do relatório final da Comissão Nacional da Verdade (CNV), assim como relatórios de comissões estaduais da verdade. Conclui que a exígua punição civil, criminal e profissional aos médicos envolvidos com a violência do regime, protegidos pela Lei da Anistia de 1979 e outras provisões legais, caracteriza o rompimento incompleto com os legados autoritários do passado, com consequências para o presente e o futuro da democracia brasileira.

Historical Primer on Obstetrics and Gynecology Health Inequities in America: A Narrative Review of Four Events.

Four historical events provide context for racial injustices and inequities in medicine in the United States today: the invention of race as a social construct, enslavement in the Americas, the legal doctrine of Partus sequitur ventrem, and the American eugenics movement. This narrative review demonstrates how these race-based systems resulted in stereotypes, myths, and biases against Black individuals that contribute to health inequities today. Education on the effect of slavery in current health care outcomes may prevent false explanations for inequities based on stereotypes and biases. These historical events validate the need for medicine to move away from practicing race-based medicine and instead aim to understand the intersectionality of sex, race, and other social constructs in affecting the health of patients today.

Bodies of science and law: forensic DNA profiling, biological bodies, and biopower.

How is jurisdiction transferred from an individual's biological body to agents of power such as the police, public prosecutors, and the judiciary, and what happens to these biological bodies when transformed from private into public objects? These questions are examined by analysing bodies situated at the intersection of science and law. More specifically, the transformation of 'private bodies' into 'public bodies' is analysed by going into the details of forensic DNA profiling in the Dutch jurisdiction. It will be argued that various 'forensic genetic practices' enact different forensic genetic bodies'. These enacted forensic genetic bodies are connected with various infringements of civil rights, which become articulated in exploring these forensic genetic bodies''normative registers'.

Advertising Phuket's nightlife on the Internet: a case study of double binds and hegemonic masculinity in sex tourism.

One significant human rights violation in Southeast Asia is the exploitation of women through sex tourism. Such sexual exploitation occurs in Thailand because institutions are complacent and society accepts the practice. This case study, guided by the concepts of double binds and hegemonic masculinity, sought to understand if Thai culture is symbolically constructed in ways to portray Thailand as a desirable "sex tourist" destination. Websites portray Phuket as a patriarchal world where men can live their fantasies of being perfect hegemonic males because Thai bar girls are young nymphomaniacs that have no need to be talked to or understood.

[Hnat Omelianovych. Ruchko (1883-1937): tragic destiny of the scientist].

The life and scientific activity of Gnat O.Ruchko, an outstanding scientist-microbiologist, the former director of the Institute of Microbiology and Epidemiology are investigated. Many data and facts are represented for the first time, some of them are refined and corrected, since their sources are both the recollections of scientist's colleagues kept in the Institute archives and extracts from personal file trumped-up by NKVD (People's Commissariat of Internal Affairs) after Ruchko's imprisonment and kept in SBU (Ukrainian Security Service) archives. Special attention is devoted to analysis of scientist's works on bacteriophages, epidemiology and also to role of Gnat O.Ruchko in the Institute reorganization and creation of the Department of Agricultural Plants Bacterioses.

The League of Nations' rescue of Armenian genocide survivors and the making of modern humanitarianism, 1920-1927.

The essay centers of the efforts by the League of Nations to rescue women and children survivors of the 1915 Armenian Genocide. This rescue -- a seemingly unambiguous good -- was at once a constitutive act in drawing the boundaries of the international community, a key moment in the definition of humanitarianism, and a site of resistance to the colonial presence in the post-Ottoman Eastern Mediterranean. Drawing from a wide range of source materials in a number of languages, including Turkish, Armenian, and Arabic, the essay brings the intellectual and social context of humanitarianism in initiating societies together with the lived experience of humanitarianism in the places where the act took form. In so doing, it draws our attention to the proper place of the Eastern mediterranean, and its women and children, in the global history of humanitarianism. The prevailing narrative of the history of human rights places much of its emphasis on the post-World War II era, the international reaction to the Holocaust, and the founding of the United Nations. yet contemporary human rights thinking also took place within practices of humanitarianism in the interwar period, and is necessarily inseparable from the histories of refugees, colonialism, and the non-West.

Probable posttraumatic stress disorder and disability in Cambodia: associations with perceived justice, desire for revenge, and attitudes toward the Khmer Rouge trials.

CONTEXT: Millions of Cambodians suffered profound trauma during the Khmer Rouge era (1975 to 1979). A joint United Nations-Cambodian tribunal (the "Khmer Rouge trials") was empanelled in 2006 to prosecute top Khmer Rouge leaders and began substantive hearings in March 2009. OBJECTIVES: To establish the prevalence of probable posttraumatic stress disorder (PTSD) among adult Cambodians and to assess correlates of PTSD symptoms and disability with perceived justice, desire for revenge, and knowledge of and attitudes toward the trials. DESIGN, SETTING, AND PARTICIPANTS: A national probability sample of 1017 Cambodians was assembled using a multistage, stratified cluster design, including 813 adults older than 35 years who had been at least 3 years old during the Khmer Rouge era and 204 adults aged 18 to 35 years who had not been exposed to the Khmer Rouge era. Face-to-face interviews were conducted between December 2006 and August 2007. MAIN OUTCOME MEASURES: Prevalence of probable PTSD using the PTSD Checklist, Civilian version (cutoff score of 44), and mental and physical disability using the Medical Outcomes Study 12-item Short Form Health Survey. RESULTS: The prevalence of current probable PTSD was 11.2% (95% confidence interval [CI], 8.6%-13.9%) overall and 7.9% (95% CI, 3.8%-12.0%) among the younger group and 14.2% (95% CI, 11.0%-17.3%) in the older group. Probable PTSD was significantly associated with mental disability (40.2% vs 7.9%; adjusted odds ratio [AOR], 7.80; 95% CI, 3.90-15.60) and physical disability (39.6% vs 20.1%; AOR, 2.60; 95% CI, 1.26-5.39). Although Cambodians were hopeful that the trials would promote justice, 87.2% (n = 681) of those older than 35 years believed that the trials would create painful memories for them. In multivariate analysis, respondents with high levels of perceived justice for violations during the Khmer Rouge era were less likely to have probable PTSD than those with low levels (7.4% vs 12.7%; AOR, 0.54; 95% CI, 0.34-0.86). Respondents with high levels of desire for revenge were more likely to have probable PTSD than those with low levels (12.0% vs 7.2%), but the difference was not statistically significant in the multivariate analysis (AOR, 1.76; 95% CI, 0.99-3.11). CONCLUSIONS: Probable PTSD is common and associated with disability in Cambodia. Although Cambodians had positive attitudes toward the trials, most were concerned that the trials would bring back painful memories. Now that the trials have begun, longitudinal research is needed to determine the impact of the trials on Cambodians' mental health.

Bioethics, biopolitics and medical regulation: learning from the Nazi doctor experience.

The phenomenon of abuse committed by medical practitioners during the Nazi era generated the creation of a series of important human rights instruments. Its evolution from sterilisation of persons with intellectual disabilities and euthanasia of those with mental illnesses constituted a dreadful fusing of legal and medical initiatives. Together these made possible the dehumanising rhetoric and then actions against Jews, the creation of the death camps by doctors, and the commission of human experiment atrocities by medical practitioners at the camps. There remains much that we must remember and learn if we are to formulate effective checks and balances to reduce the risk or repetition of such conduct. Numbered among these is a preparedness to name "evil" when it occurs so as to facilitate distinctions being drawn between conduct that is professionally acceptable and that which is repugnant and inconsistent with all principles of ethical conduct by medical practitioners.

Violations of human rights: health practitioners as witnesses.

For humanitarian health-care practitioners bearing witness to violations of human dignity has become synonymous with denunciations, human rights advocacy, or lobbying for political change. A strict reliance on legal interpretations of humanitarianism and human rights is inadequate for fully understanding the problems inherent in political change. With examples from the HIV/AIDS epidemic in the USA, the Rwandan genocide, and physician-led political activism in Nepal, we describe three cases in which health practitioners bearing witness to humanitarian and human-rights issues have had imperfect outcomes. However these acts of bearing witness have been central to the promotion of humanitarianism and human rights, to the pursuit of justice that they have inevitably and implicitly endorsed, and thus to the politics that have or might yet address these issues. Despite the imperfections, bearing witness, having first-hand knowledge of humanitarian and human-rights principles and their limitations, and systematically collecting evidence of abuse, can be instrumental in tackling the forces that constrain the realisation of human health and dignity.

[Pandora's box of anatomy].

Physicians in Nazi Germany were among the first to join the Nazi party and the SS, and were considered passionate and active supporters of the regime. Their actions included development and implementation of the racial theory thus legitimizing the development of the Nazi genocide plan, leadership and execution of the sterilization and euthanasia programs as well as atrocious human experimentation. Nazi law allowed the use of humans and their remains in research institutions. One of the physicians whose involvement in the Nazi regime was particularly significant was Eduard Pernkopf. He was the head of the Anatomy Institute at the University of Vienna, and later became the president of the university. Pernkopf was a member of the Nazi party, promoted the idea of "racial hygiene", and in 1938, "purified" the university from all Jews. In Pernkopfs atlas of anatomy, the illustrators expressed their sympathy to Nazism by adding Nazi symbols to their illustrations. In light of the demand stated by the "Yad Vashem" Institute, the sources of the atlas were investigated. The report, which was published in 1998, determined that Pernkopfs Anatomy Institute received almost 1400 corpses from the Gestapo's execution chambers. Copies of Pernkopfs atlas, accidentally exposed at the Rappaport School of Medicine in the Technion, led to dilemmas concerning similar works with a common background. The books initiated a wide debate in Israel and abroad, regarding ethical aspects of using information originated in Nazi crimes. Moreover, these findings are evidence of the evil to which science and medicine can give rise, when they are captured as an unshakable authority.

Psychiatry and political-institutional abuse from the historical perspective: the ethical lessons of the Nuremberg Trial on their 60th anniversary.

Sixty years ago at the Nuremberg Trials, 23 Nazi leaders were tried as war criminals, in what was known as "The Doctors' Trial". This trial exposed a perverse system of the criminal use of medicine in the fields of public health and human research. These practices, in which racial hygiene constituted one of the fundamental principles and euthanasia programmes were the most obvious consequence, violated the majority of known bioethical principles. Psychiatry played a central role in these programmes, and the mentally ill were the principal victims. The aim of the present work is to review, from the historical perspective, the antecedents of the shameful euthanasia programmes for the mentally ill, the procedures involved in their implementation and the use of mentally ill people as research material. The Nuremberg Code, a direct consequence of the Doctors' Trial, is considered to be the first international code of ethics for research with human beings, and represented an attempt to prevent any repeat of the tragedy that occurred under Nazism. Nevertheless, the last 60 years have seen continued government-endorsed psychiatric abuse and illegitimate use of psychoactive drugs in countries such as the Soviet Union or China, and even in some with a long democratic tradition, such as the United States. Even today, the improper use of psychiatry on behalf of governments is seen to be occurring in numerous parts of the globe: religious repression in China, enforced hospitalization in Russia, administration of psychoactive drugs in immigrant detention centres in Australia, and the application of the death penalty by lethal injection and psychiatric participation in coercive interrogation at military prisons, in relation to the USA. The Declaration of Madrid in 1996 constituted the most recent attempt to eradicate, from the ethical point of view, these horrendous practices. Various strategies can be used to combat such abuses, though it is uncertain how effective they are in preventing them.

The political use of psychiatry: A comparison between totalitarian regimes.

BACKGROUND: After the end of Second World War, the recent experience of the Nazi horrors stimulated a debate about the political use of psychiatry. Over the years, the focus shifted on major dictatorships of the time and especially on Soviet Union. AIMS: This article aims to provide a critical review of the ways in which psychiatry was used by totalitarian regimes of the 20th century. METHODS: We summarized relevant literature about political use of psychiatry in totalitarian regimes of the 20th century, with particular focus on Fascism, Nazism, Argentina dictatorship, Soviet Union and China. RESULTS: One of the features that are common to most of the dictatorships is that the use of psychiatry has become more prominent when the regimes have had the need to make more acceptable the imprisonment of enemies in the eyes of the world. This for example happened in the Nazi regime when sterilization and killing of psychiatric patients was explained as a kind of euthanasia, or in the Soviet Union after the formal closure of the corrective labor camps and the slow resumption of relations with the capitalistic world, or in China to justify persecution of religious minorities and preserve economic relations with Western countries. CONCLUSION: Psychiatry has been variously used by totalitarian regimes as a means of political persecution and especially when it was necessary to make acceptable to public opinion the imprisonment of political opponents.

The United States cover-up of Japanese wartime medical atrocities: complicity committed in the national interest and two proposals for contemporary action.

To monopolize the scientific data gained by Japanese physicians and researchers from vivisections and other barbarous experiments performed on living humans in biological warfare programs such as Unit 731, immediately after the war the United States (US) government secretly granted those involved immunity from war crimes prosecution, withdrew vital information from the International Military Tribunal for the Far East, and publicly denounced otherwise irrefutable evidence from other sources such as the Russian Khabarovsk trial. Acting in "the national interest" and for the security of the US, authorities in the US tramped justice and morality, and engaged in what the English common law tradition clearly defines as "complicity after the fact." To repair this historical injustice, the US government should issue an official apology and offer appropriate compensation for having covered up Japanese medical war crimes for six decades. To help prevent similar acts of aiding principal offender(s) in the future, international declarations or codes of human rights and medical ethics should include a clause banning any kind of complicity in any unethical medicine-whether before or after the fact-by any state or group for whatever reasons.

Health, human rights, and malaria control: historical background and current challenges.

Malaria, a parasitic infection, causes hundreds of millions of disease episodes and more than a million deaths every year, nearly all of them occurring in the poorer and more vulnerable sectors of the world's developing countries. In spite of the great burden of suffering caused by malaria, the human rights implications of this disease have not been well described. This article summarizes important associations between the spread of malaria and human rights abuses (such as those associated with slavery and armed conflict) and between poverty, socio-economic inequity, and access to malaria-control measures. The author concludes that malaria control merits inclusion as a core element in global strategies to achieve progressive realization of the right to health.

Incommunicado detention and torture in Spain:Part I: The Istanbul Protocol Project in the Basque Country.

There is increasing evidence to show that torture is a serious problem in the Basque Country. Whilst such evidence can be found in reports of international human rights monitoring bodies, sentences of Spanish and international courts, and empirical studies, they are limited in not having followed the Istanbul Protocol (IP) in order to evaluate the reliability of torture. A working group composed of professional associations of psychiatrists, psychologists, physicians and lawyers, in collaboration with the University of the Basque Country, conducted a four-year study on the medical and psychological consequences of torture in incommunicado detainees, including an assessment of credibility in line with the IP. The methodological design included a multi-level peerreviewed blind assessment and input by an external expert (from the Independent Forensic Expert Group facilitated by International Rehabilitation Council for Torture Victims (IRCT)). A sample of 45 Basque people held in short-term incommunicado detention under anti-terrorist legislation (between 1980 and 2012) in Spain who had reported ill-treatment or torture was selected. The findings are divided into four papers: the present introductory paper; the second analyses the credibility of the allegations of torture and introduces an innovative methodology that enhances the IP, the Standardized Evaluation Form (SEC); the third provides an analysis of the methods of torture and introduces the concept of Torturing Environments; and, in the last paper, the psychological and psychiatric consequences of incommunicado detention are analyzed. The collection of papers are intended to be useful not only in the documentation of torture in the Basque Country and Spain, but also as an innovative example of how the IP can be used for research purposes.

Incommunicado detention and torture in Spain, Part II: Enhanced credibility assessment based on the Istanbul Protocol.

BACKGROUND: The Istanbul Protocol (IP) is the key instrument in the documentation of allegations of torture. However, few scientific studies have evaluated its effectiveness as a tool to assess credibility of allegations of ill-treatment or torture. OBJECTIVE: Present data on the credibility of allegations of torture in a sample of 45 Basque people held in short-term incommunicado detention between 1980 and 2012, using a modified version of the Standard Evaluation Form for Credibility Assessment (SEC), a new tool to assess credibility based on the IP. METHOD: Each case was evaluated by two psychiatrists, a psychologist and a physician through a layered system of simultaneous, independent assessments, blind audits and peer-review processes. Clinical interviews following the IP were contrasted with psychometric tests and external documentary evidence by independent experts. All available data were structured using the SEC and cases were accordingly classified as having Maximum consistency, Highly Consistent, Consistent or Inconsistent. FINDINGS: According to the SEC, 53% of allegations of torture were considered to have Maximum Consistency, 31% Highly consistent, 15% Consistent and 0% Inconsistent. The items that most contributed to the overall credibility assessment came from the psychological evaluation, including the description of alleged torture, emotional reactions, objective functional changes, changes in identity and worldviews and clinical diagnosis. There was little contribution from previous medical reports. INTERPRETATION: When applied competently, the IP is an essential tool in the documentation of torture. Our study shows: (a) evidence that allegations of ill-treatment and torture in the Basque Country are consistent and credible, being ascertained beyond reasonable doubt and aside from any political debate; (b) the wider use of the IP as a tool to assess credibility of allegations of ill-treatment and torture; and, (c) the usefulness of the SEC as a tool. The SEC can help as a tool for documenting torture in contexts where there are political differences and figures are distorted as a result of polarized political debates, and where legal documentation is needed for judicial purposes. Forensic science can help by providing an objective assessment of the credibility of allegations.