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Part ~ Torture, Psychiatric Abuse, and the Ethics of Medicine INTRODUCTION Gerard Debreu Over the past two decades the systematic use of torture and psychiatric abuse have been sanctioned or condoned by more than one-thirc] of the nations in the United Nations, about half of mankind. They have shown no discrimination according to ideologies or to races. They have raised many questions that concern this academy and the Institute of Medicine. Some of those questions are of a scientific nature. What are the long-range physical and psychological consequences of torture and of psychiatric abuse? How can they be treated? How do the victims react when they are faced with excruciating pain or the loss of their mental integrity? How does a human being become a torturer? How does a society tolerate torture and the commitment of political dissidents to psychiatric hospitab? The first part of this symposium will deal with some of those issues, but it wiD also focus on ethical questions. Outstanding among them is the participation of physicians in both torture and psychi- atric abuse. The fact that men, women, and sometimes children are subjected to torture is an outrage. The outrage is greater when physicians, committed by their profession to healing and to relieving suffering, become active participants in inflicting pain and in abusing psychiatry for political purposes. 21

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Many members of the worldwide medical community have spo- ken and acted forcefully in their condemnation of those professional abuses and in their defense of human rights. Four of them are with us today. The three discussants, Drs. Helen Ranney, Albert Soinit, and Alfred Haynes, have all served as members of our Committee on Human Rights. Dr. Helen Ranney is chair of the Department of Medicine at the University of California at San Diego and Distinguished Physician at the Veterans Administration Medical Center in La JolIa. She will discuss torture, collusion of physicians in torture, and scientists and health professionals as victims of torture. Dr. Albert SoInit is Sterling Professor of Pediatrics and Psychi- atry at the Child Study Center at Yale University. He will discuss the basic tenets of psychiatric treatment of victims of torture and the abuses of psychiatry for political ends. Dr. Alfred Haynes is professor, Department of Community Medi- cine at the Charles R. Drew Postgraduate Medical School in Los Angeles. He will discuss the responsibility of scientists and medical personnel to condemn abuses and to provide support for those who speak out against or refuse to collude in torture and psychiatric abuse. Our guest speaker, Dr. Juan Cuts Gonzalez, Is a surgeon and president of the independent Medical Association of Chile. ~ hac] the privilege of meeting Dr. Gonzalez one morning in March 1985, when a human rights mission of the academy spent a week in Santiago. On that occasion, Dr. Gonzalez and his colleagues commanded the respect of our mission for their professionalism and thoroughness. They won our admiration for the courage with which they condemned the practice of torture and the collusion of physicians with torturers in their country. Gonzalez testified before the U.S. Congress on torture in Chile, and he accepted the Scientific Freedom and Responsibility Award for 1986 from the American Association for the Advancement of Science for the Colegio Medico de Chile. In 1986, he became the president of the National Civic Assembly in Chile, a group of representatives of professional, social, and community organizations and trade unions who oppose the Chilean government. When Dr. Gonzalez was arrested on July 11, 1986, with 15 other members of the board of the National Civic Assembly involved in the planning of the July 2d and ad general strike, the Committee