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34 detainees and prisoners. She saw the physical results of persons who were punished, whipped, kicked, and teargassed, and her medical superiors refused to investigate the prisoners' complaints. She saw a lawyer who gave her two choices. She could, like the rest of her fellow physicians, ignore what she had seen or she could go to court and seek an injunction and possibly lose her job. She chose to be a nonparticipant observer and went to court and won a temporary restraining order against assaults by the police. Such persons deserve our commendation. Finally, there are those ~ call the participant observers. You might wonder why I call them participants, because all they do is observe. In fact, they participate by their silence. Jacobo Timerman, the distinguished Argentine newspaper editor, said the holocaust will be understood not so much through the number of its victims as through the silence in which it existed. The Institute of Medicine has decided not to be counted among those who participate by their silence and is exploring a variety of ways in which it can join other scientists in the defense of human rights. QUESTIONS AND ANSWERS Gerard Debreu The speakers will welcome questions. Douglas Sanmelson, American Statistical Association, Committee on Scientific Freedom and Human Rights As you know, in many cases, such as detainment of a scientist, it is possible for scientific societies in the West to argue forcefully in that scientist's behalf with the government responsible for the action. To raise similar arguments for the end of torture or for chang- ing the medical ethics practiced within a government is much more difficult. Do any of you have any thoughts, any insights, about what means Western scientific societies may use to persuade governments to restrict the use of torture?

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35 Juan [uis Gonzalez ~ think my government is absolutely resistant to any kind of pressure that can be made by scientific associations. For the Chilean government, the only pressure that can be made is political pressure. So, that Is the way to do things. Helen Rodney ~ would like to ask Dr. Gonzalez if other groups are protesting the abuse of human rights by the current government there outside of the medical group that has done such an admirable job In Chile. Juan [nis Gonzalez Not only the Chilean medical association has been protesting against abuses and defending human rights. Also the Catholic church and other churches have been working very hard on that, along with other professional associations, such as the lawyers, the engineers, and many others. Helen Penney Is there any second political party that is being allowed to emerge at all? Juan [uis Gonzalez In my country, political parties are forbidden. Joe} Lebowitz, Rutgers University ~ was just going to ask members, especially those from the In- stitute of Medicine, to what extent medical ethics, particularly con- cerning torture, Is now being taught in all medical schools. How much can such education be extended in the hope that it will have some effect, in general? Albert Soinit ~ think that the concept of informed consent is one that fails to be implemented perfectly. It is an effort on the part of orga- nizations conducting experunental treatments or treatments of any

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36 kind to make sure that obtaining consent ~ legitimately delegated to an appropriate person and is provided for painful or experimental treatments. ~ believe we have entered into an era when we can begin to approx~nate a healthy answer to that question. Virginia M. Bouncier, Washington Office on Latin America ~ would like to ask Dr. Gonzalez if he could comment on the recent ruling by the Chilean government regarding the use of secret detention centers, what he thinks that will mean for the pattern of torture in Chile, and if the Chilean medical association has taken a stand on that. Juan [ule Gonzalez You will have to excuse me, but ~ do not understand what you say, Ginny. Virginia M. Bouvier There was a recent ruling by the Chilean government banning the use of secret detention centers, ~ understand. ~ wonder if you had heard that and what you think that will mean for Chile. Juan Luis Gonzalez Yes, ~ have heard of that, and ~ think they are only words and nothing more. Participant ~ would like to direct my comment to Dr. Haynes. My hope is that the Institute of Medicine will make its activities public, so that a broader range of people than those in this room and those who read occasional documents about the abuse of medicine in torture will become aware of this situation. ~ think that it is necessary, in the end, that a political process brings this practice of torture to an end in any country around the world, but if this remains private information of Chilean or American medical associations or other associations, then ~ think it will fall far short. ~ hope that that can be done.

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37 M. Aided Haynes ~ am reasonably certain that this will be done. As ~ said earlier, what the institute has been trying to clarify is exactly what its role can be. The problems are so enormous worldwide and they appear, in some cases, to be increasing. The institute is reluctant to take on more than it can handle competently, but ~ can assure you that there is a very serious attempt on the part of the institute to do all it can and that it wiB take appropriate steps to encourage others who come within its domain to do their part.

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