New project develops ethical framework to help doctors make difficult decisions

Medical professionals have a duty of care to relieve suffering and save lives. Although they will occasionally make mistakes, it is rare that someone deliberately participates in wrongdoing. But there are times when carrying out what is perceived as ‘good’ work can end up supporting something bad – a situation known as medical complicity.

For example, while a doctor may not deliberately participate in torturing a prisoner, he or she may be indirectly complicit in torture by agreeing to treat the victim’s wounds so that others can continue to hurt them. Other examples of medical complicity may be less extreme but still pose significant ethical dilemmas for doctors trying to decide on the right thing to do. The EU-funded MEDCOM project aims to provide guidance.

“The concept of complicity means that you don’t do the wrong directly yourself, but you may still be aiding harm done by others,” explains Katrien Devolder of the University of Oxford in the UK, who leads MEDCOM. “Ethics tends to focus on direct wrongdoing, which is easier to see. This area of complicity is underexplored because it’s really complicated.”

Studying difficult cases

MEDCOM attempted to tackle some of the ethical issues faced by medical professionals by focusing on three main questions: does complicity require a medical professional to contribute to the wrongdoing of others; for example, by enabling more torture? Can someone really be complicit in wrongdoing if their contribution is very small or imperceptible? And how do we judge to what extent someone is complicit?

By analyzing specific case studies, the project aimed to come up with a practical framework to help healthcare professionals think through ethical dilemmas that arise during their work.

One case study concerned Frank Van Den Bleeken, a rapist and murderer with psychiatric problems who requested euthanasia after being kept in poor conditions in a regular prison in Belgium rather than a specialist psychiatric unit.

Euthanasia is legal in Belgium under certain circumstances, if the request is voluntary, repeated and well-considered; one doctor was prepared to carry out the procedure, thereby respecting Van Den Bleeken’s personal autonomy. By agreeing to kill the prisoner rather than pushing for him to be rehoused in better conditions, the concern is that the doctor may be complicit in supporting the poor treatment of prisoners with psychiatric illness.

After considering all aspects of the case, Devolder concluded that the issue of complicity in poor prison conditions, although important, did not outweigh the need to respect Van Den Bleeken’s own autonomy over his life. By writing articles and drawing attention to the issue of medical complicity in this case, the researcher was able to contribute to deliberations on an extremely controversial case that made national and international headlines.

From past to present

Another case centered on the role of the US government in indirectly supporting horrific medical experiments carried out on Chinese citizens by Japanese scientists during the Second World War. The US obtained the results from the research in return for providing the perpetrators with immunity from prosecution. It thus helped cover up the research and became complicit in Japan’s failure to bring about justice for the victims and their families.

By drawing attention to the complicity of the US government in the cover-up of unethical medical research through the work of the MEDCOM project, the Japanese experiments were added to the US National Institute of Health Research Ethics Timeline.

As a result of MEDCOM, Devolder is now recognized as an international expert on medical complicity. To bring this issue to a wider audience, she has launched a YouTube channel, Practical Ethics, which discusses this and other challenges in modern ethical research.

“It’s an ongoing journey to develop the concept of medical complicity,” says Devolder. “We have provided different examples of cases where complicity arises and analyzed them in detail to look at the ethical impact of possible actions. I hope that medical professionals will find out more about the considerations to take into account when they are confronted with complicity-related dilemmas and use our philosophical tools to help resolve them.”.