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Involvement of doctors in judicial punishment

The situation of Raif Badawi, the Saudi blogger jailed and flogged, makes us ask ourselves who is looking after him, whose job it will be to sign him off as fit to be flogged. Are they trying to help him? Can we help them?

Mr Badawi’s lashings were due to be administered 50 at a time every Friday over a period of 20 weeks. Before each session, doctors would assume the responsibility of evaluating Mr Badawi’s physical fitness to withstand the lashings. The first set of 50 lashings was administered some time ago. Since that time it appears that he may not have been found fit for further flogging.

There can be no justification for corporal punishment in a modern, liberal world in which the community is capable of charging people’s debts to society without brutalisation of them, and of itself. Religion should not be an invisibility cloak beneath which the gloves are off.

What might Saudi doctors do, and how might we support them?

Ruaim Muaygil writes on the Saudi perspective in the Cambridge Quarterly of Healthcare Ethics (2016), 25 , 479 – 492 . on the Role of Physicians in State-Sponsored Corporal Punishment.

He says that Mr Badawi’s case has been the subject of much discussion within Saudi Arabia. Some analysts and scholars have called for reforms of the judicial system. Many members of the Saudi public have been voicing their support for Mr Badawi on social media. Debate centres on whether such punishments were in accord with sharia teachings. If not, the public holds the view that the participation of medical professionals in carrying out these sentences cannot be ethically justified.

The Saudi Commission for Heath Specialities, SCFHS oversees residency programs and is responsible for setting the standards for practice. The SCFHS publishes a code of ethics manual, but its stance on physician participation in judicial punishments is unclear.

Initially, its code states:
The healthcare practitioner should not be used in any way as a tool to weaken the intellectual or bodily resistance of a human. He/she should not condone, support, or participate in any act of torture, or any other practice that includes the humiliation of any member of the community; regardless of the crime that this person was suspected, accused, or convicted of having committed.

However the code goes on to make an exception “for what was approved by the Islamic sharia, and with a ruling from the religious judiciary.”

Muaygil explains that sharia is the foundation of Saudi Arabia’s constitution, through which all regulations in the kingdom are governed. Given this fact, all convictions could be considered religious judicial rulings, sanctioning the participation of physicians in judicial corporal punishments.

Beyond its borders, Saudi Arabia is a member of several international medical associations, including the World Health Organization.
The World Medical Association (WMA), in its declaration of Tokyo, first signed in 1975, condemns physician participation in torture or any other cruel or inhuman procedure, regardless of the offence. The declaration strongly forbids the physician from providing any assistance including premises, instruments, substances, or knowledge, and from being present during any procedure that results in degrading or inhuman treatment. The WMA also promises its support to any physicians and their families who refuse to take part in these acts and encourages other medical associations to do the same.

In addition to conflicts of professionalism, Muaygil argues that Saudi physicians’ involvement are bound by Islamic bioethics. With its focus on the promotion of mercy and compassion and the preservation of human life, Islamic bioethics seems not to condone a physician’s participation in any act that would result in intentional injury without the goal of medical benefit.
In 1981, the first international conference of Islamic medicine endorsed the Islamic Code of Medical Ethics with the goal that it would serve as guidance to
Muslim physicians. It includes the Oath of the Muslim Doctor, which has been
adopted and recited at graduation ceremonies at medical schools in Muslim countries.This oath includes a vow “to strive in the pursuit of knowledge and [to harness] it for the benefit but not the harm of mankind.”

Of course in addition to the regulations of the medical community, physicians are also subject to the rules of the society in which they live.
Physicians may thus feel compelled to follow judicial rulings and participate in corporal punishment if it is state sanctioned. Doctors have an interest in preserving justice in their communities and may perceive a responsibility to be part of the practice that safeguards that justice. Saudi physicians’ dual citizenship, as both medical community members and Saudi nationals, may put them in a dilemma with conflicting obligations.

What could Saudi Doctors do?
Muaygil calls for a national medical meeting sponsored by the SCFHS to debate the issue with participating professionals from medical, religious, and legal backgrounds could be a starting point. The SCFHS should come out strongly against physician participation in state-sanctioned corporal punishment. The SCFHS has the power to influence the ethics culture and hold physicians who violate the code of ethics to account.

The SCFHS needs to offer safeguards and support for those who refuse to be a part of these sentences. Physicians who work in state or military hospitals or in prisons may feel pressured to comply with requests to aid in carrying out judicial sentences or risk job loss or even prosecution themselves.
The SCFHS should also engage officials at the MOJ in conversation about the ethical concerns surrounding these sentences and should officially request that physicians no longer be enlisted to participate in state-sanctioned corporal punishment.

As a direct result of the high moral status granted to physicians in Islam, they have a major role to play in the debate over state-sanctioned corporal punishment. Physicians have not only a duty to refrain from involvement in judicial corporal punishments but also a positive responsibility to actively help bring the practice to an end. Muslim physicians have an obligation to uphold the values of their profession and to ensure that the safety and integrity of their fellow citizens are respected, as well as a duty to stop ethically unjustifiable practices in their community at large.

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