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Medical Complicity in Human Rights Abuses: A Case Study of District Surgeons in Apartheid South Africa

This research builds on the South African Truth and Reconciliation Commission process. At its health sector hearings, while district surgeons were widely criticized, chiefly for their work with detainees, they and their testimony were largely absent. Their views and perceptions of their experiences remain unknown. This article, based on in-depth interviews with eighteen district surgeons in 1999, investigates the charges of medical complicity in custodial human rights abuses from their perspective. Medical practitioners describe behavior, strongly corroborated in the secondary literature, that potentially resulted in complicity in abuse. The four main forms of behavior are the routinization of visits, police presence during medical examinations, the compilation of inadequate medical reports, and a broader pattern of moral disengagement. Among the reasons given for this behavior are ideological conformity, a lack of definitional and moral clarity with regards to torture, inadequate education and training, and an absence of institutional support. Examples are then provided illustrating that district surgeons could have exercised and did exercise their discretion in ways that furthered human rights. Broadly speaking, both the forms of and reasons for complicity mirror those documented elsewhere. Particular insights are gained, however, into how these dynamics play out in the context of institutional racism, and into the layered and interlinked foundations for complicity—individual/attitudinal, professional/systemic, contextual/political. This is a study providing insights of relevance to custodial and noncustodial medicine, past and present, redress and reform, and post-apartheid South Africa and elsewhere.