The political abuse of medicine and the challenge of opposing it

A fundamental aim of medicine is to protect and promote health. The practice of medicine has, however, been used to promote political aims which may be detrimental to health. The article attempts to isolate the ways in which political abuses may interfere with good medical practice: by allowing health policies to be influenced by undemocratic political considerations; by using health services to reward or punish political supporters or opponents; by direct medical involvement in political acts which contradict accepted medical ethics; and by the support which conventional medical practises give to perpetuating inequalities in health and social services. Each of these is examined with the use of a number of examples. The ways in which medical personnel have opposed the political abuse of medicine is explored by a brief review of the opposition of Chilean doctors to torture, the involvement of South African doctors in opposing the abuse of health services in perpetuating apartheid, and the growing medical movement in opposition to nuclear war. Some comments concerning the monitoring of a multitude of medical disciplines which are open to political abuse are made. The purpose of the paper is primarily to stimulate debate around this important issue and it does not attempt to provide a comprehensive review of the political abuse of medicine.