The Unbreakable Vow

In the aftermath of the successful assassination of Osama bin Laden, reporters uncovered a deeply troubling scheme the CIA used to verify if bin Laden was resident in Abbottabad.  CIA operatives organized a sham Hepatitis B vaccination drive as a way to procure DNA samples from residents; they hoped to find DNA of bin Laden’s wives or children.  The operation didn’t end up helping the U.S. locate bin Laden, and, even if it had, I would have found the cost much higher than the benefit.

The doctors and agents carrying out this deception were blaspheming the medical profession, no less so than than the doctors at Tuskegee.  First of all, they actively harmed the patients they ‘treated’ by administering only two doses of a three dose vaccine (leaving people underprotected).  The act of deception caused harm to a far broader swathe of people.

You have to be able to trust a doctor administering a vaccine or any medication.  Even a epidemiology wonk like me doesn’t have the capacity to sample and analyze whatever’s in the needle before the doctor sticks it in my arm.  People who don’t know much about how immunity and illness work have even less ability to second guess the guy in the coat.  Since we have no ability to test, the only possible reaction to strong doubts is to opt-out.  Which tends to have predictably terrible consequences.

I doubt any disciplinary action is in the cards for the people who planned and carried out this action, and that’s a shame.  But I’m not sure this kind of situation could be prevented merely by upping the odds of chastisement and/or the severity of punishment for transgressors.  The reason I called this a blasphemy against medicine is because it really ought to register at the gut-punch level of a taboo.  The trouble is, we’re bad at setting those up.In a post titled “Prices or Bindings,” Eliezer Yudkowsky wishes there were a secular equivalent of the seal of the confessional:

If a serial killer comes to a confessional, and confesses that he’s killed six people and plans to kill more, should the priest turn him in? I would answer, “No.” If not for the seal of the confessional, the serial killer would never have come to the priest in the first place. All else being equal, I would prefer the world in which the serial killer talks to the priest, and the priest gets a chance to try and talk the serial killer out of it.I use the example of a priest, rather than a psychiatrist, because a psychiatrist might be tempted to break confidentiality “just this once”, and the serial killer knows that. But a Catholic priest who broke the seal of the confessional – for any reason – would face universal condemnation from his own church. No Catholic would be tempted to say, “Well, it’s all right because it was a serial killer.”I approve of this custom and its absoluteness, and I wish we had a rationalist equivalent.The trick would be establishing something of equivalent strength to a Catholic priest who believes God doesn’t want him to break the seal, rather than the lesser strength of a psychiatrist who outsources their tape transcriptions to Pakistan. Otherwise serial killers will, quite sensibly, use the Catholic priests instead, and get less rational advice.

We’ve learned that institutions aren’t perfect, so we value independent verification and oversight a lot more than we used to.  Building in safeguards is a prudent choice, but people seem to have a hard time finding a middle ground between total faith and rampant distrust (think of the authority-shy vaccine doubters). How could we go about developing trust and strong expectations of institutions, now?  We could start by having the Surgeon General publicly condemn the Abbottabad deception, but it would take a lot more than that.  I doubt that harsh penalties would be sufficient, either.  The goal is really to build up a strong institutional culture with high expectations for honor.

Bonus reading: Alcoholics Anonymous has been conflicted about whether the relationship between addicts and sponsors should fall into a similar category of inviolable compact.  The ambiguity has had deadly results.

Bonus reading II: Michael Swanwick has a great fantasy novella  set in a world with magically-constrained Truth-Tellers.  He later expanded it to the novel The Dragons of Babel, but I think it was much less cluttered as the novella.  Luckily the whole story I like is available in pages 1-53 of the Google Books preview.