The Unbreakable Vow

The Unbreakable Vow August 27, 2011

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.

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  • That really is hideous. I can't believe they did that. I agree with your assessment at the end, though. The only way to truly address this is to change the expectations of honor, which is even something of a dirty word these days. Terrible.

  • The reason for the comments and back posts being italic is a missing which should be directly after "The ambiguity has had deadly results." Alternatively the before "Bonus reading II" is should not be there.

  • Thanks for the catch, Gilbert!

  • Leah,I was involved in technical work for the US intelligence community in the late ‘80s and much of the ‘90s. I of course was not involved in anything like the operation you mention, but I did get to see the attitudes that prevailed in the intelligence community.Those attitudes were intensely opposed to “whistle-blowing.” For example, when I tried to blow the whistle on contract fraud by one of my bosses, the reaction was very negative even from people who were not at all involved in the fraud: blowing the whistle was something that one simply did not do.And, that explains a lot about the incident you relate: It is not possible to guarantee that no human beings are ever dishonest, unscrupulous, ruthless, etc. But we have hope of reasonably restraining such people if they know someone may well blow the whistle on their behavior. However, if whistle blowing is strongly stigmatized, whistle blowers are unlikely to step forward, and then the thugs have free rein.This also has application to the main subject of your blog, religion. I have been told personally by members of the clergy with whom I was friendly that they knowingly and intentionally lied to their congregations about their own beliefs concerning traditional Christian teachings. People with much more contact with the clergy than I have confirmed this: I hope you have read The Dishonest Church by retired United Church of Christ minister Jack Good, who goes into great detail on this subject.However, those of us who point out that Christianity is largely based on systematic lying by members of the clergy are viewed as having committed a social faux pas. This is the sort of thing that one just does not do in polite company.Unless and until the socially negative attitudes towards bluntly and openly “blowing the whistle” on liars and con artists changes, we will continue to have incidents such as you relate, the criminal actions in the business world that we all know of, fraud and deception in the world of religion, etc.Dave

  • Wow. I took the Hippocratic Oath earlier this month during our White Coat Ceremony, which is a deeply meaningful ceremony in which we donned the white coat for the first time and formally joined the ancient profession of medicine. My medical school takes the Oath and the white coat very seriously. The Oath is supposed to be a reminder of the trust that is put in the profession we are part of and of everything the white coat means: compassion, professionalism, and trust. It's unspeakably tragic to see it dragged through the dirt like that. These are people who must have taken the Hippocratic Oath at some point in their lives. I agree with Calah. There has to be an appeal to something absolute and bigger than oneself, whether that's the almost-mystical sense of "the profession of medicine" or the sacred "Seal of Confession".

    • The oath is not what it was. Only a small minority of oaths today include injunctions against abortion and euthanasia.

  • Blamer ..

    We oughtn't mitigate the virtues of honesty and compassion for mere confidentiality.That's why sham doctoring is unethical.That's why harbouring criminality is unethical.Medicine and law both exist as social institutions for minimising suffering based on verifiable facts. We must avoid the moral myopia inherent with these doctor/patient and confessor/criminal pairings. It ought be impermissible for me to proscribe you a placebo (sacrificing honesty) or keep your abuser's confessions private (sacrificing compassion) because of the profoundly impacted third parties.

  • I think Dave's point is spot-on. I would be curious if an honor-shame based (or even widely influenced) culture would have correlation with being against whistle-blowing. If that is the case, it could be counter productive in many aspects.

  • @Matt: That would seem to depend a lot on whether a culture valued honor for the attitudes it produced in outsiders and the status it signified (bad for whistleblowing) or whether the honor was an end in itself and betrayal of the order/the profession was like wounding a living thing and had to be healed (better for whistleblowers).Trouble is, I think most sacred trusts slide from the latter to the former.

  • *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.*No. I call Modern-Day Sin Eater on that. The medical example I get, but the priest: no dice.Specifically: What am I supposed to value about this part here:"If not for the seal of the confessional, the serial killer would never have come to the priest in the first place"I don't *care* about the serial killer's soul. I don't care about anyone's soul because I don't believe in souls.Too, ordinary citizens are usually obligated to report crimes and criminals they know about. Since I acknowledge no meaningful distinctions between citizens and priests, why should I as an atheist give the priest a 'pass' in this situation?Or maybe this: Yeah, sure the priest can withhold the serial killer's identity. And if the priest's knowledge of the crime and failure to report it is later discovered, he may proceed directly to state prison to do a nickel for impeding justice. And while we're at it, his diocese shall be invited to kick in a generous state fine for it's official complicity as well.

    • You should give the priest a pass in this case because you’re transgressing a red line. If the police pressure priests to violate the seal of the confessional they will largely go to jail. Jail priests for fulfilling sacramental duties and the Church goes to war, a war that atheists will lose. It really is that simple. No requirements for any particular spiritual belief, decency, or even tolerance necessary.

  • @Leah: That would seem to depend a lot on whether a culture valued honor for the attitudes it produced in outsiders and the status it signified …or whether the honor was an end in itself and betrayal of the order/the profession was like wounding a living thing and had to be healed …If the intelligence community is like the NYPD or most Mediterranean cultures–both of which I have overextensive firsthand family experience with–then the latter. The "honor" that you violate by whistle-blowing (or, if you're a woman, being raped) is entirely coextant with The Tribe. What other people outside think of The Tribe is not particularly important (except maybe insofar as they Fear Us). What matters is loyalty, very narrowly defined.

  • Patrick

    The problem with venerating a principle as bigger than oneself for the consequentialist purpose of reducing violations of that principle by short sighted individuals is that anyone who knows you're doing that is automatically immune to the moral suasion of your efforts.

  • @Patrick: I don't think that's automatically true. Yudkowsky (in the article linked above) certainly aspires to make himself a counterexample.

  • Patrick

    You can't justify deontology by means of consequentialism. You can justify THE VALUE OF BELIEVING deontology by claiming that it will have consequentialist payoffs, but if you're aware that the value of believing deontology is in its consequentialist payoffs, then pretty much by definition you don't actually believe in deontology.

  • @PatrickI don't think Yudkowsky idea is "venerating a principle as bigger than oneself for the consequentialist purpose of reducing violations of that principle". More like "giving up the freedom to violate a principle on the conventionalist ground that other people relying on a credible abrogation of that freedom has better consequences then the freedom itself". Now there is the question of how to enforce such an abrogation, but there his answer doesn't seam to be "deontology" (at least not in the normal meaning of the term) but "future sci-fi tech".

  • Mark

    We are just about back to the mentality of 9/10 where we fail to realize we are at war with people who have zero morals or qualms about sending in people in plans to the WTC or suicide bombers into crowded streets. If one simply looks at what was done in the war of the “greatest generation”, and we put today’s restrictions on our secret services and troops, we would all be speaking german today and millions would have died in the death camps worldwide.

    I would love to see the hand wringers in charge of the intelligence community and when they don’t get the information needed, millions die and everyone, even the former hand wringers, are lining up screaming for your head for not doing your job. Most American don’t vote and most of those who do don’t have a clue about what they are voting for. Many are in deep distress over the NFL strike and yet we have Obama destroying the entire country and they don’t seem to get it.

    • leahlibresco

      You know, when we fought the Cylons, we did it to save ourselves from extinction. But we never answered the question “Why?” Why are we as a people worth saving? We still commit murder because of greed and spite, jealousy, and we still visit all of our sins upon our children. We refuse to accept the responsibility for anything that we’ve done, like we did with the Cylons. We decided to play God, create life. And when that life turned against us, we comforted ourselves in the knowledge that it really wasn’t our fault, not really. You cannot play God then wash your hands of the things that you’ve created. Sooner or later, the day comes when you can’t hide from the things that you’ve done anymore.

      You’re right that we’re in a struggle to preserve something, but it’s not just our lives, so not all weapons that kill the enemy are well suited to our task. You may be interested in the posts under the “sin-eaters/dirty hands” tag.

      • mmmmmmmBattlestar