This article belongs to With a Grain of Piquant Salt column.

The United Kingdom was attacked recently by a group of terrorists. Ho-Hum, you say, so what's new? Well, the new angle was that most of the terrorists were doctors. Terrorism is shocking anyway. Then the gruesome and incendiary images of two men in a burning Jeep rammed into the door of Glasgow airport terminal were displayed.

And finally the horrifying realisation that these men who wanted to kill so many other human beings by burning them (one of the most painful ways to die) were actually doctors. Why did this cause such a huge adverse reaction? As usual, several factors came together for this essay. The first was a book which I picked up at Hong Kong Airport by Atul Gawande, "Better: A Surgeon's Notes on Performance" (ISBN-10: 1861978979). It's a fascinating book, all about how surgeons see the world: why they are overconfident, how they are determined in fighting off the grim reaper. It describes how the American Armed forces doctors managed to bring the casualty rate in Iraq down to 10% and how polio is near wiped out. It also explains why medical malpractice kills the doctors and criticises the bizarre medical insurance system in USA. And so on and so forth. I strongly recommend this book for anybody who is interested in how doctors perform.

The reason this is so interesting is because when you and I make a mistake, all we get is a bollocking, but when doctors make a mistake, it can, at best ruin you or at worst, make you push up daisies. This sort of puts things into perspective, doesn't it? But still, how doctors refuse to wash their hands and allow MRSA to explode. Why all the patients and public think of doctors as very high skilled people. Yes, they are, but they are just like any other professional person, with some very good doctors, a great mass of middling doctors and then a bunch of frankly bungling idiots. But Gawande talks about how even good doctors make mistakes. All in all, it is a good book. My own GP was the second cause. He is a tyrant. First he got on my case about my smoking, and when I stopped that, he is now after my weight. I told him that I am special, for everybody else, their bodies are their temples, me my body is a rotunda. But displaying a regrettable lack of humour and understanding, he has medicated me, scared me, poked me, prodded me and I am shedding pounds faster than Osama Bin Laden is setting up the USA Appreciation Society in Afghanistan. But he is a nice chap and I am grateful for all his attention and advice. The third and main factor was of course the terrorist doctors. The fact that some of them were from India shocked me deeply, but that is going to be explored in another essay.

I had written about two groups of doctors before, one group who operated on my father for his second heart bypass surgery (, and how they are treated like Gods. With due reason, their skills and expertise help people to extend and improve their lives and they steal living days away from death. The more complicated the operation is, the more lethal the disease, the more the doctor will fight to save his patient. And the more they fight, when they finally succeed, you see the patient and relatives treating the doctors as if they are divine. And from time immemorial, the oaths that doctors take, the principles that they live by all rely on one shining rule, not to harm anybody. This is what humans believe, and for a doctor to violate this, causes shock and horror. Now killing for a political or religious reason? That's worse. Why? We had doctors who were murderers, such as Dr. Harold Shipman here in the UK who was convicted of killing fifteen of his elderly patients and was given fifteen life sentences.

The police suspect he was responsible for more than 150 another patients in his thirty-year career. Nobody is clear about his motives still, as there wasn't much motive involved, although the reason he was caught was his bungled attempt to forge one patient's will. But that was just one patient, what about all the others? Dr Michael Swango of the USA was sentenced on the crime of murdering three patients and suspected of killing up to sixty more. Both seem to be driven by the power they had over life-and-death. But while these incidents were shocking, they were written off as individuals going off the rails and being bad eggs. Mental problems, drug addiction, etc. was to blame. We also excuse bungling and inept doctors.

If they are not excused, at least we try to understand what happened and fine them, launch malpractice legal cases against them, and the worst they suffer is prison. An example would be the conviction of Dr David Benjamin of NY for causing the death of a patient because of a bungled abortion. Or the seven (two doctors among them) at the Al-Fateh Hospital in Benghazi, Libya who are on trial in Tripoli, charged with murder of 393 children by injecting them with HIV. There are huge numbers of other cases where doctors have been successfully prosecuted and punished in various ways for making mistakes, making wrong judgements, being incompetent or causing harm. Again, while it is surprising, it is not that shocking, as people are reasonably accepting the fact that people can be incompetent and can make mistakes. But to go back to the original question about doctors who cause death because of ideological or religious reasons?

How about the doctors in the USA who help out in the executions of death row prisoners? Whether they pushed the needle in or signed the death certificate, they are still involved in the process. Despite the fact the prisoner might be a mass murderer or a child rapist/murderer, a doctor is supposed to treat them irrespective. So it is not surprising there is a tense relationship between the doctors who help out on the executions and the general medical community. Nobody thinks about these doctors. See the Gawande book, it delves deep into this. But people will not recognise this in the UK, as we don't have the death penalty. But we do have legal abortion.

Now that's a fair complicated aspect and it all revolves around when you believe life begins. Legally and, it is only when the foetus has been born (or thereabouts the exceptions and exclusions around this issue are gobsmacking). But there are people who think that life begins at conception and therefore an abortion is an act of open murder. Dr John Nyamu of Kenya was hauled before a judge charged with murder because of abortion. Abortion doctors in most of the western world, where abortion is allowed, are careful, because they have been attacked in many places, some have been killed, abortion clinics attacked, etc. While people believe in the right to choose, I will bet that if a doctor admits to being an abortion doctor on the dinner table in front of guests, there will be an uncomfortable silence before people will resume eating and talking. So it is understandable and not so shocking. No? You don't believe that it is shocking? How about euthanasia? What are your thoughts about mercy killing, living wills and the rest of it? What do you think of Dr. Kevorkian, Dr Michael Irwin, Dr David Moor, Dr Wilfred van Oijen, etc. all who have been accused of hastening death, albeit at the patient's request? If you were going to go through severe endless pain and know there is no cure, would you ask for your death to be carried out so you can avoid unnecessary pain? And what would you think of the doctor? What will you think of the doctor if you were the patient's father or mother, who has to impotently witness the pain of your child? Or a pro-life activist? This is also explainable and to a certain extent understandable, if surprising behaviour from doctors.

Again, the doctor will do it out conviction that they are helping their patients avoid pain. But the line seems to be drawn firmly when one inflicts pain because of ideological or religious reasons. After the horrors of the Nazi medical experiments, the World Medical Association was set up to make sure this was not ever going to be repeated. The Tokyo Declaration of 1975 codified the principles on doctors and torture and urges doctors even under threat to use their skills to heal and comfort. But this is a dicey complicated area (see the Amnesty International article on Doctors and Torture here, For more specifics, take a look at the New England Journal of Medicine here ( This flat out accuses the US doctors in the armed forces of torture. Or see the famous article in the Lancet by Steven Miles about Abu Gharib's doctors (Military medicine and human rights, The Lancet, Volume 364, Issue 9448, 20 November 2004-26 November 2004, Page 1852). Or see what I had written about doctors who violate their oaths here. The storm of vituperation which broke over the USA is, in my opinion, partially because of the shocking news that some doctors were complicit in the torture of the prisoners. This was a step too far. But even so, ignorance of the boundary between torture and medical assistance is rife (many medical schools and army medical schools teach this topic because of this reason), and the criticism is slightly muted (wrongly again in my opinion), because the torture doctors are ours, while the prisoners, well, are prisoners anyway regardless of their origins.

This brings us to the doctors in the United Kingdom and Australia, who would presumably have carried out the attack for a variety of reasons, ranging from protesting against British foreign policy or how the Christian crusaders are rampaging in Iraq and Afghanistan or how Britain supports Israel and oppresses Palestinians. A whole bunch of reasons (some of which I have explored before here But then as in now, these doctors have no fig leaf to hide behind. They violated every law, ethic, principle, moral, feeling, emotion and rule about doctors not causing pain and suffering. It is also not like it was a spur of a moment decision in a moment of madness. It was well-planned and very much deliberate, even if badly executed. They actually wanted to kill people by burning them. It was by design. For some medieval, bizarre, barbaric religious and/or political faulty ideology, they were no longer doctors, but plain and simple barbaric murderers. They gave up their humanity and turned into butchers. And that is what put them beyond the pale. All this to be taken with a grain of piquant salt!