graduated from law school with an Echoing Green Foundation Fellowship to bring human rights cases from Mexico to international tribunals and treaty monitoring bodies.1 One of the first cases I worked on involved the annihilation of nearly an entire family. Francisco Quijano Santoyo was allegedly engaged in drug trafficking and was involved in a shootout that resulted in the death of a police officer. The next day, antinarcotics agents from the Federal Judicial Police (PJF, according to the acronym in Spanish), the Mexican equivalent of the FBI, surrounded the family’s house in Mexico City and exterminated two of three other brothers: Jaime and Erik. In human rights language, that kind of murder by state agents is referred to as “extrajudicial execution,” a rather technical term for the bloodbath that occurred in this case.
Another brother, Héctor, was injured and detained after the shootings and eventually tortured to death. It was a particularly brutal torture; the PJF agents cut out Hector’s tongue with a small knife and attached electrodes to various parts of his body. Eventually he died of cardiac arrest. But what made Héctor’s torture almost unimaginably horrendous to me was that the PJF forced his mother and sister to listen to and watch parts of it, which is of course a torture in and of itself.
Six months afterward, Héctor’s father, Francisco Quijano Garcia, who had been campaigning publicly for an investigation into the deaths of his sons, was himself disappeared; his body was found months later at the bottom of an unused well. The police accused an associate of Mr. Quijano Garcia, but the man, who was convicted of homicide in the case, stated he had confessed under police coercion.2
I got to know Héctor’s sister, Rosa, quite well. We were about the same age. We’d both just gotten married. I felt like my adult life and career were just beginning. Her life as she knew it had just ended; her world had been shattered.
I learned from Rosa something that I have heard repeated by torture victims too many times to count in the intervening years: the most awful thing about torture is not the physical pain, as intense and unbearable as that can be; the most awful thing about torture is that it destroys a person’s sense of herself and her world.
Elaine Scarry has described the “unmaking of the world” that occurs through torture.3 Focused on the effects of the physical pain, Scarry explains that “as in dying and death, so in serious pain the claims of the body utterly nullify the claims of the physical world.”4 Anyone who has experienced it knows that intense pain makes us small; rather than feeling our bodies in space, space and time are limited by our bodies. The physical pain experienced by torture victims destroys the world they project as well as the one they know. “This unseen sense of self-betrayal in pain, objectified in forced confession is also objectified in forced exercises that make the prisoner’s body an active agent, an actual cause of his pain.”5 Pain, as Scarry writes, is a central part of that destruction of one’s world.
But, as I learned from Rosa, personally experiencing physical pain is not always a prerequisite. Seeing a loved one being tortured and being impotent to stop the pain can also unmake one’s world. In Prisoner Without a Name, Cell Without a Number, Jacobo Timerman relates his own experiences as a prisoner in a clandestine prison during the Argentine Dirty War. He speaks particularly to the experience Rosa had in Mexico:
Nothing can compare to those family groups who were tortured often together, sometimes separately but in view of one another, or in different cells, while one was aware of the other being tortured. The entire affective world, constructed over the years with utmost difficulty, collapses with a kick in the father’s genitals, a smack on the mother’s face, an obscene insult to the sister, or the sexual violation of a daughter. Suddenly an entire culture based on familial love, devotion, the capacity for mutual sacrifice collapses. Nothing is possible in such a universe, and that is precisely what the torturers know.6
Torture destroys any possibility of human agency in the victim through its physical effects; but it also destroys the narrative we construct to make sense of ourselves emotionally and psychologically.7 It is this shattering of human agency—and, in turn, of human dignity—that lies at the core of torture and makes it the quintessential abuse of human rights.
In this chapter, I discuss understandings of human dignity, the link between health and human rights, and why human rights matter. The equal dignity of all people is the basis for the notion of universal human rights. Dignity requires the conditions that enable one to govern one’s self and exercise ethical as well as physical independence within a specific social context; it also requires us to respect the humanity in others.
There is an important link between torture—the classic violation of human rights and dignity, defined in more detail later in this chapter—and health, in terms of both the severe physical and psychological impacts on victims as well as the frequent use of specialized knowledge by health professionals in carrying it out. Moreover, some abuses in health care—through the manner in which services are inflicted and through the denial of treatment—rise to the level of what is considered “torture or cruel, inhuman, and degrading treatment” under international law. The common thread among these different facets of torture and inhuman treatment is that they stem from, and result in, a denial of the full humanity of the victim.
I go on to argue, however, that confining our focus on torture to the actions of state agents, whether police or health personnel, reflects an inadequate conception of human rights and state responsibilities—especially if we are concerned about the health of women and children. Women and children overwhelmingly face abuse in the private sphere, and applying a human rights framework to health must enable us to redress that suffering. The annihilation of self that occurs when an adult is tortured by strangers is only one kind of assault on dignity; it can be just as awful when children are raised to internalize a sense of themselves as inferior or defective—a sense of themselves as less than fully human or even deserving of abuse—before they are able to acquire any degree of autonomy. Thus, human rights frameworks need to be empowering, as well as protective, of agency across multiple spheres.
Human Dignity: A Universal Concept with Varying Conceptions and Implications
Recognition of the dignity inherent in all human beings is the basis for human rights.8 Across countless cultures and philosophical as well as religious traditions, there is a concern for the “equal dignity of the human person,” which is set out in the Universal Declaration of Human Rights and in many other international documents. Dignity has been assailed as meaning different things to different people. As the late legal philosopher Ronald Dworkin argues, dignity has fallen into “flaccid overuse.” Yet, at its core, the principle of dignity is most often explained in terms of requiring that people be treated as ends and not mere means. Thus, torture is the ultimate example of reducing victims to being means—means to obtaining information, exacting revenge, or expressing discrimination toward or contempt for a certain group.
The liberal philosopher Immanuel Kant was a leading articulator of this meaning of human dignity: “Everything has either a price or a dignity. Whatever has a price can be replaced by something else as its equivalent; on the other hand, whatever is above all price, and therefore admits of no equivalent, has a dignity. But that which constitutes the condition under which alone something can be an end in itself does not have mere relative worth, i.e., price, but an intrinsic worth, i.e., a dignity.”9 Kant’s insight has implications for how we relate to others as well as to our own lives. That is, if life has objective, intrinsic value, then it follows that both your own life and the lives of others have that value. It is not just you who can possess dignity while other human beings are slaves. Out of respect for your own dignity, you must treat yourself as an “end”—or an independent subject. At the same time, out of respect for the dignity of others, you must treat them as ends in and of themselves, and not as means for your own benefit. Kant’s notion that we should be able to universalize how we wish to be treated implies that achieving dignity in one’s own life requires respect
