Doctors on Suicide Bombing Missions? Not as Strange as It Seems.

So much for the Hippocratic Oath. The latest terror attacks in the United Kingdom were apparently carried out by doctors.

The specifics of the case are admittedly bizarre, but the general principle that acts of terror are often committed by individuals with high levels of education is not at all unusual, a fact I learned from economist Alan Krueger‘s excellent new book What Makes a Terrorist: Economics and the Roots of Terrorism, due to be published next month.

I’ll write more about Krueger’s book when it is closer to the publication date.


This is not new. Most, if not all, the 9/11 terrorists were from well-off families with a good level of education. Osama comes from a very wealthy family.

I wouldn't be surprised that looking back at similar people in history will show that most of the leaders/main participants were well off and well educated for the time.

Which follows. If you are poor you don't have the time, inclination or resources to really formant trouble.


Ted Kaczynski


I've never understood the popular idea that terrorists are the malleable, ignorant, brain-washed. Many kinds of terror require an intellectual commitment which places an ideal above human life. The extreme reach of "the ends justify the means" has been seen in the Bolshevist infliction of terror, in the Chinese Communist use of terror, in the 60's/70's radical gangs, etc. The Bolsheviks talked openly about the importance of terror as a tool.


I'm not a doctor, nor do I play one on TV, but I've always understood the Hippocratic Oath to apply only to the practice of medicine and not to a doctor's entire life. For example, if a doctor were at home when an armed lunatic broke in and threatened him, and the had an opportunity to shoot the intruder, and thus go on living and helping people and saving lives, that would be the morally correct thing to do, although certainly not a pretty choice.


It's always been understood that revolutionaries come from the middle classes, which is part of the reason despots like to eliminate the middle class. Poor people are too busy just surviving to worry about changing the world, and the wealthy tend to benefit too much from the way things are. of course now that wealth is much more portable, you can see a lot more of the truly wealthy willing to act out (usually from a safe distance).


I don't know if the oath would apply to one's entire life, but I don't think self-defense counts as "harm" in anyone's book. If anything, the intruder does harm to himself by invading another person's property.


I assume there's a correlation between intelligence and a good terrorists, I also assume the stupid terrorists just suck at life (and thats a wee bit sad).

Juggling Frogs

An important reference in this theme is the book "The Nazi Doctors: Medical Killing and the Psychology of Genocide" by Robert Lifton.


Do doctors in Britain still take the Hippocratic Oath ?


In September 2003, Dr. David Appelbaum, the respected head of the ER at Shaarei Zedek Hospital in Jerusalem and a pioneer in emergency medicine, was killed with his daughter in a terrorist attack. In reporting on his death, the UK-based medical journal Lancet (Editorial. Doctors in conflict: understanding Israel's despair. Lancet 2003; 362: 928.) drew a very clear and offensive parallel between Dr. Appelbaum and Dr. Mahmoud al-Zahar, a terrorist plotter and leader. In their attempt to be "fair", the editors of Lancet even printed side-by-side photographs (labelled "Two physicians, two stories").

At the time, I sent a letter of protest (see below), which was not published. Others were. Even though I had subscribed for quite a few years to Lancet, that was the last year. When my subscription ended, I did not renew. It's bad enough that anyone -- especially a doctor -- is a terrorist, but it's truly dispicable that there exists enough "tolerance" in the medical culture to keep these murderers within the fold.

I don't know why this is only being noticed now, with the UK terrorists, but it's about time the British medical establishment paid attention to the consequences of misdirected tolerance.

Here's the letter I wrote then:
Sir --

I was appalled and embarrassed by the glaring attempts to draw parallels between the lives of Dr. David Applebaum and Dr. Mahmoud al-Zahar.[1] In making an effort to provide a balanced view of the Middle East crisis (a laudable goal), you have chosen the wrong story, and the wrong people to flatter with your impartiality. By printing side-by-side photographs (labelled "Two physicians, two stories"), by equating their losses (both lost children soon to be married), you humiliate every ideal that medicine strives for: relief of human pain, respect for human dignity.

Regardless of where one stands on the tangled issues confronting Jews and Arabs in Israel, to attempt to "equate" an innocent murder victim with a man who might possibly be the brains behind his murder is a travesty of decency and an insult to the memory of the deceased. (Dr. al-Zahar "is described as a Hamas leader by Palestinians"[1]; in September, the E.U. officially declared all wings of Hamas "a terrorist organization".[2])

Is it possible that in a publication so concerned about the involvement of doctors in political and cultural violence that a doctor's leadership role in an organization which plans the murder of civilians is condoned? Is there truly no moral difference between a doctor who spends his time plotting suicide bombings and a doctor who spends his time improving care for patients, Arab and Jew alike?

Dr. Appelbaum and his family (what remains of it) deserve better treatment. A meaningful apology from your editorial staff is certainly called for.

Sarah Lipman

1. Editorial. Doctors in conflict: understanding Israel's despair. Lancet 2003; 362: 928.

2. Bruni F. The Mideast turmoil: the militants; Hamas placed on terror list by Europeans. The New York Times 2003 Sep 7;Sect. 1:22 (col. 1).



Dunno if you have read Occidentalism (Buruma, Margalit) but it provides some satisfying insights into the thinking of some of the people involved in these kinds of acts. In particular it covers how the educated middle class are more likely to succumb to the 'romanticism' of fundamentalist violence.

But we probably knew that anyway, right?


It takes a lot of work to become a doctor. My surprise at this does not involve the oath. Not all doctors are "good", but the ones who are not tend to be money hungry climbers. The ones who are idealists tend to speak of wanting to help people. And all of them pay their dues with some time in the ER helping trauma victems.

There is still plenty of room to be surprised at MDs as terrorists.


The part that seems strange to me is that the folks who are usually the true believers of any ideology, whether it be one of a religious nature or one of a secular one - do not typically have the highest education - especially not one of a scientific nature.

I completely agree with the idea that revolutionaries typically come from the middle to upper classes (celebrating July 4 reminds me all of those revolutionaries were upper class revolutionaries). Yet this undermines my belief that education is a way through which we can temper extremism.


In reply to civan93- You temper extremism by providing economic opportunity and security. Education is a path to opportunity rather than to a moderation of ideas. If you are secure and prosperous, it does not matter if your students form a counter-culture.


I couldn't disagree more with Nathaniel- the historical pattern has been that despotic regimes rise to power via the gutting (literally) of the intelligentsia- and the wealthy are usually complicit in the stealing of the poorer class' resources/land


If you have access to the Journal of Economic Perspectives, take a look at the paper by Krueger and Maleckova (Fall 2003). Presumably this is the basis of Krueger's book.

In short, they find no evidence relating poverty and terrorism. There is a positive correlation between educational attainment and support for terrorism among Palestinians. Suicide bombers are better educated and less likely to be poor than the population as a whole. While terrorists are more likely to come from poorer countries, when the authors control for civil liberties, GDP per capita is no longer negatively correlated with terrorism. In their words: "The data seem to suggest that a lack of civil liberties is associated with higher participation in terrorism and that low income has no direct connection."

Of course, conventional wisdom (i.e., the media - including the newspaper with which Dubner is closely associated) still believes that terrorism is due to poverty. But one should never let facts interfere with a good story.



I disagree strongly with mgroves' assertion, in response to my original comment on this threat, that self-defense does not constitute harm. How can you deliberately take another person's life, even if your own life is on the line, and not harm them? Death is pretty much the ultimate harm, since it causes you to cease to exist. Justifiable harm is still harm. The Hippocratic Oath does not state, "First, do no unjustifiable harm." So if we interpret that oath literally, and apply it to the oath-taker's entire life and not just to the practice of medicine, self-defense would be prohibited to doctors, and they'd just have to just stand by and let themselves be slaughtered by whoever wanted to kill them. I don't think reasonable person would support this approach. So either the Oath does not apply outside of medical practice, or it does, and the word "unjustifiable" is implied.


I'm not sure how frankenduf is disagreeing with my statement. I made no mention of how despots seize control -- those are not usually considered "revolutions", they are usually considered coups or something similar, where a small number of people simply overthrow the government with little popular support but with extensive economic/military/political resources.

Certainly in many situations the wealthy become so (and continue to be so) by taking poorer people's resources. That is true regardless of revolutions or coups, though they may be more likely to support one if they see it benefits them more directly than the existing structure. But wealthy classes rarely took risks historically unless they were already in danger of losing status under the existing system.


I think the Hiipoc ratic Oath of "first, do no harm" SHOULD apply to one's entire life, and not just to the practice of medicine. Everyone should take it privately, and every politician should be made to take it -- and lose their jobs when they violate it.


Two problems with zatavu's proposal: (1) the oath would have to be modified to "first, do no unjustifiable harm" so that it would permit self defense. Second, "no harm" is too broad. Every time I get in my car I'm doing harm by polluting the air. If I take a bus where I'm the last person who could possibly squeeze on board, I'm still polluting the air by adding my weight to the bus and thus reducing its fuel efficiency by a microscopic amount. Attempting to reduce the complexity of ethical human interaction to a four-word phrase is never going to work.