As young medical students at Guanabara State University, Luiz Roberto Tenório and Ricardo Agnese Fayad received some of the best medical education offered in 1960s Brazil. For six years, the peers in the same entering class had studied the principles of the healing arts and practiced their application at the university's teaching hospital. They had also witnessed the Brazilian military oust a democratically elected president and install a dictatorship that ruled the country for 21 years (1964–85). After graduating, however, Tenório and Fayad embarked on very distinct paths. The former became a political dissident in opposition to the military regime and provided medical assistance to members of the armed left. The latter joined the armed forces and, as a military physician, participated in the brutal torture and cruel treatment of political prisoners. At the end of military rule, Brazil's medical board would find him guilty of violating the Brazilian code of medical ethics and revoke his license.
Exploring the intersections and divergences in Tenório and Fayad's trajectories, this article illuminates the underexamined yet significant history of medical professionals under the military dictatorship in Brazil. First, it reveals the essential role doctors played in both facilitating and contesting state-sponsored repression. Physicians serving the regime's security agencies systematically monitored detainees to enable prolonged torture sessions, falsified death certificates to conceal extralegal executions, and even advised agents on how to inflict pain efficiently. On the other side, however, were progressive physicians who campaigned for public health reforms and better working conditions, denounced human rights abuses, and even provided medical care to members of the armed opposition. Second, the article looks into subsequent efforts to hold doctors accountable for violating medical ethics under the dictatorship. In the context of Brazil's gradual transition to democracy, a movement of progressive junior physicians mobilized to remake the sector's leadership and introduce ethical reforms to its regulatory bodies. Relying on the virtually untouched records of Rio de Janeiro's medical board, the article reveals the movement's initiatives to investigate various health professionals involved in torture and degrading treatment of political prisoners.
The history of the medical community and its complex relationship with the military regime has largely been omitted in the scholarship. Studies on the involvement of physicians in state-sponsored repression and genocidal episodes during the twentieth century rarely explore Latin American cases.Footnote 1 In contrast, the substantial historiography on medicine and disease in Latin America that examines the role of doctors in shaping state policies and advancing “healthy society” focuses mostly on early to mid-century public health campaigns.Footnote 2 Although studies exploring Latin America's Cold War often refer to the health policies carried out by high profile physician-leaders such as Juscelino Kubitschek, Che Guevara, and Salvador Allende, little has been written about the health professionals who supported or opposed the era's authoritarian regimes.Footnote 3
In addition to expanding these bodies of knowledge, this article contributes to the scholarship on the Brazilian military regime and its guided transition to democracy. First, the history of the medical community challenges a traditional historiographical interpretation that depicts Brazil's liberal professionals—journalists, lawyers, academics, and others—as consolidated forces of opposition to Brazilian authoritarianism in the early 1980s.Footnote 4 As the following analysis suggests, white-collar professionals were never unanimous in their support for liberalization processes. In fact, organizational support for democratic change was possible only after a complete leadership changeover within the medical sector's regulatory and professional organizations.Footnote 5
The historiography on the dictatorship saw a resurgence after the conclusion of the long overdue National Truth Commission (2012–14) and the fiftieth anniversary of the 1964 coup (2014).Footnote 6 Historians have revealed the considerable support within congress, the business elite, and large segments of the public for the ouster of João Goulart.Footnote 7 They have explored gender roles in the student movement and rethought the relationship between the regime and institutions of higher education.Footnote 8 And they have reassessed United States’ role, both in the 1964 coup and in response to the human rights violations of the 1970s.Footnote 9 Scholars have also analyzed the dictatorship's intricate mechanisms of torture and counterinsurgency, as well as reconsidered the impact of its social and economic reforms.Footnote 10 More recently, historians have introduced new analytical prisms to the historiography, explicating the regime's policies through the lenses of sexuality and culture, and decentering the transition to democracy by analyzing the dialectic relationships between the state and informal urban communities.Footnote 11
Informed by this wave of innovative research, the article explores the bioethical controversies confronted by the medical community to elucidate the methods and consequences of state-sponsored repression. It shows how the response to the 1964 coup fractured a medical community already polarized over different interpretations of professional medicine and the social role of the physician. The military, which began purging physician-advocates of social medicine shortly after seizing power, received the backing of many of their professional critics. Gaining control of medical associations and ethics boards, the latter not only permitted the regime to advance the growth of a dysfunctional private health care industry but also overlooked shocking violations of medical ethics in the name of national security. Thus, as security forces detained “subversive” doctors—particularly after the regime intensified repression in 1968—medical torturers wont to disregard the Hippocratic oath willingly served the regime.
In the late 1970s and early 1980s, bioethical controversies also formed a critical element in the struggle for redemocratization and transitional justice in Brazil. Various studies of Latin America's post-authoritarian period highlight Brazil's controlled transition to democracy and the government's reluctance to hold perpetrators accountable.Footnote 12 In a time marked by an Amnesty Law (1979) that shielded human rights violators, former political prisoners and victims of torture resorted to publishing testimonials as a way to contest the state's disregard of its violent past.Footnote 13 Yet as this article demonstrates, the efforts of medical boards to discipline professionals complicit in state-led abuse were unparalleled in advancing processes of accountability and truth-seeking.Footnote 14
Social Medicine and Politicized Health in 1950s and 1960s Brazil
Luiz Roberto Tenório and Ricardo Agnese Fayad were born in the early 1940s in the state of Rio de Janeiro.Footnote 15 In 1963, both entered medical school at the Universidade do Estado da Guanabara (Guanabara State University).Footnote 16 A year before the civilian-military coup, Brazil was already beset by social unrest and political paralysis. President João Goulart had taken office two years earlier following the sudden resignation of Jânio Quadros. A Vargas protégé, Goulart faced fierce conservative opposition from the very outset of his presidency.Footnote 17 His national plan to fight the raging inflation of 80 percent by raising taxes and reducing public expenditures failed to stabilize the economy, and his attempts to increase salaries of public servants and military personnel further antagonized industrialists and opposition party leaders.Footnote 18 Losing congressional support, Goulart turned directly to the masses and in a series of rallies announced an extensive suite of basic reforms (Reformas de Base), which included the nationalization of foreign-owned companies and the redistribution of land. These plans drew massive support from the popular sectors, but vehement rejection from the rural oligarchy and the upper classes, already displeased with earlier decisions to expropriate privately owned refineries. In the congress, the National Democratic Union party (União Democrática Nacional, UDN) lambasted the president's reform plan, contending that he had violated his constitutional powers.Footnote 19
The crisis was inevitably magnified through the Cold War optic. Most of the armed forces’ leading generals had long opposed Goulart's attempts to cut military budgets and particularly begrudged his affinity with the lower ranks.Footnote 20 They blamed the president for the country's economic and political instability and saw his proposed reforms as a threat to national security.Footnote 21 Classified communications from US officials strengthened these assessments, warning that Goulart's agenda could lead Brazil to communism.Footnote 22 At the same time, anti-government propaganda disseminated by conservative think tanks asserted that a second Cuban revolution could take place in Brazil.Footnote 23 The Communist Party of Brazil (PCdoB) and the National Union of Students (UNE), on the other hand, lauded Goulart's shift toward popular leftist politics, urging the president to restructure the economy.Footnote 24 The political and social tensions reached a boiling point in early 1964, when large-scale rallies both in favor of and against Goulart mobilized hundreds of thousands of politicized Brazilians.Footnote 25
Similar processes of politicization and polarization occurred within Brazil's medical sector. Until the mid twentieth century, only a few medical schools and professional societies existed in Brazil, and doctors teamed up mostly in regional public health or vaccination campaigns.Footnote 26 An official national organization of physicians appeared only in 1951, with the formation of the Brazilian Medical Association (Associação Médica Brasileira, AMB).Footnote 27 In 1953, the AMB was the first in the country to publish an original code of medical ethics, taking into consideration both international ethical principles and local professional settings.Footnote 28 Unlike its predecessors, which harbored the physician's autonomy and promoted a top-down perception of the doctor-patient relationship, the 1953 code integrated elements from modern international charters like the World Medical Association's Declaration of Geneva and emphasized care for all people, regardless of religion, race, politics, or social order.Footnote 29 Brazil's medical councils, instituted in 1957 by President Juscelino Kubitschek to regulate medical licensing and ethics in the country, endorsed the text as the official ethical code of Brazilian physicians.Footnote 30
The emergence of new models of medical training and public health policy in the late 1950s and especially in the early 1960s further disrupted the medical community's longstanding conservative tradition. Despite the efforts of President Kubitschek (1956–61) to “modernize” Brazil's industry, education, energy, and nutrition, indicators of national health still lagged.Footnote 31 The mortality rate of children under the age of five was 172 deaths per 1,000 (the United States registered 30 per 1,000), and life expectancy averaged 56 years for women and 52 years for men, against 68 and 62 in Argentina, and 73 and 66 in the United States. Less than half of Brazil's municipalities had access to a central water supply system; only a third were connected to sewers.Footnote 32 And while the World Health Organization's malaria eradication program (launched in Brazil in 1958) showed some progress, the risk of infection was still present in more than 90 percent of the country's territory.Footnote 33 Coping with these diseases was an onerous task for most Brazilians: social security programs covered only 7.4 percent of the population in 1960.Footnote 34 As journalist Tad Szulc asserted that year on the first page of the New York Times, “racked by chronic malnutrition and rampaging disease, … northeast Brazil poverty breeds threat of a revolt.”Footnote 35
The limited access to medical care and dire public health conditions galvanized doctors who sought a better future for Brazil's health and medical profession. Inspired by post World War II approaches to medicine, professors of medicine and public health practitioners called for the state to reform health care services, advance preventive care programs for poor populations, and integrate social medicine into policy making.Footnote 36 Their claims reflected a larger international shift in the practice and conceptualization of health. In late 1950s France—which had long served as a role model for the Brazilian political, cultural, and medical intelligentsia—young health practitioners called for incorporating social medicine into the codes of medical ethics.Footnote 37 In England, the fifth annual meeting of the Society for Social Medicine in 1961 focused on “the general practitioner and preventive medicine.” Closer to home, Che Guevara's 1960 call to “provide public health services for the greatest possible number of persons” swayed many Latin American doctors.Footnote 38 In the preceding decade, they had participated in conferences sponsored by the Pan-American Health Organization that promoted preventive medicine and community health.Footnote 39 Now they were witnessing the Cuban regime declare health care a basic universal right.Footnote 40
Before long, progressive faculty members in Brazilian medical schools began incorporating epidemiology, community health, and social medicine elements into their traditional curriculum.Footnote 41 Successful examples were readily available. In the United States, departments of preventive medicine—whose number had tripled between 1950 and 1960—were offering courses in community and occupational health, social and environmental medicine, epidemiology, hygiene, and genetics.Footnote 42 At the Guanabara State University medical school, where Tenório and Fayad studied, professors of medicine advocated for similar courses and encouraged discussion of the social aspects of sickness and health. Professor Américo Piquet Carneiro, for example, led a curriculum reform that added social studies and general knowledge courses to first-year classes. He urged students to consider health not only as a matter of biology but also as a social and economic phenomenon. He also required his trainees at the Pedro Ernesto University Hospital to conduct home visits in which they learned about the effects of social conditions on their patients’ well-being. The fact that Piquet Carneiro was not affiliated with the left—he was in fact a progressive Catholic who opposed “political radicalism”—illustrates the impact of social medicine in the early 1960s.Footnote 43
Medical professors at other universities, including the University of São Paulo and the Ribeirão Preto campus, introduced similar themes.Footnote 44 Many of their students supported the innovative attitudes toward health, which correlated with their leftist affinities. For example, the primary medical student organization at Guanabara State University, the Centro Acadêmico Sir Alexander Fleming (CASAF), was affiliated with the leftist Brazilian National Student Union and advocated for additional courses in social medicine and the sociology of health.Footnote 45 The University of São Paulo's key medical student organization, the Centro Acadêmico Oswaldo Cruz (CAOC), criticized the traditionally individualized nature of the school's curricula and called upon faculty to prepare students for their future “social role.”Footnote 46
These positions dovetailed with the reform plans of President Goulart, who was attuned to the dynamic on medical school campuses and public health debates. Goulart's first health minister, Estácio Souto-Maior, sponsored the Fifteenth Brazilian Congress of Hygiene (1962), which examined issues such as nutrition and sanitation in underdeveloped areas, internal migration, and water supply.Footnote 47 Furthermore, the government's three-year plan of national socioeconomic development, devised by Minister of Planning Celso Furtado, allocated funds for education, technology, and public health.Footnote 48 And most significant, in 1963 Goulart's second health minister, Wilson Fadul, convened Brazil's Third National Health Conference to devise a new national health policy.Footnote 49 In his opening address to the conference, President Goulart asserted that “health does not mean the simple absence of disease, but a comprehensive state of physical, social, and mental well-being.”Footnote 50 Minister Fadul concurred, affirming that the nation's health problems “cannot be solved divorced from the social reality” and emphasizing that the government would prioritize programs that “benefit the largest number of people.”Footnote 51 After six days of discussion, the conference working groups recommended setting up a national health plan that would decentralize health services and grant greater authority to local municipalities in managing care for the Brazilian population.Footnote 52
The 1963 national conference marked a critical shift in the way the Brazilian state understood and managed public health. The government's pledge to increase health protection, however, did not appeal to all medical professionals. In a politically polarized Brazil, research-informed models bearing such terms as “social” and “collective” were readily associated with socialism and radicalism. Senior physicians and heads of professional societies found the leftist turn toward socialization of health troubling. They saw social-medicine initiatives as a threat to the individualized nature of their profession and repudiated the “communist” ideas populating their field.Footnote 53 Moreover, conservative medical groups frequently branded leftist student organizations such as Guanabara State University's CASAF and the University of São Paulo's CAOC as secret cells of the Brazilian Communist Party.Footnote 54 In the contentious climate of early 1964, professional disagreements about health care models and medical training thus turned into public policy questions, linked to and amplifying sociopolitical conflicts. They set the stage for the stark divisions that typified the medical community under military rule. Luiz Tenório and Ricardo Fayad, who began their medical training at Guanabara State University that same year, could not escape the fray.
Doctors, Health, and Repression under Military Brazil
On March 31, 1964, the Brazilian armed forces staged a coup d'état. Supported by various businessmen, politicians, and major newspapers, the generals swiftly took over strategic points in Rio de Janeiro and São Paulo and detained Goulart's leading political allies.Footnote 55 The president flew to Porto Alegre in southern Brazil, where he still enjoyed the support of Governor (and brother-in-law) Leonel Brizola. In the congress, Senate president Auro de Moura Andrade declared the presidency “vacant,” and swore in the speaker of the house, Pascoal Ranieri Mazzilli, as acting Brazilian president. The United States, which had supported the plot from its inception by deploying destroyers and aircraft carriers toward Brazil, as well as guaranteeing an arms supply in case of need, sent its “warmest good wishes” to the installed president.Footnote 56 Lacking both military and political support, Goulart boarded a plane to Uruguay on April 4.Footnote 57 A relatively bloodless civilian-military overthrow was complete.Footnote 58
While the toppling of Goulart's government received considerable public support, the immediate purges of public representatives, civil servants, and professionals, as well as restrictions on civil liberties, drew negative responses that deepened social schisms.Footnote 59 In the medical sector, the coup intensified political polarizations. Four days after the military takeover, 22 academic board members of the University of São Paulo's Medical School signed a statement expressing their “support for the brave civilians and glorious armed forces … that restored order, obedience, and law to the country, rejected foreign and communist ideologies, and introduced the Christian path of social peace.”Footnote 60 The student representatives on the board, however, refused to sign the motion and instead organized a protest opposing the overthrow.Footnote 61
While some medical students celebrated the coup—conservative groups at Guanabara State University, for example, raided the offices of leftist student organizations in search of “communists”—the student movement as a whole ardently opposed the ouster of Goulart.Footnote 62 The UNE paid a hefty price for its dissent, as police forces broke into the offices of student organizations and arrested key leaders across the country.Footnote 63 In November, Minister of Education Flávio Suplicy de Lacerda followed with legal measures, passing legislation that sought to break up the UNE and prohibit student organizations from carrying out any political activity.Footnote 64 Conservative student groups at Guanabara State's medical school were hoping to benefit from the restrictions and win control of the student body in the 1965 student elections.Footnote 65 The leftist Student Unity slate won easily, however, sending Luiz Roberto Tenório—by that time a prominent student activist—to assume the presidency of CASAF.Footnote 66
The mobilization at Guanabara State and other medical schools concerned government officials. As Minister of Health Raimundo de Brito stated in April 1964, “While there are no boundaries for science, there are boundaries for scientists. … [O]ur country needs men to help in ending the suffering of the people, not those whose only goal is to destroy liberty.”Footnote 67 Putting words into action, security forces were deployed to stifle medical students’ activism. Before long, military officials and coup-backing politicians carried out “clean-up” efforts in medical schools and research institutions, the locus of social medicine discourse and training. Military Police Inquiries (inquérito policial militar, IPM)—set up to investigate activities “against the state, its property, [or] public or social order” in state bodies and public institutions—facilitated the ouster of thousands of state employees, among them professors of medicine and medical researchers.Footnote 68
In the year following the coup, investigations into “potential communist agitators” were opened at the medical school of the University of Minas Gerais (later the Federal University of Minas Gerais) and the Paulista School of Medicine, resulting in the expulsion of various faculty members.Footnote 69 The University of São Paulo's renowned school of medicine, whose conservative faculty held considerable administrative and political power on campus, saw particularly extensive purges. With the encouragement of university rector Luís Antônio da Gama e Silva—an avid supporter of the coup who would serve as Brazil's minister of justice in the late 1960s—secret investigative committees and military police inquiries targeted not only leftist but also reformist professors of medicine.Footnote 70 The majority of faculty members expelled from the University of São Paulo came from the medical school.Footnote 71
The reactionary wave at the University of São Paulo and other universities illustrates the efforts of the regime to rid the medical community of leftist “obstacles.” Yet it also reflects the avid opposition of conservative physicians to reforms led by their junior colleagues, particularly regarding training models and the academic chair system.Footnote 72 Faced with the loss of their political and professional influence within their universities, senior professors of medicine promoted the purge of their young rivals. The generational and professional conflict involved class frictions as well. Historically, medicine had been considered among the most prestigious professions in Brazil, one whose practitioners belonged to a small group within the middle and upper classes.Footnote 73 Many senior doctors supported Goulart's ouster in 1964 precisely because his reform plans threatened their social standing. Following the coup, their anticommunist zeal and efforts to maintain the traditional character of the profession coalesced in the hostility toward junior practitioners who were challenging long-standing social hierarchies.Footnote 74
By the end of 1964, various leftist and reformist doctors had been removed from their professional community. When protests arose—usually by medical students—security forces were quick and aggressive in suppressing them. In September 1966, for example, the military police violently quelled a protest organized at the medical school of the University of Brazil (today Rio de Janeiro's Federal University) in opposition to the dictatorship. Troops stormed into the school's building, beating many of the students who had taken shelter inside and causing considerable damage to classrooms and lab equipment.Footnote 75 Clashes between security forces and students reached a high point in 1968, as a wave of labor strikes and large-scale protests broke out in the country. Frustrated by four years of authoritarian restraints on civil liberties and workers’ rights, hundreds of thousands of autoworkers, students, and public figures took to the streets in demand for reform and democracy.Footnote 76 At Guanabara's medical school, violence erupted toward the end of the year—the last in Tenório and Fayad's studies—when a protest organized by medical students was met with harsh suppression by military police forces, who shot and killed a medical student at the entrance of the university hospital.Footnote 77 The school administration, operating under a provisional director appointed by government officials, proved incompetent in the face of Brazil's moment in the global youth protests of 1968.Footnote 78
In the context of increasing social unrest and urban guerrilla attacks, the last month of that tumultuous year presented a dramatic congressional crisis when deputy Marcio Moreira Alves publicly denounced police violence and the practice of torture.Footnote 79 In response to the congress's dissent, President Costa e Silva issued Institutional Act No. 5 (AI-5) on December 13. Ushering in the most violent period of the military rule, AI-5 allowed the president to shut down the congress, intervene in state governments, suspend citizens’ political rights, and confiscate private property in the name of national security.Footnote 80 In the course of the following six years, security forces detained, arrested, and tortured tens of thousands of “subversive” political activists. Hundreds of civilians were forcibly disappeared.Footnote 81
Additional institutional and supplementary acts passed during the first months of 1969 extended the reactionary wave to academia, labor organizations, and professional associations.Footnote 82 Decree-Law 477, commonly called the “universities’ AI-5” (February 26, 1969), not only prohibited protests in universities but also facilitated the summary investigation and expulsion of any professor, student, or staffer involved in “subversive activity.”Footnote 83 The latter had a significant effect on the medical community, which lost some of its leading researchers and professors of medicine due to purges.Footnote 84 Tenório himself witnessed several of his professors expelled from the Pedro Ernesto University Hospital, where he served as an intern during his final school year.Footnote 85 He was arrested as well, soon after graduating in 1969. The authorities charged him with subversive activity for involvement in the student movement and suspended his political rights for ten years.Footnote 86
Ricardo Fayad took a path very different from Tenório's. Not long after graduating, he joined the armed forces as a military doctor. Records show Fayad serving as a second-lieutenant physician in the First Battalion of the army police as early as 1969.Footnote 87 The battalion's barracks, located on Barão de Mesquita Street in Rio de Janeiro's northern neighborhood of Tijuca, hosted one of the regime's most infamous detainment and torture facilities, Rio's DOI-CODI (Destacamento de Operações de Informações – Centro de Operações de Defesa Interna). Established in 1970 under President Emílio Garrastazu Médici's policy of intensified repression, the DOI-CODI units formed a national network of intelligence and operational units that brought together agents from the army, military, and federal police who tortured and carried out forced disappearances of “internal threats.”Footnote 88
Rio's DOI-CODI began small-scale operations in late 1969 but soon expanded to a two-story detainment center that included solitary chambers customized for sensory deprivation, as well as special torture rooms.Footnote 89 In 2014, Brazil's National Truth Commission concluded that 48 detainees had lost their lives in the facility during the dictatorship's most repressive phase (1969–74), whether under torture or by execution. To this day, 33 of them are still considered “disappeared.”Footnote 90 As a military doctor, Ricardo Fayad was responsible for the health of soldiers serving in the barracks of the army police's First Battalion. As multiple testimonies later revealed, however, Fayad also played an essential role in the torture of DOI-CODI detainees, monitoring their health and medically advising their interrogators. His name appears on the Truth Commission's list of 377 agents of the state “responsible for gross human rights violations.”Footnote 91
Shortly after Fayad began his service at the army police's First Battalion, Tenório was released from detention. For the next two years, he and other colleagues affiliated with leftist opposition groups provided medical assistance to urban guerrilla members and other patients persecuted by the regime.Footnote 92 In 1972, agents in civilian clothes appeared at Tenório's clinic in Rio's Bonsucesso neighborhood and kidnapped him to the DOI-CODI. Suspected of affiliation with the armed left, Tenório underwent brutal torture. The interrogators threatened to kill him and his family and employed mock-drowning techniques to break his resilience. On the pau de arara or “parrot's perch”—a long pole from which victims, usually naked, were suspended by their tied wrists and ankles—Tenório suffered severe beatings and electric shocks. After several days of interrogation, his health was in danger. The physical torture had perforated his left eardrum. Psychological torture had left him mentally distressed. Back in his cell, Tenório developed a high fever and began speaking incoherently. Recognizing the escalating health crisis, his cellmate cried for medical intervention. Eventually, a doctor appeared—Tenório's old classmate.Footnote 93
Seeing Fayad was encouraging, Tenório later recounted. He reckoned that the military doctor would at least notify his family about the circumstances of his disappearance. While they stood on opposite political sides, he would recall, they had also spent six years together in medical school. Fayad had a quick look at his former classmate and shook his head. He then turned to the torturers, assured them that the detainee's condition was not severe, and asserted that the interrogation could continue. After Fayad left, Tenório later testified, one of his torturers remarked: “Well, with colleagues like that, who needs enemies?” An hour later, he was on the way back to the torture room.Footnote 94 Tenório spent a total of 20 days at the DOI-CODI. He was then transferred to another military compound in Rio de Janeiro's São Cristovão neighborhood (1° Batalhão de Guardas), where he remained for several more months. On his release, the military supreme court acquitted him of all charges.Footnote 95
By 1972, the year of Tenório and Fayad's disturbing encounter, the Brazilian medical community was completely transformed. The dictatorship's repression of progressive doctors and medical scientists in the preceding years resulted not only in the purging of “social medicine” and “preventive health” from professional vocabularies but also in a decade of uncontested conservative control of medical associations and regulatory bodies. Thus, even when information about ethical violations by Brazilian doctors began to surface, the medical leadership refuted it. In mid-1972, for example, both Amnesty International and the World Medical Association (WMA) sent letters to Pedro Kassab, president of the Brazilian Medical Association, requesting clarifications regarding allegations of medical involvement in torture.Footnote 96 Although reports of international human rights organizations had already documented the role of doctors in the dictatorship's repression, Kassab dismissed Amnesty and WMA's allegations.Footnote 97 Upholding Brazil as an “example” of respect for human life, he advised the WMA to focus instead on Cuban and Soviet doctors purportedly involved in the torture of their colleagues and the internment of dissidents. Kassab's response—representing the leading medical association in Brazil—demonstrates the extent to which the conservative medical leadership backed the regime during its most repressive phase. It can also be seen as yet another reflection of the historically close relationship between the Brazilian medical elite and the state, which engendered various other controversial public health campaigns over the course of the twentieth century.Footnote 98
The conservative medical authorities' support of the dictatorship also paved the way for the government to advance a market-oriented health care industry. In 1966, the regime established the National Institute of Social Welfare (Instituto Nacional de Previdência Social, INPS), a social security agency that offered health protection for urban employed contributors, primarily through outsourced private medical hospitals.Footnote 99 By expanding health care, government officials hoped to advance the goals of the Brazilian National Security Doctrine, most identified with General Golbery do Couto e Silva.Footnote 100 Promoting national health, they contended, could secure Brazil's geopolitical vitality and prevent the spread of communism, believed to thrive under poverty and poor health conditions.Footnote 101 Increasing coverage also allowed the regime to extend its control into areas where the state had been absent and lower chances of social mobilizations and labor unrest.Footnote 102
Following a model of state capitalism, the officials sought to expand and regulate public services, but not necessarily to operate them. Social protection and health care, government technocrats envisioned, would be administered by an elaborate private market run by multinational and national corporations outsourced to treat social security contributors.Footnote 103 Despite efforts in the mid-1970s to expand coverage to some rural, senior, and urban poor populations, health officials remained unwilling to part with the organizing principle of ‘care for contributors,’ and bolstered contracts with private hospitals.Footnote 104 Thus, while the number of hospital treatments provided to Brazilian urban patients from 1973 to 1978 grew by 78.8 percent, public services increased by a mere 14.6 percent. In 1975, for example, 3,191 agreements were signed between INPS and private healthcare providers, compared to 17 agreements with public university medical institutions.Footnote 105
Due to its selective initiatives and focus on curative rather than preventive care, the regime's efforts to reform the health care system did not succeed in improving health conditions. The regime boasted that the number of hospital beds in the country had grown substantially in the first decade of military rule, but taking into account Brazil's concomitant population growth shows that the ratio of beds per capita did not change significantly.Footnote 106 In addition, lack of government oversight in outsourcing medical services led to rampant corruption in overbilling the healthcare administration, contributing to the formation of what critics called a Brazilian “medical-industrial complex.”Footnote 107 Finally, health indicators such as life expectancy, nutrition, and mortality rates lagged, and outbreaks of epidemics demonstrated a persistent health equity gap between the southeastern urban centers and the impoverished Northeast.Footnote 108
The Struggle for Ethical Renewal and Medical Accountability
Fayad and Tenório met next in the early 1990s. Military rule ended in 1985 and a return to democracy was completed only in 1988, but the transition within the medical sector began a decade earlier. Against the backdrop of the ongoing inequalities in health care, economic contraction, and a relative lessening of state repression during the mid 1970s—due to President Geisel's policy of political decompression—a new generation of physicians mobilized to remake Brazil's medical politics and health policies.Footnote 109 First, public health practitioners (sanitaristas) formed professional networks and journals to disseminate new critical theories on collective health, preventive care, and population planning.Footnote 110 Second, junior resident doctors embarked on a series of massive hospital strikes protesting their poor wages, extended working hours, and shortages in staff and medical supply.Footnote 111 Beginning in early 1977 in São Paulo and expanding to other major Brazilian cities, residents' strikes soon included senior hospital physicians who shared similar views about the devaluation of the medical profession.Footnote 112 Brazil's economic downturn and the instability caused by the security agencies’ killing of prominent public figures led various other sectors to go on strike in 1978, most notably autoworkers in the state of São Paulo.Footnote 113
The mobilizations in hospitals and the sociopolitical context gave rise to the Movement for Medical Renewal (Movimento Renovação Médica, REME), which spearheaded a dramatic political, and consequently, ethical shift within the Brazilian medical sector. REME encompassed a diverse group of professionals, many of them located somewhere on the left side of the political spectrum. Frustrated by the political and ethical agenda of their professional community, they sought to remove the old guard that had controlled the medical sector since the mid 1960s and to advance reforms within its professional and regulatory bodies. After winning the elections for the boards of doctors' unions in Rio de Janeiro and São Paulo in 1977-78, REME's campaign spread across the country, achieving decisive electoral victories in various associations, unions, and medical councils.Footnote 114
Although REME won elections by impressive margins, both the sector's conservative leadership and the military worked tirelessly to curb the movement's momentum. The Federal Medical Council (CFM) and the Brazilian Medical Association (AMB)—the strongholds of Brazil's conservative doctors—employed various tactics to thwart REME's achievements, from disqualifying candidates running for office to annulling election results.Footnote 115 Rankled by the movement's increasing popularity and escalating hospital protests, the regime's intelligence agencies produced hundreds of reports expressing fear of “the communist infiltration” into the medical community.Footnote 116 Their agents monitored REME's assemblies and protest events, and regularly detained key campaign and union leaders.Footnote 117 Indeed, security officials were alarmed not only by the repercussions of hospital strikes but also by the emerging collaborations between leaders of the doctors’ and the autoworkers’ campaigns.Footnote 118 Moreover, the conservative Brazilian Medical Association chastised REME's leadership for supporting physicians on strike. Forsaking the doctor's obligation to treat the sick, the association stated, was “unethical” and “unpatriotic.”Footnote 119
Ultimately, Renovação Médica overcame these obstacles. While not all doctors shared its political agenda, many were dissatisfied with the direction in which the professional community had been heading since the early 1970s. As salaried professionals in public and private medical institutions, they saw their wages declining as the cost of living rose.Footnote 120 The poor quality of health care, the government's ineptitude, and military and police harassment of activist doctors further antagonized physicians, bolstering support for REME's campaigns.Footnote 121 By 1980, therefore, REME controlled more than half of the states’ medical associations and all major doctors’ unions, in addition to the regional medical councils of São Paulo, Pernambuco, and Minas Gerais.Footnote 122 In 1981, REME finally won the elections for the Brazilian Medical Association, replacing its powerful president of six-consecutive terms, Pedro Kassab.Footnote 123
Pledging to “raise the value of the doctor's practice and labor” and “preserve the ethical principles that govern the profession,” Renovação Médica sought to advance its vision for the Brazilian medical sector—a democratic community whose members struggled for the population's socio-health needs and committed themselves to the ethical practice of medicine.Footnote 124 Thus, as early as 1980 REME-led boards began to rethink the Brazilian code of medical ethics. Leading the revision project, São Paulo's medical council (Conselho Regional de Medicina do Estado de São Paulo, CREMESP) collaborated with other regional councils in organizing public forums and working groups to study medical ethics literature, international ethics codes, and relevant domestic legislation.Footnote 125 Since the conservatives still controlled the entity codifying medical ethics in Brazil—the Federal Medical Council (Conselho Federal de Medicina, CFM)—it was unlikely that a new code would be approved.Footnote 126 In fact, it took another seven years and a transition to democracy for Brazil to adopt a progressive charter of medical ethics.
Yet regional medical councils still held considerable disciplinary power under their authority to regulate the practice and conduct of physicians. As regulatory boards whose independence was protected under the law, they could impose disciplinary actions, including the revocation of medical licenses. As information about doctors’ complicity in torture made its way to mainstream press outlets—especially after censorship was lifted in 1978—pressure to investigate alleged violations increased.Footnote 127 Indeed, the newly elected REME board at CREMESP (the São Paulo medical council) categorically rejected collaboration in state repression in its first executive resolution, which pledged commitment to the World Medical Association's Declaration of Tokyo.Footnote 128 The document, adopted by the WMA in 1975, stated that physicians “shall not countenance, condone or participate in the practice of torture or other forms of cruel, inhuman or degrading procedures.”Footnote 129
Ratifying the Tokyo Declaration was the first sign of a more forceful approach to medical ethics. Three months into its term, CREMESP's board moved from declarations to action, opening its first investigation into medical complicity in repression. The probe focused on Harry Shibata, the head of São Paulo's medical examiner's office (Instituto Médico Legal, IML), who allegedly played a key role in the state's employment of repression. Through hearings of testimonies and analysis of medical records, the investigation revealed that the prominent medical examiner not only issued false medical reports that concealed evidence of torture but also forged autopsies of guerrilla members and political activists that masked extralegal executions.Footnote 130
The disciplinary process against Shibata faced a number of challenges. Military officials charged that CREMESP had been taken over by “subversives” who sought “communist revenge” and had launched a “defamation campaign against the security forces.”Footnote 131 They pursued both procedural measures and outright intimidation to thwart the investigation.Footnote 132 Shibata's lawyers, who accused CREMESP of politicization, employed various legalistic arguments to call off the disciplinary process.Footnote 133 The board's councilors, however, were loath to bring the investigation to a halt. Seeking to defend a professional integrity tarnished by more than a decade of authoritarian rule, they unanimously found Shibata guilty of violating the code of medical ethics and revoked his medical license in October 1980.Footnote 134
The historical significance of Caso Shibata cannot be overstated. Although its verdict was later overruled by the conservative federal medical council, CREMESP's disciplinary process was essentially the first in Brazil—and in the Southern Cone—to condemn an individual for playing a role in state-sponsored repression.Footnote 135 This was particularly remarkable given the enactment of the 1979 Amnesty Law. The law, which pardoned not only former and existing political prisoners but also the regime's security agents, was supposed to protect perpetrators of human rights violations and forestall future appeals for justice.Footnote 136 While CREMESP's official indictment charged Shibata with violating the code of medical ethics, the implication was clear: professionals who committed or abetted human rights abuses in the interest of national security could be held accountable for their actions.
The Amnesty Law also allowed Luiz Roberto Tenório to regain his political rights and find formal medical work.Footnote 137 In the early 1980s, he returned to political activism as a member of the Rio de Janeiro doctors’ union.Footnote 138 Ricardo Fayad's path had also altered under the regime's de-escalation of repression. In 1979, he left the army's counterinsurgency agencies to join the Fourth Battalion of the military's construction engineering arm, located in Bahia. In 1982, recently promoted to major, he moved back to Rio de Janeiro to teach at the Army's school of health (Escola de Saúde do Exército).Footnote 139
As political violence gradually subsided in the 1980s, progressive doctors relaunched protest. Relying on a national network of mobilized associations, unions, and councils, the doctors’ movement demanded better working conditions, improved public health, and health care reform.Footnote 140 In 1983-84, the movement joined other professionals, opposition leaders, and millions of citizens in support of democracy and immediate direct elections (Diretas Já).Footnote 141 The proposed amendment to reinstate direct presidential elections ultimately failed in congress, but public and congressional pressure finally led to the victory of the opposition leader, Minas Gerais Governor Tancredo Neves, in the 1985 (indirect) elections.Footnote 142 Brazil would have its first civilian president since 1964.Footnote 143
Although Neves's victory is considered the end of military rule, it did not constitute a profound shift in the way the state operated, nor did it lead to a reconciliation process. In fact, for the sake of stability, representatives across the political divide shaped “a transition in which a feigned amnesia—combined with overt pride in the authoritarian past—was the order of the day.”Footnote 144 The struggle against oblivion, therefore, came from civil society organizations. Torture Never Again (Grupo Tortura Nunca Mais, GTNM), established in late 1985 by former political prisoners and relatives of the disappeared, worked relentlessly to expose former torturers who enjoyed impunity, support victims’ claims, and call attention to the legacies of authoritarianism.Footnote 145 Concomitantly, various former political prisoners and guerrilla members published memoirs and testimonials to insert their experiences into the collective memory.Footnote 146 In July 1985, publishing house Vozes released what became an instant bestseller, Brasil: Nunca Mais. A collection of secretly copied testimonies given before Brazil's supreme military court in the 1960s and 1970s, the book revealed the dictatorship's systematic torture and repressive apparatus.Footnote 147 Among the book's chapters, one focusing on “medical assistance to torture” confirmed that professionals not only medicated prisoners to facilitate “effective” torture but also advised interrogators “in their grisly labors.”Footnote 148
The chapter in Brasil: Nunca Mais on medical complicity in repression stunned many Brazilian physicians who were unaware—or in denial—of the extent of doctors’ collaboration with the security forces. Rather than a case of a few “bad apples,” the chapter revealed that medical involvement in state-led repression was widespread and systematic. Further exposés in the press and testimonies collected by the Torture Never Again Group drove medical councils to revisit previous ethical complaints. In November 1986, Rio de Janeiro's regional medical council (Conselho Regional de Medicina do Estado do Rio de Janeiro, CREMERJ) opened an investigation into the violations of Amilcar Lobo. A military doctor and later a civilian psychoanalyst, Lobo was involved in the torture and degrading treatment of detainees in various facilities, including Rio's DOI-CODI and Casa da Morte (House of Death), a clandestine torture center in Petrópolis.Footnote 149 Drawing considerable public attention, CREMERJ's ethics commission scrutinized the allegations for more than a year and in March 1988 unanimously found Lobo guilty of violating seven principles and seven proscriptions of the ethics code.Footnote 150 The verdict, approved in 1989 by the federal medical council, permanently revoked his medical license.Footnote 151
Medical Transitional Justice
The medical sector's decade-long redemocratization process culminated in 1988 with the approval of Brazil's new code of medical ethics. Reflecting a bottom-up dialogue involving doctors, public health practitioners, and human right advocates, the code represented a significant turning point in how medical associations and regulatory bodies in Brazil saw and defined their members’ profession.Footnote 152 It recognized employed doctors’ right to strike, instituted informed consent, and considered the emerging bioethical facets of “organ donations,” “transplants,” and “scientific work.” A chapter on human rights explicitly repudiated medical involvement in abuse, forbidding doctors to “provide means, instruments, substances, or knowledge that facilitate the practice of torture,” and proscribing participation in other forms of cruel, inhuman, or degrading treatment.Footnote 153 Indeed, the “humanitarian, socially engaged” code presented an unequivocal affirmation of patients’ rights and a sincere attempt to eradicate medical complicity in human rights violations.Footnote 154 Yet even under a commitment to higher bioethical standards and a new federal constitution that defined torture as a heinous crime, ensuring accountability for physicians complicit in repression presented considerable challenges.Footnote 155
Since the early 1980s, multiple testimonies, reports, and newspaper articles had referred to Ricardo Fayad's role in the torture and degrading medical treatment of detainees.Footnote 156 Amilcar Lobo himself identified Fayad as his colleague, at both the army police's First Battalion and Casa da Morte.Footnote 157 “I have no doubt,” Lobo told a reporter in 1986, “Fayad was right-wing, and in favor of torture.”Footnote 158 Rio de Janeiro's medical council (CREMERJ) was thus eager to launch an inquiry into Fayad's alleged violations, approving an ethics probe on the very same day Lobo was convicted, in March 1988.Footnote 159 The investigation ran into various roadblocks at the outset, however. Unlike Lobo, Ricardo Fayad was a high-ranking officer serving as the commander of the army's school of health. Before the inquiry had even begun, Fayad's legal team disputed the council's regulatory jurisdiction, citing a law—commonly called the “Shibata Law”—that exempted military health professionals from disciplinary action by regional medical councils.Footnote 160 CREMERJ ultimately managed to circumvent the restriction by discovering that Fayad had registered as a civilian “liberal professional” in local municipal records, which subjected him to council authority.Footnote 161 Yet the lengthy juridical debate postponed actual investigations by more than three years. In late 1992, CREMERJ relaunched the probe, appointing a new ethics commission to lead the disciplinary process.Footnote 162
Over the course of a year, the ethics commission examined various press materials and revisited previous depositions that referred to Fayad's involvement in state-sponsored repression. It also summoned five former political prisoners to testify, among them Luiz Roberto Tenório, by that time the entering president of Rio de Janeiro's doctors' union.Footnote 163 Their testimonies revealed Fayad's collusive and abusive conduct at Rio's DOI-CODI. They depicted a doctor who instilled fear in prisoners, advised torturers on their victims’ ability to endure pain, and brought detainees back to consciousness after they had passed out under torture.Footnote 164 As one of the witnesses commented, Fayad never exercised his expertise to “alleviate pain or to cure … but on the contrary, as an effective piece of the system of torture.”Footnote 165 Tenório's testimony, which detailed his arrest, brutal torture, and disturbing confrontation with his former classmate, served as a vivid illustration of the above.Footnote 166
Fayad's lawyers had also called for witnesses. Non-military colleagues attested to Fayad's professionalism, responsibility, moral rectitude, and good character.Footnote 167 Military peers praised his longtime professional service and lauded his collegiality. All of them stressed that Fayad—by then a colonel and the head of São Paulo's General Army Hospital—would have never taken part in human rights violations.Footnote 168 Yet they also seemed oblivious to the specifics of his medical work at the DOI-CODI. Only one witness—an Army Command officer who claimed to have frequented the First Battalion barracks in the early 1970s—maintained that Fayad had exercised his role under strict professional guidelines and never to facilitate torture.Footnote 169
In addition to arguing that the “Shibata Law” precluded CREMERJ from disciplining the military doctor, Fayad's lawyers cited a regulatory article issued by the federal medical council that prescribed a limit of five years for bringing disciplinary action. Since Fayad's alleged violations took place in the early 1970s, his lawyers asserted, the statute of limitations had expired.Footnote 170 CREMERJ's legal department refuted both claims. First, it insisted that the “Shibata Law” was not applicable due to Fayad's nonmilitary practice. Moreover, it argued that Fayad's interactions with political prisoners did not fall under the medical “military duty” protected by that law. After all, detainees were neither soldiers nor prisoners of war, but rather civilians held illegally in a detention center. Second, CREMERJ's lawyers cited a federal law (Lei 6.838, 1980) that set the initiation of the five-year period for disciplinary action against medical professionals with the “verification of facts.”Footnote 171 Since the council's investigation had not begun until 1992, they concluded that there were no legal restrictions to disciplinary action.Footnote 172
As the case drew to a close, former political prisoners rallied in support of CREMERJ, pressuring councilors to condemn Fayad.Footnote 173 The military, on the other hand, impugned the council's investigation by promoting Fayad to the rank of brigadier-general.Footnote 174 Adding fuel to the fire, the defense team of the now army general-doctor spared no effort to delegitimize Rio's medical council. The ethics commission, Fayad's lawyers stated, investigated “malicious and cowardly facts” in an “affront to medical ethics.”Footnote 175 The harshest attack, however, was directed at Tenório, accused of “nothing but hatred” toward his “declared enemy,” who in reality had “treated him with sincere humanity.”Footnote 176
On May 4, 1994, CREMERJ's councilors convened to cast their final vote. A group of doctors, relatives of the disappeared, and former political prisoners—Tenório among them—gathered outside the council's building in anxious anticipation of the board's ruling.Footnote 177 Inside the council's courtroom, the board's commissioners, rapporteur Mauro Brandão Carneiro and his assistant Paulo Cesar Geraldes contended there was a clear contrast between the testimonies given by victims of torture and Fayad's colleagues.Footnote 178 While witnesses on behalf of the defense suggested Fayad was an amiable coworker, nowhere did they refute the allegations of his involvement in torture. As Brandão Carneiro affirmed, these “frivolous” testimonies and the defense's legalistic arguments served to “deliberately disguise the military doctor's participation in monstrous crimes” that proved to be gross violations of the Hippocratic oath.Footnote 179 In fact, he asserted, the accounts of former political prisoners revealed the military doctor to be an “integral part of the torture scheme.”Footnote 180 As Brandão Carneiro emphasized to the commission prior to the vote, Fayad's case did not reckon only with the “ghosts of the past.” Brazil, he explained, still lived “with the indelible marks” of the dictatorship: “inflation, unemployment, and entrenched impunity and corruption.” He concluded, “[I]n these current times when the society is committed to democracy, silence serves as an obstacle for the coming future.”Footnote 181 After five hours of discussion, CREMERJ's councilors unanimously found Fayad guilty for violating five articles of the Brazilian code of medical ethics, ruling to revoke his medical license.Footnote 182 The crowd outside the council's offices erupted in cheers of joy. “This decision certainly alleviates the souls of those tortured during the dictatorship,” Tenório told a reporter.Footnote 183
Fayad immediately appealed the decision to the Federal Medical Council (CFM).Footnote 184 Meanwhile, in a clear rebuff to CREMERJ, the army nominated the military doctor for the rank of second deputy director of health (2° Subdiretor de Saúde do Exército).Footnote 185 Tenório and members of Torture Never Again strenuously objected the nomination, to no avail.Footnote 186 Next, Fayad's lawyer accused CREMERJ of political bias in contravening legal procedures and sought to file a defamation complaint against the council.Footnote 187 Finally, military officers mobilized to pressure federal councilors reviewing the appeal. The case's rapporteur, CFM vice president Regina Ribeiro Parizi Carvalho, received more than 500 telegrams from military officers demanding an acquittal. Some directly threatened her with retaliation. Several times she was stopped in public by strangers who warned of “possible consequences” for an unfavorable ruling. Her children's school received surprise visits from unidentified men who claimed to be relatives picking up the children.Footnote 188 Nonetheless, the evidence presented in the case was unequivocal, Carvalho ruled. As she asserted in her final recommendation before the federal council's Supreme Court of Medical Ethics, Fayad was first and foremost a doctor, regardless of his military officer status.Footnote 189 As such, she explained, he could exercise his military duty, but only within the boundaries of the Hippocratic oath. “Doctors,” she concluded, “are not allowed, under any circumstances, to practice anti-medicine.”Footnote 190 Concurring with Carvalho's vote, on August 10, 1995, the council's board unanimously rejected Fayad's appeal and upheld the decision to revoke his license.Footnote 191
Fayad's final conviction by the federal medical ethics board was monumental for human rights groups and victims of torture. Indeed, by that time regional medical councils had already investigated and penalized several physicians for their involvement in political repression, most notably Harry Shibata and Amilcar Lobo. This was the first time in Brazilian history, however, that an active duty military doctor holding the rank of brigadier general was disciplined by a civilian medical council for his complicity in human rights violations. Fayad persisted in his efforts to annul the verdict in federal courts, with some success.Footnote 192 The army also sought to promote him once more, this time in early 1998, to first deputy director of health.Footnote 193 Yet Fayad's reputation had been badly tarnished by then, and the military's saber-rattling was less prominent.
Concomitantly, Fernando Henrique Cardoso's administration (1995–2002) was promoting human rights policies at home and abroad, seeking to strengthen Brazil's international standing.Footnote 194 The campaign against Fayad's nomination—led by Tenório, members of Torture Never Again, and other human rights organizations—was therefore more effective than previous attempts, leading Cardoso to call off the appointment.Footnote 195 Faced with strong political and professional opposition, Fayad retired from active service in 2001.Footnote 196 Tenório, on the other hand, earned professional laurels. Following his tenure at the union, he served as a staff physician at the Rio de Janeiro State University (UERJ), his alma mater.Footnote 197 In the same year as Fayad's retirement, Tenório began working with the city of Niterói's health bureau and was later appointed its municipal secretary of health.Footnote 198
Tenório and Fayad's paths crossed one more time. In 2012, Brazil instituted a National Truth Commission, nearly three decades after the end of military rule. In September 2014, at the commission's request, Tenório delivered an emotional testimony of his arrest, torture, and unsettling encounter with Fayad.Footnote 199 In the same month, Fayad was also called to the stand. He was the only one out of five military officials summoned for a public hearing to appear before the commission.Footnote 200 Assisted by his lawyer, he refused to answer any of the questions presented by the commission members.Footnote 201
Conclusion
Ricardo Fayad's unanimous conviction by both the regional and federal courts of medical ethics illustrates the dramatic transformation Brazil's professional medical organizations had undergone since the late 1970s. A little more than a decade prior to the ruling, conservative doctors had a tight grip over regulatory power and frequently curbed initiatives to reform ethical principles and professional norms. As this article has demonstrated, their undisputed rule was made possible by the ouster of “subversive” physicians in the years following the 1964 civilian-military coup. In the 1970s, with opposition removed, the medical leadership not only supported the regime's policies to install a market-oriented healthcare system but also condoned medical involvement in torture as part of Cold War counterinsurgency. Only after a decade-long struggle spearheaded by the Movement for Medical Renewal (REME) would the medical community endorse firm bioethical standards, epitomized in the 1988 Code of Medical Ethics. Penalizing physicians complicit in state-sponsored repression reflected the commitment to human rights values enshrined in that code.
The disciplinary processes against Fayad and other medical professionals involved in repression highlight the significant role doctors played in the struggle for transitional justice in Brazil. Various studies have correctly underscored Brazil's extremely limited efforts to seek truth and hold perpetrators accountable after the end of military rule, especially by comparison to its neighbors Argentina and Chile.Footnote 202 Indeed, while legal scholars and human rights practitioners gathered in the late 1980s to discuss truth and justice in post-authoritarian societies—thereby solidifying the concepts and frameworks for the emerging transitional justice field—Brazil's post-dictatorship governments shunned acknowledgment of the violent past and persistently disregarded victims’ claims.Footnote 203 In fact, only 27 years after the end of military rule did the Brazilian government institute a national truth commission (2012–14).Footnote 204
Scholars of Brazil's transition to democracy have observed the high number of testimonials and memoirs published in the immediate years following redemocratization. Since the road to achieving justice was blocked, they have noted, former political prisoners and victims of torture turned to the cultural realm as a way to contest the state's policy of forgetting.Footnote 205 As this article has shown, however, not all avenues for seeking justice were closed. To be sure, national security laws—some remained in effect until the country's complete redemocratization in 1988—and the 1979 comprehensive amnesty law shielded human rights violators. But neither protected doctors who failed to abide by an ethics code. The focus on violations of medical ethics, therefore, institutionalized investigations of torture and turned the medical councils into unprecedented arenas for testing accountability processes. In essence, the medical sector's disciplinary hearings introduced key pillars of transitional justice: they revealed the dictatorship's human rights abuses, identified its “violence workers,” and, in the case of Fayad, permitted the conviction of a senior military officer.Footnote 206
In the context of political oblivion of state repression, the proceedings were also unparalleled in providing a protected space for truth-seeking. Former political prisoners who chose to appear before the ethics commission—many declined out of fear—were not required to recount the reasons for their arrest, nor their activity in clandestine opposition groups. They could talk freely about the torture they suffered and the degrading treatment they endured during their detention. For those witnesses, there was a therapeutic, liberating aspect to testifying at a medical council rather than before a criminal court. While federal judges—many of whom had been appointed by the military regime—represented the coerciveness of the justice system, the physicians leading the investigations were often themselves former activists who had suffered the brunt of regime repression. Victims of torture thus found the support of councilors who honored their testimonies and validated their narratives. In many ways, therefore, the investigations served as “unofficial truth commissions” that helped break former political prisoners’ sense of isolation and “mistrust of society.”Footnote 207
Luiz Roberto Tenório and Ricardo Agnese Fayad's three encounters—at medical school, at the torture center, and at the medical ethics’ hearing— serve as windows onto the polarization and transformation in the professional community's history. They also reveal the factors shaping the fitful process of bioethical accountability after the return to democracy. In this sense, the story of the two doctors is a microcosm for the social and political tensions that have racked Brazil over the last half century.
