WikiLeaks and Medical Ethics

WikiLeaks, the secure website that publishes documents leaked by whistleblowers, has been front page news since it published 92,000 secret Pentagon documents from Afghanistan. Its founder - Julian Assange - is a fascinating person. He, and the WikiLeaks venture, have a lot to teach about organizational ethics. (My information and quotes come from a terrific New Yorker article about Assange by Raffi Khatchadourian.)

My goal for this blog (and for much of my work) is the same as Assange's - to improve the ethical performance of organizations and public agencies. But our world views and methodologies are so different that I fear Assange would describe me as he described physicists at a conference he attended - "sniveling fearful conformists of woefully, woefully inferior character."

I operate from the quality improvement perspective - the belief that most people in health care want to do the right thing, but may be impeded by faulty systems, which include intellectual/ethical constructs as well as production processes. My methodology is analysis, teaching, and advocacy.

Assange's world view is much darker. Here's how Khachadourian describes it:

He [came] to understand the defining human struggle not as left versus right, or faith versus reason, but as individual versus institution. As a student of Kafka, Koestler, and Solzhenitsyn, he believed that truth, creativity, love, and compassion are corrupted by institutional hierarchies, and by “patronage networks”—one of his favorite expressions—that contort the human spirit. He sketched out a manifesto of sorts, titled “Conspiracy as Governance,” which sought to apply graph theory to politics. Assange wrote that illegitimate governance was by definition conspiratorial—the product of functionaries in “collaborative secrecy, working to the detriment of a population.” He argued that, when a regime’s lines of internal communication are disrupted, the information flow among conspirators must dwindle, and that, as the flow approaches zero, the conspiracy dissolves. Leaks were an instrument of information warfare.

Assange learned this outlook early. His mother "believed that formal education would inculcate an unhealthy respect for authority in her children and dampen their will to learn." She told Khatchadourian "I didn't want their spirits broken." When Assange was eleven his mother separated from his stepfather, who she feared was part of a dangerous cult. "Assange recalled her saying, 'Now we need to disappear,' and he lived on the run with her from the age of eleven to sixteen." By the time Assange was fourteen they had moved thirty-seven times.

Assange's mission is to expose injustice, and injustice is everywhere. Because he sees injustice and exploitation as the basic truth about the world, the default position for organizations and governments, he rejects the Hippocratic injunction to "first, do no harm." His precept is "first, fight tyranny!"

His mission is to expose injustice, not to provide an even-handed record of events. In an invitation to potential collaborators in 2006, he wrote, "Our primary targets are those highly oppressive regimes in China, Russia and Central Eurasia, but we also expect to be of assistance to those in the West who wish to reveal illegal or immoral behavior in their own governments and corporations." He has argued that a "social movement" to expose secrets could "bring down many administrations that rely on concealing reality—including the US administration."

Assange does not recognize the limits that traditional publishers do. Recently, he posted military documents that included the Social Security numbers of soldiers, and in the Bunker I asked him if WikiLeaks’ mission would have been compromised if he had redacted these small bits. He said that some leaks risked harming innocent people—"collateral damage, if you will"—but that he could not weigh the importance of every detail in every document. Perhaps the Social Security numbers would one day be important to researchers investigating wrongdoing, he said; by releasing the information he would allow judgment to occur in the open.

To those for whom harm perpetrated against individuals by government and large organizations is the default expectation, primum non nocere is Pollyanna foolishness.

Assange's ethic is that of public health, not clinical medicine. His passion is for social justice, and in pursuing that aim, individuals will inevitably be injured.

Societies need ferocious warriors for justice like Assange, but his stance of constant vigilance and deep suspiciousness come at a high cost - isolation, fear, and vulnerability to despair. Societies also need gentler leaders who expect imperfection, meet individuals and organizations where they are, and ask them to become better, more in tune with their ideals.

That's the Yin and Yang of organizational ethics!