Wednesday, 13 May 2009

Michael Portillo and the Milgram Experiment


BBC 2 last night broadcast Michael Portillo's long-awaited documentary How Violent Are You? Its basic conclusion, that most people have an inbuilt propensity towards committing acts of savage aggression, wasn't particularly surprising in itself. But it gave us another opportunity to watch a thoughtful and articulate public performer, and to ponder what a great loss he was to politics.

As with Portillo's earlier documentary about capital punishment, much of the pleasure came from watching the former defence secretary placed in uncomfortable (if not, this time, life-threatening) situations. Here, we saw him punching a Bolivian farmer and, in a longer set-piece, "caring" for two perpetually crying artificial babies and working as a sous-chef, the object being to deprive him of sleep. The psychologist in charge claimed that he was "displacing his anger" onto the production team. But then what other possible objects for his anger were there? The plastic babies?

The situation up in the Andes was faintly disturbing. They were there to film a festival in which the locals beat each other up. A couple of children were cheered on as they knocked each other about the head - not footage the crew would be allowed to film back in Britain, I suspect - but what really shocked was the matter-of-fact way in which an evidently educated and civilised Bolivian explained how it is considered auspicious when one of the participants gets killed. It's good for the harvest, apparently. I was wondering what the authorities thought of all this, and whether charges were ever brought, but such questions were left unexplored. It was explained that the local culture gave people "social permission" to release their natural aggression - which left me, for some reason, thinking of the Metropolitan Police.

The programme also featured an interview with a Sudanese former child-soldier reflecting on the "joy of revenge" (which, in his case, included hacking off the private-parts of a still-breathing prisoner and stuffing them in his mouth to "make him feel the pain"). Tacked onto the end came a recreation of the notorious Milgram "obedience" experiment. As in the original, conducted by Stanley Milgram at Yale in the early 1960s, volunteers from the general public were invited to take part in a psychological "experiment" to see if learning could be enhanced by punishing errors in recall with electric shocks. They were told that a fellow participant - in reality a stooge - would be wired up to an electrical machine which they would operate. Various levels of shock were indicated on the machine's dashboard - the higher levels were potentially lethal, and clearly indicated as involving "extreme danger". Despite this, and with varying levels of protest and discomfort, the majority of the participants (nine out of the twelve) were willing to administer the shocks under the direction of a white-coated "scientist" who told them that their compliance was "essential to the experiment".

It's not clear what the segment was doing in a film about violence, since the whole point of the Milgram experiment was to test the extent to which ordinary people are willing to obey immoral instructions when there is no direct violence involved. Unlike the later Stanford prison experiment, which did involve actual violence, the set-up here is designedly clinical. The subjects hear occasional yelps and demands to be let free - and their reactions are disturbing enough to watch - but they are not asked personally to hit or kick their victims, who are (they think) in another room. Previous sections of the documentary had stressed the idea that the potential for violence was something that most people managed to keep in check, and explored various disinhibitory mechanisms, including stress, excitement, dopamine release, brain injury and sleeplessness. (Though Portillo did not mention it, strong religious conviction can also be an effective disinhibitor, as can nationalistic fervour.) But the Milgram experiment isn't about the breaking through of dark impulses from the subconscious.

Quite the opposite, in fact: it concerns the power of social conformity and deference to overcome the natural desire not to inflict unnecessary pain on others who have done you no harm. The experiment distances torturer from victim, just as the lawyers who drew up articles of acceptable torture for the Bush administration had no direct contact with the people being interrogated (while the interrogators, for their part, were following legalistic protocols which absolved them from personal blame). The subjects in Portillo's film, as in the original experiment, exhibited no sadistic joy (well, not most of them, anyway). They protested, complained, showed signs of stress, clearly knew that what they were doing was wrong, obtained reassurance that they would not be legally responsible; but they went ahead and did it anyway. As Milgram himself wrote in 1974,


Ordinary people, simply doing their jobs, and without any particular hostility on their part, can become agents in a terrible destructive process. Moreover, even when the destructive effects of their work become patently clear, and they are asked to carry out actions incompatible with fundamental standards of morality, relatively few people have the resources needed to resist authority.


Milgram carried out several variants of his experiment, discovering, for example, that obedience declined if the "victim" was physically present in the room or if the experimenter wasn't. In the most disturbing version, carried out by a different team several years later, the human victim was replaced by a puppy, who actually did receive shocks. Levels of compliance were just as high; but if what was being tested was the conflict between morality and obedience to "scientific" procedure, it was the experimenters, more than their test subjects, who must be said truly to have failed. Far more benign was the man reported in Stuart Sutherland's book Irrationality, the Enemy Within, who "boarded a London tube, went up to a stranger and said 'will you please give me your seat?' Almost everyone approached stood up to let him sit down."

One of the few in last night's film who did decline to pursue the experiment to its (potentially lethal) conclusion - a man in his fifties - found the willingness of the others to follow orders "scary". "It sounds a bit like the Nazis", he said - which was, of course, Milgram's original point. A younger man, who carried on despite voicing severe doubts, later expressed appropriate self-disgust. But some of those who had disgraced themselves seemed startlingly unabashed. The women, I'm sorry to report, appeared to be the worst. A pretty nineteen year-old student dished out the shocks without a flicker of emotion or thought - even after hearing a voice screaming "let me out - my heart's starting to bother me". After that, the subject stopped answering - an obvious sign that something was seriously amiss. But this did not even occur to the airhead at the controls, who continued flicking the switches, until eventually she turned to the "professor" with a beaming smile and asked "have we killed him?" Terrifying.


(I suppose it's possible she had watched Derren Brown's recreation of the Milgram experiment a couple of years ago and knew what was going on. But presumably the participants had been screened for prior knowledge.) Paula, a "personal coach" in her early forties, was a little more troubled by what was going on, but her main worry was over whether her victim had "signed the form" absolving her of any responsibility for injury or death. When she was told at the end that she hadn't actually been administering any shocks she sounded surprised, even disappointed, and not particularly relieved.

It was a small sample, and we weren't shown the whole of it or how easy the producers found it to recruit volunteers, so it would be unwise to draw too many conclusions. Apart, perhaps, from ignorance. The "maximum" of 450 volts is almost twice the mains voltage and it is - ahem - shocking to learn that so many people are unaware of its lethality. Participants were assured that the experiment caused "no permanent tissue damage", which seemed to be enough for most of them. The ratchet effect may be significant: participants began administering a very moderate "dose of electricity", increasing in steps that were, themselves, fairly small. Such a procedure can create an impression of moderate change and continuity even over a very short timespan, as framers of terrorist legislation are well aware.

The psychologist suggested that the "ideological" belief participants obeyed because of their belief that they were helping "science". It's an interesting suggestion, and one with enormous implications that weren't further examined. But I doubt it's the whole truth. What this trial - like other versions of Milgram that have been conducted over the years - does suggest is that the decline in social deference since the 1960s has not led to increased willingness to question "authority" - even when that authority takes the attenuated form of a mild-mannered experimenter. In the original, 65% of those tested went on to the bitter end. Here it was three quarters.

Portillo himself expressed surprise at this when speaking about the programme on Start the Week some months ago. But how surprised should we be? Society has, if anything, become more conformist and bureaucratic in the past fifty years. Automatic obedience to conventional figures in authority - teachers, men in uniform (and, of course, politicians) - may have declined, but it has come to be replaced by deference to procedures and rules. It was striking how all the MPs caught out taking advantage of the expenses system stressed that their behaviour was "within the rules", as though that somehow absolved them of personal responsibility. The box-ticking, arse-covering culture of the nanny state discourages both individual initiative and accountability. Ethics have become to a great extent externalised: doing, saying or even thinking "the right thing" is now established by conformity to a set of regulations rather than a person's internal moral yardstick. Deviation from established procedure may lead to punishment, even if the decision itself is the best one, as when whistleblowers are disciplined or rescuers sanctioned for endangering themselves without a first carrying out a proper safety assessment. Intricate, legalistic codes of behviour and "best practice" loom larger than actual human beings, leading inevitably to disasters such as the Haringey social services scandal.

To judge (most unscientifically) from the footage, the younger participants were markedly less likely to raise objections. "I didn't think about it too much", grinned one (male) student. "My job was just to do the list". "Just doing my job" is, of course, the modern, fluffier equivalent of "only following orders". These are Blair's children, schooled in the language of tolerance, products of perhaps the most liberal educational and social regime in human history. Many observers have noted the extreme levels of social conformism exhibited by today's young adults. A survey carried out by anthropologist Kate Fox (for her book Watching the English) found, among other things, that only 14% of 14-24 year olds agreed that "at my age, having fun is more important than thinking about the future", a lower percentage than among people in their forties. She wrote:

My concern is that these largely commendable tendencies are also symptoms of a wider and more worrying trend: our findings indicated that young people ware increasingly affected by the culture of fear, and the risk-avesion and obsession with safety that have become defining features of contemporary society. This trend, described by one sociologist as a "cultural climate of pervasive anxiety", is associated with the stunted aspirations, cautiousness, conformism and lack of adventurous spirit that were evident among many of the young people in our survey and focus groups....what worried me was that these young people were more conservative, moderate and conformist than their parents' generation, that there seemed to be a trend towards even greater excesses of moderation.


And more likely to administer electric shocks on demand, possibly.

Paula's insistence on knowing whether her victim had signed the consent form - and the weight she placed on a meaningless piece of bureaucracy - gave the scenario another very 21st century twist. Yet none of the participants was in reality "doing a job"; they had nothing to lose even financially by disobeying, and everything, potentially, to lose by doing what they were told. Only social compliance - politeness, even - stood between them and their consciences. No wonder most whistles stay unblown. No wonder good, well-intentioned, domestically blameless nurses and doctors allow elderly patients to starve to death in hospitals. No wonder that so often, in the passive voice beloved of blame-shirkers everywhere, "mistakes are made".

The Milgram experiment revealed the troubling flip side of the socially useful instinct to co-operate and follow rules and instructions laid down by others. It identified what is perhaps a basic flaw in human psychology. But its expression is as much cultural as biological, though. It may be that natural British reserve and unwillingness to create a fuss - and a hard-wired belief in the benign nature of authority and public institutions - leaves us particularly vulnerable. It's not that we are natural sadists; it's more that too many of us are convinced that the innocent have nothing to fear.

22 comments:

Samwise said...

Brilliant. Best blog post I've read in a long time. And now I'm off to find the Portillo prog on iPlayer...

WoollyMindedLiberal said...

The Portillo of today is indeed a loss to politics now, but let's not forget that at the time he was first lost to politics he was no loss at all.

WeepingCross said...

It's all so very true. I have had a perfectly agreeable upbringing, and a consistent (and in its early stages self-developed) ideological standpoint which privileges compassion and moral responsibility. But in practice I am a coward, and constantly, endlessly compromise what I actually think for what amounts to a quiet life. The slightest deviation from the line of least resistance costs enormous concentration and effort of will.

asquith said...

You've hit the nail on the head there. Some older people actually imagine the youth of today are free-wheeling, rugged individualists. But binge drinking, casual sex & so on does not designate a free thinker.

Most of my age cohort (I am 24) are staggeringly conformist. They are superficially different to each other but their inner deadness & conformity is incredible.

I do sometimes accuse myself of being weak-minded, indecisive & cowardly. But I actually think I am a lion compared to most.

You've depressed me a bit- but my peers are even more depressing, apart from my friends, & I chose them as friends because they are nothing like most people.

valdemar squelch said...

Perhaps I'm fortunate to have met some younger people who are intelligent, moral and witty.

I am however constantly amazed at the ignorance of history (and its old pal geography) many young uns display. Perhaps that's part of the problem? History can give some moral perspective and sense of proportion. Now they get Hitler and the Henrys, apparently - two unconnected slices of history, except that both were dominated by absolutist bastards with a totalitarian ideology.

A bit OT, Portillo's radio history series 'Things We Forgot to Remember' was damn good.

asquith said...

Oh, I know some top of the range under 25s. But we're kidding ourselves if we say they are a majority of the young cohort.

I prefer the company of older people- but I do think that the youth of today will improve with age as everyone does. Because most weighty, significant middle-aged people used to be vapid divs at earlier stages in their lives.

Sorry- I must sound like I'm a bit depressive & morbid today. But that is how I feel.

Re: history. I learnt little at school (of this or any other subject), but I taught myself out of books &, now blogs. I think that is the sign of a proper person. There is far too much reliance on formal education to spoonfeed people.

I observed it at university, where most undergrads wouldn't dream of picking up a book unless a professor told them to, whereas I did a load of private reading & bitterly resented the set texts regime.

In fact, they didn't thrive in formal exams & those with a wide "hinterland" fared better even if they did little studying.

I do take the point though- most people will always need to be socialised by schools etc & a good basic education is necessary for those who will not do anything of their own accord.

Aye- sorry if I seem maudlin & a bitch. I suppose it depends which youngsters you speak to, as I have only good things to say about my friends, which is why I became friends with them in the first place.

WoollyMindedLiberal said...

People have been moaning about how ghastly the youth of today are since the days of Ancient Greece at the very least. Some things never change. All the young people I know these days (the children of friends) seem rather more sociable, self confident, well adjusted and frankly nicer than I recall my generation being. This is anecdotal about a small sample set so don't read too much into it. It would be a fascinating sociological study if someone could compare 18-20 year olds of today with those of the previous decades.

13eastie said...

While you rightly point out that the Milgram experiment does not lend itself particularly well to investigating the innate violence we possess, it continues to explain many of the paradoxes we encounter in the news, where courageous individuals are publicly punished for attempting to right wrongs, and the procedure is more important than the underlying principal:

1) MP's can never have felt comfortable with some of their "expense claims", so they had a system whereby "absolution" could be granted by a minion in the expenses office to make everything all right

2) Parliamentary/Government whistle-blowers, such as Christpher Galley wrestle with their consciences, find the courage to do the "right thing", and for their trouble have Knacker of the Yard on their doorstep the next morning

3) Margaret Haywood, a senior nurse with decades of unblemished service was publicly humiliated and sacked when she stuck her neck out and judged appalling shortcomings in patient care to be of more importance than management blushes

4) Phil Woolas, too weak to be comfortable in a minority and presented with a moral issue, is willing to be subjugated by whomever happens to be nearby, regardless of whether they actually have any rank over him

WoollyMindedLiberal said...

3) Margaret Haywood, a senior nurse with decades of unblemished service was publicly humiliated and sacked when she stuck her neck out and judged appalling shortcomings in patient care to be of more importance than management blushesAs they say in Pushing Dasies, the facts were these ...

She was struck off by the Nursing and Midwifery Council after being found guilty of misconduct. She acted unprofessionally by not respecting her patient's rights to confidentiality and privacy. She gave the Nursing and Midwifery Council no choice. The council is independent of both government and the NHS Trust who employed Haywood. Check them out for yourself, no need to take my word for it.

Linda Read, chair of the panel, said: ‘Although the conditions on the ward were dreadful, it was not necessary to breach confidentiality to seek to improve them by the method chosen.’

I hope you will have the decency to retract those comments which are unfair and innaccurate. It says something about you that you rush out to blether such serious allegations without even the most minimal fact checking or research. Presumably you are an Observer journalist.

WoollyMindedLiberal said...

2) Parliamentary/Government whistle-blowers, such as Christpher Galley wrestle with their consciences, find the courage to do the "right thing", and for their trouble have Knacker of the Yard on their doorstep the next morningYou are wrong to classing Christoper Galley as a 'whistle blower' since his only intent was to cause maximum embarrassment to the government. He had nothing of importance to the national interest to relate. I welcome anything that embarrasses the Labour Party of course but this is narrow party political interest and not public interest.

The arrest of Damian Green was ridiculous, not as over the top as the arrest of Lord Levy, but still a mistake. Fundraisers are popular scapegoats and sticking up for their rights is like sticking up for the rights of jews in Nazi Germany. It certainly seperates the real liberals from the faux liberals at the Grauniad.

The Heresiarch said...

Even by your standards, Woolly, your points about Margaret Haywood are truly extraordinary. The MRC had no choice? Well, let me see. Haywood had uncovered shocking ill-treatment was going on at the Brighton hospital for several years. She was by no means the first to do so. Patients, relatives and other staff members had been making complaints for a long time, and nothing was being done. People who had gone through the correct procedures got nowhere. Hence the necessity of an exposure in the public interest. None of the patients whose privacy was allegedly breached complained. Several relatives supported Haywood at the NMC hearing. Their and the patients' consent was obtained in advance. Breaches of confidentiality are allowed under NMC guidelines in exceptional circumstances; if this wasn't exceptional, what was?

The NMC was perverse, as blatant a case of shooting the messenger as has been seen in recent years. Almost as perverse as your defence of it, in fact.

13eastie said...

Wooly,

Re. Margaret Haywood, by stipulating that anyone had "no choice", you are rather making my more general argument for me, but anyway:

1) The NMC, in order to take action, needed a complaint to be raised. From where did this come? Not from the patients, not from their surviving relatives, and not from Ms Haywood's colleagues. It came from the Trust itself. A Trust that, while it was willing to turn a blind eye to patients who lay in their own faeces, wanted to beat the drum on a national stage for the same patients' rights to confidentiality. The Trust had every chance to exercise discretion in dealing with Ms Haywood, considering the circumstances, but instead seized cynically the opportunity to try to discredit the nurse that had embarrassed them by making a smokescreen issue out of patient confidentiality.

2) You seem to be under the misapprehension that a patient's right to confidentiality is absolute and paramount. This is simply not the case. There are many justifiable reasons for such breaches to made that occur in a variety of situations and this view is supported frequently by case law and NMC/GMC rulings when they find that action has been taken in patients' best interests.

3) Re Galley & Co. you are welcome to your opinion as to whether the leak was in the public interest, but I personally prefer to know whether government departments are routinely lying to me.

4) Re. "Observer Journalist", I've never written anything for publication in my life, so I'm not sure whether to take this as a compliment (to be on the safe side I will assume intended insult, but take no offence) For the record, I usually take the Telegraph and, while I would be loathe to pay for the paper itself, I have always found the crossword puzzle in the Guardian to be quite the best there is.

WoollyMindedLiberal said...

Even by your standards, Woolly, your points about Margaret Haywood are truly extraordinary. The MRC had no choice?Well their other options would have been to break the law, resign or refuse to do their job. These really aren't options are they?

I see that you aren't a fan of Civil Liberties but the rights of patients to be treated in confidence and privacy are important to liberals. OK, so maybe you're not a liberal, not everyone is, that doesn't necessarily make you a bad person. I have some good friends who are terribly nice people but they aren't liberals or much interested in civil liberties either.

WoollyMindedLiberal said...

Breaches of confidentiality in exceptional circumstances are allowed. I remind you of what the NMC said - "Linda Read, chair of the panel, said: ‘Although the conditions on the ward were dreadful, it was not necessary to breach confidentiality to seek to improve them by the method chosen.’"
The guidelines are clear and Haywood was clearly in breach of them.

It is clear from your descent into obvious logical fallacies that your hatred of the party in power has blinded you and turned your brains off but the NMC guidelines are available online to inspect should you develop an interest in the facts.

It doesn't matter whether the complaint was made by Gandhi or Adolf Hitler as to whether or not she broke her professional code of conduct. If you read some basic philosophy then you might learn that these Ad Hominems you use here merely make you look rather silly to those who have read even a little.

---------------------------------

Respect people's confidentiality
• You must respect people's right to confidentiality
• You must ensure people are informed about how and why information is shared by those who
will be providing their care
• You must disclose information if you believe someone may be at risk of harm, in line with the
law of the country in which you are practising

...

Uphold the reputation of your profession
• You must not use your professional status to promote causes that are not related to health
• You must cooperate with the media only when you can confidently protect the confidential
information and dignity of those in your care

WoollyMindedLiberal said...

3) Re Galley & Co. you are welcome to your opinion as to whether the leak was in the public interest, but I personally prefer to know whether government departments are routinely lying to me.Ah the News of the Screws defence. The public was interested therefore it was in the public interest.

I suspect you have already decided that the government lies to you and only want people to confirm your assumption.

The Heresiarch said...

Woolly, you ignore the main point, that the patients concerned, and their relatives, did not object to the breach of confidentiality. What they objected to was the ill-treatment that Haywood had exposed. They gave their permission for the footage to be shown. They breached their own confidentiality. They did so because they were disgusted by the trust's attitude. They are even more disgusted now.

Of course it was open to the NMC to find that the breach of confidence, though regrettable, was justified in the circumstances. The only effect of their ruling, besides the loss of a good nurse, is that the abuses that Haywood exposed will continue. No doubt you find that a great result.

WoollyMindedLiberal said...

The Heresiarch said...

Of course it was open to the NMC to find that the breach of confidence, though regrettable, was justified in the circumstances. The only effect of their ruling, besides the loss of a good nurse, is that the abuses that Haywood exposed will continue. No doubt you find that a great result.
You appear to be saying that if the facts had been different then the finding could have been different. Well, yes of course, thats a truism isn't it? If the only option open to Haywood had been to sacrifice her duty of confidentiality to the patients then the NMC's judgement would be wrong.

The NMC has not got the power to stop abuses and if they continue then it is the failing of managers at trusts and not the NMC. Maybe you think the NMC is populated by cackling villains rejoicing at the prospect of vulnerable people being mistreated and drinking the blood of their victims.

A nice non-sequitur at the end there. Have you been taking lessons from peitha? I haven't been presented with such an obvious set of logical fallacies since the last time she had a go at me on CIF! No, it is not a good result that a basically good nurse who really cared for the patients has been barred from working.

The only crumb of comfort is that the NMC applies the rules fairly, objectively and without favour. They take the rights of patients more seriously than the patients (and their relatives) seem to.

The people who are happiest about the outcome will doubtless be the journalists who got a juicy story with the heart-rending twist of the brave caring whistle-blower being sacked. I suspect they don't have much concern for poor Mrs Haywood since it all worked out rather well for them.

The Heresiarch said...

Woolly: Maybe you think the NMC is populated by cackling villains rejoicing at the prospect of vulnerable people being mistreated and drinking the blood of their victims.

No, it's worse than that - hence the appropriateness of looking at the procedure in the light of the Milgram experiment. They genuinely believe - wrongly, as you appear to - that they had no choice than to come to a decision that will inevitably lead to more abuses going undetected in the future. As for the patients not taking their own rights seriously - I suggest that they took their right not to be mistreated very seriously indeed.

To return to the point, there is good evidence that the NMC could have used to show that Haywood had no choice. That is the fact that over a period of years others had attempted to bring the situation to the attention of the "proper authorites", and were repeatedly ignored.

13eastie said...

WoolyMindedLiberal:Ah the News of the Screws defence. The public was interested therefore it was in the public interest.

I suspect you have already decided that the government lies to you and only want people to confirm your assumption.
You have a rather odd tendency for interspersing your diatribe with references to the names of newspapers.

For the record (not the Daily Record, Wooly), I should be very content for the government to refute accusations of lying by allowing the evidence (the public knowledge of which it is now agreed posed no threat to national security) to become known.

Would you prefer that there was a little more mystery around such stories?

The manner in which you continue to snatch at a single element of "patients' tights" suggests strongly that you have no experience of medical ethics.

WeepingCross said...

"No, it's worse than that - hence the appropriateness of looking at the procedure in the light of the Milgram experiment. They genuinely believe - wrongly, as you appear to - that they had no choice than to come to a decision that will inevitably lead to more abuses going undetected in the future."

Exactly right, and, may I say, also apposite to the current expenses business. The ability of human beings to compartmentalise their lives is amazing, yet we all do it - we manage to move effortlessly from one area of activity governed by one set of ethical standards to another in which matters are entirely different. So it seems not to have occurred to large numbers of our legislators that it might be wrong to apply for the full whack of their allowances when they were not actually using them for the purposes they were intended; that doing so was 'within the rules' was enough. It's actually extraordinarily difficult to integrate different areas of our moral lives and it often needs somebody from outside to point out the inconsistencies.

WoollyMindedLiberal said...

The Heresiarch said...

To return to the point, there is good evidence that the NMC could have used to show that Haywood had no choice. That is the fact that over a period of years others had attempted to bring the situation to the attention of the "proper authorites", and were repeatedly ignored.There is no doubt that she had no choice but to blow the whistle. And for doing that she deserves a lot of praise. She did not have to violate the code of conduct and betray the rights of her patients. Obviously the journalists loved it because it made a more moving story to put names and faces to those suffering rather than preserving their anonymity.

But if you have evidence that the facts are otherwise and that she could not possibly have blown the whistle without trampling over the rights of the patients then I'd be interested to see it and would of course revise my opinion in that light.

I note that you seem much angrier with the NMC who seem to have acted properly than you are with the management of the trust who seem to have acted most improperly. Is it because NHS Trusts were a Tory idea and the NMC a Labour one? I do hope not.

The Heresiarch said...

Not at all, I'm angry with them both. However, it's the decision of the NMC that is at issue. i still fail to see how obtaining the permission of the patients and/or their relatives amounts to "trampling over their rights".

Father W, you right that "it often needs somebody from outside to point out the inconsistencies". No doubt you would say that's where God comes in?