The practice of medicine should be humanitarian, in which the primary object is the relief of suffering and the interests of patients are paramount. In certain circumstances even the best of doctors might find it difficult to sustain these principles. Doctors, especially those employed by the State, may be expected to participate in aspects of corporal or capital punishment, which introduces a conflict of loyalties and subordinates the interests of individuals to those of the State. Others, in the prison or police services, may get drawn into or comply with physical abuse and torture, most commonly through failing to report incidents that come to their notice. In this paper I discuss some aspects of medicine under tension in the light of the South African experience.