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Dr Ernesto ‘Che’ Guevara: a study in moral ambiguity
  1. John Launer
  1. Associate Editor, Postgraduate Medical Journal, London, UK
  1. Correspondence to Dr John Launer, Associate Editor, Postgraduate Medical Journal, London, UK; johnlauner{at}

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There are few doctors in history whose image is recognisable almost everywhere in the world. Dr Ernesto Guevara, known universally as ‘Che’, is one of them. In his most famous photo, he exudes an air of glowering passion and self-conscious ‘machismo’, as if he already knew he would become an enduring icon. (see figure 1) If you ask most people about him, they are likely to describe him as a revolutionary hero, although others may call him a ruthless executioner, depending on their political beliefs. Both accounts are true. His life raises important moral issues, not only for doctors who aspire to be activists, but for anyone interested in bringing about social justice, or in how best to achieve this.

Ernesto Guevara de la Serna was born in 1928, not in Cuba as many assume, but in Argentina. His family were landowners with Spanish and Irish ancestry. His later nickname derived from his habit of interspersing his speech with the word ‘che’ (meaning roughly ‘hey you’, a common mannerism in Argentina, but apparently a source of amusement elsewhere in Latin America) Despite severe bouts of asthma in childhood – which continued all his life – he grew up to be a highly competitive sportsman, an accomplished chess player and an avid reader of just about anything he could lay his hands on, including Latin American and European literature, philosophy, Freud and Marx. Before completing medical school, he undertook a 7 month journey with a friend that took him around much of south and central America, before returning to complete his medical degree in Buenos Aires. It was this journey that raised his consciousness of the appalling conditions of life for much of the population of south America, largely due to working practices imposed by US companies, backed by brutal and corrupt national governments.1

Within a few months of qualifying as a doctor, Che set off on another trip, this time visiting three more countries: Bolivia, Guatemala, and Mexico. While in Guatemala he helped in a malaria laboratory, saw some patients, and started to write a book about the role of the doctor in oppressive social and political circumstances, but his ambitions already lay elsewhere. He was busy reading works of revolutionary socialism and meeting up with radicals in every place he visited. A US-backed coup against the reforming president there convinced him that only a violent struggle by an armed populace could improve conditions for the mass of people and this was where his own vocation lay. In September 1954, at the age of 26, he fled to Mexico. There he met the Cuban revolutionary Fidel Castro. Castro had already staged an unsuccessful uprising in Cuba and was imprisoned but then released in an amnesty. Now he was gathering a band of other revolutionaries and planning to return. Guevara joined up.

Self-discipline and ruthlessness

Castro’s invasion of Cuba was one of history’s most improbable victories. Reduced at one point to a fighting force of only 20 or so men, the rebel army ended up entering the capital Havana and ruling the entire country in just over 2 years. The factors that made this possible included the exceptionally venal and unpopular government of Cuba’s president Fulgencio Batista, along with the desperate conditions of life on the sugar plantations and subsistence farms, and the willingness of peasants to take up arms alongside the rebels. At the same time, there is little doubt that Guevara’s own genius as a guerrilla leader played a crucial part in the rebels’ success. Becoming Castro’s second in command early on, he applied his phenomenal energy to the work of revolution, not only as an army commander and tactician but in providing the rebels with an education in Marxism, and setting up military training schools and clinics. His extraordinary capacity for self-discipline and for enduring physical privations was matched by his ruthless punishment of deserters and informers, including summary executions.

Once the revolution had succeeded, Guevara continued the same pattern of gruelling dedication in his government roles – supreme prosecutor, as well as director of industrialisation and president of the national bank. He appears to have been a highly effective administrator, playing the leading role in a programme of land reform which redistributed farms to local peasants and to communes. However, his role as prosecutor has attracted indictments by many historians: more than a hundred executions may have been carried out directly under his jurisdiction.2 His defenders argue that most of the victims had been murderers and torturers under Batista’s regime, and that the executions had widespread popular support. At the same time, no-one seems to disagree that Guevara had become emotionally hardened, and that he was committed to the political maxim that ‘the end justifies the means’: in other words, that attaining a just society in the future requires brutality in the here and now.

His most chilling exposition of this idea was after Castro had allowed the Soviet Union to site nuclear missiles on the island in the ‘Cuba crisis’ of 1962, which brought the world closer to nuclear war and the extermination of mass populations than it has ever been.3 When the Soviet Union made an agreement with the United States to withdraw the missiles, Guevara explained that if they had been under Cuban control, they would have been fired to defeat US imperialism.4 5

Final campaign

Castro was to remain leader of Cuba for nearly fifty years, but Guevara’s political role there came to an end after only five. He was restless by nature, and passionately committed to spreading the Cuban model of guerrilla warfare and socialism elsewhere. He was also notoriously heedless of risks to his personal safety and health. With Castro’s blessing, he embarked on a mission to the Congo, leading a Cuban brigade in support of rebels there. When this failed, he prepared what was to be his final campaign – leading an insurrection against the military junta in Bolivia. It too was a fiasco. As well as lacking support from the local peasants and discovering the Bolivian army better trained than he expected, he found he was also up against a team of commandos that the US Central Intelligence Agency had dispatched to assist in his defeat. On 8 October 1967, he was captured. The next day he was shot. He was not yet 40.

It is easy to romanticise Che Guevara for his striking appearance, personal courage, and iconic status. It is equally tempting to dismiss him on account of his extra-judicial killings, and an ideological bent that might have led him to annihilate half of humanity for the cause he believed in. However, while most of us would be aghast at the idea of committing violence personally, it is worth recalling how often our national armies have done this in foreign places on our behalf, on a much greater scale and involving mass killings of civilians. We might feel qualms, but have still acquiesced in such acts of warfare, as well as in our countries maintaining nuclear arsenals vastly larger than Guevara was willing to deploy. These matters are possibly not as straightforward as we might wish.

It is also worth considering the challenges posed by the scale of injustice and oppression carried out by wealthier nations over poorer ones, or by brutal regimes and rapacious companies, both then and now. You can hear these challenges spelled out eloquently by Che Guevara in an address to the United Nations on the evils of imperialism,6 or you can watch an extract of it on video.7 Even if Guevara’s vision of how to achieve redress for the poor and oppressed may have proved to be dogmatic and reckless, it is still not clear that we have yet found ways of doing so that might be less morally ambiguous, or more effective.

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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