Sunday, September 05, 2004

Medical Ethicists Get it Wrong

In late August, information was published  regarding the role of US medical personnel in the abuse of detainees at Abu Ghraib.  At the time, I had not seen the article quoted below.  It is from BMC Medical Ethics, an open-access journal.  Reading it now, it seems to have been almost prescient.

American physicians and dual loyalty obligations in the "war on terror"
Jerome Amir Singh1, 2
1Howard College School of Law, King George V Ave, University of Natal, Durban, 4041, South Africa
2University of Toronto Joint Centre for Bioethics, 88 College St, Toronto, M5G 1L4, Canada

BMC Medical Ethics 2003, 4:4     doi:10.1186/1472-6939-4-4

Published   1 August 2003


Post-September 11, 2001, the U.S. government has labeled thousands of Afghan war detainees "unlawful combatants". This label effectively deprives these detainees of the protection they would receive as "prisoners of war" under international humanitarian law. Reports have emerged that indicate that thousands of detainees being held in secret military facilities outside the United States are being subjected to questionable "stress and duress" interrogation tactics by U.S. authorities. If true, American military physicians could be inadvertently becoming complicit in detainee abuse. Moreover, the American government's openly negative views towards such detainees could result in military physicians not wanting to provide reasonable care to detainees, despite it being their ethical duty to do so.


This paper assesses the physician's obligations to treat war detainees in the light of relevant instruments of international humanitarian law and medical ethics. It briefly outlines how detainee abuse flourished in apartheid South Africa when state physicians became morally detached from the interests of their detainee patients. I caution U.S physicians not to let the same mindset befall them. I urge the U.S. medical community to advocate for detainee rights in the U.S, regardless of the political culture the detainee emerged from. I offer recommendations to U.S physicians facing dual loyalty conflicts of interest in the "war on terror".


If U.S. physicians are faced with a conflict of interest between following national policies or international principles of humanitarian law and medical ethics, they should opt to adhere to the latter when treating war detainees. It is important for the U.S. medical community to speak out against possible detainee abuse by the U.S. government.

The authors conclude that, if there is a conflict between national policy (in this case, the policy is "anything goes") and international ethical principles, the international principles should apply to the conduct of health care personnel.  I think they got it wrong.  In the case of a conflict of value systems, the system that is more beneficial to the patient is the one that should apply. 

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