Friday, December 21, 2007
When Do Medical Students Learn about Threatening Prisoners?

How much do American medical students know about military medical ethics? Not much, according to a survey conducted by a Harvard research team and published this fall in the International Journal of Health Services. More than one-third of students did not know that the Geneva Conventions required military health care providers to treat the sickest patients first, regardless of nationality, nor that the Geneva Conventions expressly prohibit the mistreatment of prisoners of war.

When given the following scenarios – a physician is ordered to threaten to give a prisoner a psychoactive injection, to give a prisoner a saline injection that the prisoner believes to be lethal, or to give a prisoner a lethal injection – over 27 percent of students replied that only the final, lethal-injection scenario was unethical and would require them to disobey orders. In fact, all of these scenarios describe violations of medical ethics and would require physicians to disobey orders. The authors of this study conclude that American medical schools need to do a better job in teaching military medical ethics: only six percent of respondents had received more than one hour of instruction on this topic.

The phrase “dual loyalties” is often invoked in discussions of the obligations of physicians who are also military personnel or are civilians working in military settings. The phrase can be misleading if it suggests that military orders trump medical ethics. An American Medical Association policy on interrogation, adopted in 2006, states that “physicians who engage in any activity that relies on their medical knowledge and skills must continue to uphold medical ethics.” When physicians provide medical care to enemy combatants, they do so in their role as healer. This role does not permit them to conduct, participate in, or monitor interrogations. A physician who violates this role responsibility or misuses medical training is not demonstrating loyalty to the medical profession: there is no “dual” loyalty in such acts. Integrating military medical ethics into the teaching and discussion of medical ethics, rather than treating it as a special problem, might be a better solution to the knowledge gap this research identifies.

– Nancy Berlinger

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