The following letter was published in The Lancet on November 20th, 2004.
Despite the many ethical codes cited by Steven Miles (Aug 21, p 725), asserting that healers should be advocates for those entrusted to their care, U.S. medical personnel have recently been involved in human rights abuses, including those of detainees in Iraq, Afghanistan, and Guantanamo Bay.
One reason for their behaviour might be that courses in US medical schools do not adequately address the medical aspects of human rights issues, especially those pertaining to international human rights. Only 17% (19 of 113) of schools in a survey included courses on physician participation in torture, 15% (17 of 113) discussed the role of physicians in war and armed conflict, and 22% (25 of 113) addressed violations of medical neutrality. As reported by Miles, military medical personnel in charge of detainees in Iraq and Afghanistan denied being trained in Army human rights policies.
Second, those who produce statements espousing human rights or decrying medical complicity in torture have not uniformly condemned those who violate their group’s principles. For example, the American Medical Association (AMA), which has a strong policy against physician complicity in torture, does not have a statement condemning the recent abuses on its website (http://www. ama-assn.org). A resolution has passed the House of Delegates asking for an investigation into the abuses, but the “resolved” section of the resolution does not mention physicians specifically, let alone condemn the specific instances of physician involvement in abuse. There was concern that an AMA resolution might offend a Bush administration that had supported the AMA on liability reform. The American College of Physicians, which condemns torture in its Ethics Manual, has written to President Bush: “Whether [physicians] must passively accept the inhumane actions of others or are called upon to actively participate, the pressure to compromise their professional ethics is the same.” This statement seems more concerned with the plight of military physicians than their ethical responsibility to prevent and report torture. By contrast, the president of the World Medical Association, which maintains the Declaration of Tokyo, has condemned physicians’ failure to denounce torture by physicians. The organisation has also released an online course on detainee health (http://www.wma.net).
All health-care personnel should receive training in domestic and international human rights issues to develop a base to practise competent, humane medicine. Military health-care personnel should be encouraged to report abuses, and policies should be in place to prevent retribution against them. The world’s physicians and lawyers should collaborate to ensure that health-care personnel found guilty of such abuses have their state medical licences revoked and their professional memberships in societies withdrawn. The Hippocratic Oath states: “I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrongdoing.” It is our responsibility to make these words a reality.
*Andre N Sofair, Peter G Lurie
*Yale University School of Medicine, New Haven, CT 06520, USA (ANS); and Public Citizen’s Health Research Group, Washington, DC, USA (PGL)
1 Miles SH. Abu Graib: its legacy for military medicine. Lancet 2004; 364: 725-29. [Text]
2 Sonis, J, Gorenflo, DW, Jha, P, Williams, C. Teaching of human rights in US medical schools. JAMA 1996; 276: 1676-78. [PubMed]
3 American Medical Association House of Delegates. Humane treatment of prisoners and detainees: resolution 12 (A-04). http://www.ama-assn.org/meetings/public/ annual04/012a04.rtf (accessed Sept 8, 2004).
4 Hotakainen R. Prison probe reaches medical staff. Grand Rapids Press, Aug 27, 2004.
5 Francis CK. ACP asks President Bush to investigate other US-controlled prisons. http://www.acponline.org/hpp/ humane5-17.htm (accessed Sept 8, 2004).