Military doctors reminded of wartime roles

The role of the military physician in wartime has received much attention lately with an article in the Aug. 21 issue of The Lancet and a new online course posted by the World Medical Assn.

The course is intended to raise physicians' awareness about their role in identifying prisoner abuse and to assist doctors in dealing with human rights violations. It also helps nonmedical military personnel to learn what ethical lines physicians should not cross.

The course was unveiled Sept. 7. WMA President-elect and AMA past President Yank D. Coble Jr., MD, said it was developed by the Norwegian Medical Assn. over the course of almost two years, and the timing of its release was not tied to reports coming out of Iraq or Afghanistan.

"This is to help these physicians do the right thing," Dr. Coble said. "The Norwegians initiated the curriculum because they thought it was a useful thing to do.

"It's not targeted to any particular occurrences or events," he added. "It just gradually evolved but, because of things that are going on now, it's gotten more attention than it normally would have gotten."

The topics that are covered in the WMA online course include: international principles of medical ethics dealing with the humanitarian treatment of prisoners; recognizing the medical signs of torture or degrading treatment; the responsibilities of physicians to report abuses; and the dual loyalties that physicians have both to their country and to their profession.

Detailing the alleged offenses

Steven H. Miles, MD, of the University of Minnesota Center for Bioethics, provides a comprehensive look in The Lancet at some of the reported offenses allegedly committed by medical personnel. Although Dr. Miles says doctors "helped design, approve and monitor interrogations" at Abu Ghraib prison in Iraq, most offenses by medical personnel appear to involve faulty or false record keeping.

Dr. Miles could not be reached for comment, but the WMA released a statement from its secretary general, Delon Human, MD, in response to The Lancet article.

"Physicians should in no way facilitate, condone or participate in the practice of torture or other forms of cruel, inhuman and degrading procedures of prisoners or detainees," Dr. Human said. "This ethical obligation applies to all physicians in all situations, including armed conflict and civil strife."

AMA Institute for Ethics Director Matthew Wynia, MD, noted that, while the recent Fay Report on intelligence activities at Abu Ghraib calls for further investigation into the role of medical professionals and states that at least two prison medics failed to report abuse, there are also several "instances of doctors doing the right thing under adverse circumstances."

Dr. Wynia also said the AMA and several national and international medical societies already had strong policies condemning torture and forbidding medical personnel from facilitating in interrogation techniques such as withholding food from prisoners and depriving them of sleep.

"That's not OK. We're not allowed to do that," Dr. Wynia said, and he added that these policies need to be "reiterated and disseminated."

"It's time to reassert these rules when it looks like people outside of medicine don't understand them," he said. "The basic story is that there are several ethics documents that are specifically designed to ensure that physicians and other medical professionals act as a check so abuse doesn't occur."

The medical treatment of prisoners is also the topic of the September edition of the Virtual Mentor produced by the AMA Ethics Resource Center, and it delves into the issue from historical and ethical perspectives.