Participation of Health Care Personnel in Torture and Interrogation
http://www.100md.com
《新英格兰医药杂志》
To the Editor: The profession of medicine has developed codes of ethical conduct over thousands of years. A central element of such codes is expressed in the imperative to "do no harm." Disclosures with regard to the treatment of detainees by licensed medical personnel in the "war on terror" in Iraq, Afghanistan, and Guantanamo Bay, Cuba, have revealed undeniable breaches of medical ethics among U.S. military health care personnel involved at these — and perhaps other — sites.1 The International Red Cross has charged that some of the physical and emotional tactics used constitute cruel and unusual punishment.
The Geneva Convention provides that medical personnel "shall not be compelled to perform or carry out work contrary to the rules of medical ethics." The Code of Medical Ethics of the American Medical Association (AMA) states that "ethical obligations typically exceed legal duties." The World Medical Association, of which the AMA is a member, prohibits participation even as a monitor in torture or abuse. The Uniform Code of Military Justice proscribes U.S. forces from engaging in cruelty, maltreatment, or oppression of prisoners, and even from the threat of such harm. As the Nuremberg trials after World War II taught us, the extreme circumstances of times of war, whether declared or not, do not excuse physicians and other health care professionals from their ethical responsibilities.2,3
Those who have served in the U.S. military know that there is a documented chain of command for every action. Health care personnel serving in the military all work under the authority of licensed military physicians, who are responsible for actions performed under their authority.4,5 We therefore call on the AMA and the American Psychological Association to request that relevant authorities act, at a minimum, as follows. First, the military must provide full disclosure of all medical personnel involved, directly or by chain of command, in the treatment of detainees in Iraq, Afghanistan, and Cuba — and elsewhere if relevant — since September 11, 2001. Second, the records and conduct of these personnel should be reviewed by the medical licensing boards, other responsible licensing authorities in each state where the military physicians are licensed, or both. Independent expertise in bioethical standards should be sought in conducting these reviews. Third, appropriate disciplinary action should be taken on the basis of the results of the reviews, and these actions should be made publicly available.
Philip R. Lee, M.D.
Marcus Conant, M.D.
University of California, San Francisco
San Francisco, CA 94117
Steve Heilig, M.P.H.
Cambridge Quarterly of Healthcare Ethics
San Francisco, CA 94109
heilig@sfms.org
References
Bloche MG, Marks JH. Doctors and interrogators at Guantanamo Bay. N Engl J Med 2005;353:6-8.
Sagan LA, Jonsen A. Medical ethics and torture. N Engl J Med 1976;294:1427-1430.
Pellegrino ED. The Nazi doctors and Nuremberg. Ann Intern Med 1997;127:307-308.
Mayer J. The experiment. The New Yorker. July 11, 2005:60-71.
Conant MA. The physicians of Abu Ghraib prisons: holding them accountable to our profession's standards. San Francisco Med 2005;78:27-8.
The Geneva Convention provides that medical personnel "shall not be compelled to perform or carry out work contrary to the rules of medical ethics." The Code of Medical Ethics of the American Medical Association (AMA) states that "ethical obligations typically exceed legal duties." The World Medical Association, of which the AMA is a member, prohibits participation even as a monitor in torture or abuse. The Uniform Code of Military Justice proscribes U.S. forces from engaging in cruelty, maltreatment, or oppression of prisoners, and even from the threat of such harm. As the Nuremberg trials after World War II taught us, the extreme circumstances of times of war, whether declared or not, do not excuse physicians and other health care professionals from their ethical responsibilities.2,3
Those who have served in the U.S. military know that there is a documented chain of command for every action. Health care personnel serving in the military all work under the authority of licensed military physicians, who are responsible for actions performed under their authority.4,5 We therefore call on the AMA and the American Psychological Association to request that relevant authorities act, at a minimum, as follows. First, the military must provide full disclosure of all medical personnel involved, directly or by chain of command, in the treatment of detainees in Iraq, Afghanistan, and Cuba — and elsewhere if relevant — since September 11, 2001. Second, the records and conduct of these personnel should be reviewed by the medical licensing boards, other responsible licensing authorities in each state where the military physicians are licensed, or both. Independent expertise in bioethical standards should be sought in conducting these reviews. Third, appropriate disciplinary action should be taken on the basis of the results of the reviews, and these actions should be made publicly available.
Philip R. Lee, M.D.
Marcus Conant, M.D.
University of California, San Francisco
San Francisco, CA 94117
Steve Heilig, M.P.H.
Cambridge Quarterly of Healthcare Ethics
San Francisco, CA 94109
heilig@sfms.org
References
Bloche MG, Marks JH. Doctors and interrogators at Guantanamo Bay. N Engl J Med 2005;353:6-8.
Sagan LA, Jonsen A. Medical ethics and torture. N Engl J Med 1976;294:1427-1430.
Pellegrino ED. The Nazi doctors and Nuremberg. Ann Intern Med 1997;127:307-308.
Mayer J. The experiment. The New Yorker. July 11, 2005:60-71.
Conant MA. The physicians of Abu Ghraib prisons: holding them accountable to our profession's standards. San Francisco Med 2005;78:27-8.