Professors Call on Defense Secretary to Strengthen Medical Ethics.
Two professors from the School of Public Health have joined five other leading physicians and medical ethicists in calling on the Secretary of Defense to strengthen ethical guidelines for US military medical professionals in order to protect patients and address the abusive treatment of detainees and terrorism suspects.
In an October letter to Defense Secretary Ashton Carter, the group—including George Annas, co-founder of Global Lawyers & Physicians and director of the Center for Health Law, Ethics & Human Rights, and Sondra Crosby, associate professor at the Schools of Medicine and Public Health and a clinician at the Immigrant and Refugee Health Program at Boston Medical Center—argued that current military medicine directives are flawed because they leave out “basic medical ethics principles” established by the World Medical Association and US medical societies.
The group said new guidelines proposed by the Defense Health Board (DHB), which the Department of Defense is currently reviewing, properly recommend that the military physician’s “first ethical obligation is to the patient.” But the experts said that protecting this core principle would require “significant changes in existing policies and procedures” not included in the recommendations.
“We are deeply troubled by the absence of specific, substantial information and detailed recommendations that speak to the national security detention context—recommendations that address an era of abuse that has now been studied, documented and widely publicized, including by Congress,” the group wrote.
The experts noted that the DHB report makes only passing mention of abuses of detainees and suspects, and does not offer specific ethics guidance for health professionals working in national security detention settings. Reports to Congress have detailed the involvement of medical professionals in abusive interrogations at CIA “black sites,” and other reports have exposed the force-feeding of hunger strikers in detention facilities including Guantanamo Bay.
The letter refers specifically to one detainee at Guantanamo who has been on hunger strike for more than eight years, weighs 74 pounds, and is at “significant risk of dying.” Guantanamo personnel continue to force-feed him, rather than working to get him the medical care he needs, the letter says. Guidelines putting the patient first “would outlaw such conduct,” the group wrote.
Among the specific policy changes the ethicists recommend are guidelines barring physicians from being directly involved in interrogations; allowing physicians to maintain the confidentiality of medical information and not be compelled to provide that information for use in torture or interrogations; and affording physicians clinical independence in treating detainees.
Other co-signatories to the letter are: Paul Appelbaum, Dollard Professor of Psychiatry, Medicine & Law in the Department of Psychiatry at Columbia University College of Physicians & Surgeons and past president of the American Psychiatric Association; Virginia Hood, professor of medicine at the University of Vermont and past president of the American College of Physicians; Steven S. Sharfstein, past president of the American Psychiatric Association; Gerald E. Thomson, professor of medicine emeritus at Columbia University and past president of the American College of Physicians; and Cecil B. Wilson, past president of the World Medical Association and the American Medical Association.