Doctors, Torture, and the War
Physicians have the power to prevent more prisoner abuses. The first step: educate thyself.
Various reports have alleged physicians' complicity in the mistreatment of prisoners being held by the United States at Abu Ghraib and at Guantanamo. Physicians are reported to have advised interrogators as to whether particular prisoners were fit enough to survive physical maltreatment, informed interrogators about prisoners' phobias and other psychological vulnerabilities that could be exploited during questioning, failed to report incidents of alleged torture, force-fed prisoners who were on hunger strikes, and altered the death certificates of prisoners who died.
Any or all of these actions by physicians violate the standards of the Geneva Conventions. But do most physicians even know those standards? Do they know that doctors could be drafted into military service? Some of my colleagues at Cambridge Health Alliance and I surveyed medical students on these subjects. The results astounded us.
We thought that if doctors knew about the possibility of their being drafted they might feel more personally invested in this war. (Authorized in 1987, the Health Care Personnel Delivery System established a process by which, if there is a shortage of military physicians, Congress and the President could begin drafting civilian ones quickly.)
An Internet-based survey was sent to about 5,000 students at eight medical schools nationwide, including at least one in Massachusetts. The results are being published in the current issue of the International Journal for Health Services.
Only 3.5 percent of our respondents knew about the physician draft system. If they were to be drafted, 34 percent said they'd use all legal means to avoid service, 7 percent would consider emigration, and almost 14 percent said they'd refuse military induction as an act of civil disobedience.
This was one hypothetical question:
If a prisoner is refusing to answer questions about a recent battle or skirmish in which over 50 US soldiers died, under the Geneva Conventions it is permissible to:
a) Deprive him of food or water for a period not to exceed 24 hours
b) Expose prisoners to physical stresses such as heat, cold, and uncomfortable positions, as long as such exposure causes only minor tissue damage (i.e., medical intervention not required, and full healing takes place within 48 hours)
c) Threaten prisoners with physical violence, so long as such threats are not carried out
d) All of the above
e) None of the above
The answer: None of the above. Prisoners of war who refuse to answer questions may not be threatened, insulted, or exposed to any unpleasant or disadvantageous treatment.
Given all of the double talk by the White House about torture, it is not surprising that many people might not know that. Only 63 percent of the medical students surveyed did. Given that 94 percent of our respondents reported receiving less than one hour of instruction about military medical ethics, their ignorance can be understood. But medical schools must do better. They need to teach military medical ethics as a core component of their curricula, so students who eventually enter the military - by draft or by choice - know the facts before they enter the frightening and disorienting moral climate of armed combat.
I would also argue that every physician needs to be educated about these matters. The idea of drafting doctors seems far-fetched, but since the start of the Iraq war, the number of US physicians volunteering for service has declined, as has the number of students accepting medical school scholarships in return for military service obligations.
The Latin roots of "doctor" mean "to teach" or "to lead." We physicians need to embrace this role and not stand by in the face of our government's attempt to justify torture. A recent letter to the British medical journal The Lancet from a group of doctors around the world (more than 250 people signed it) equated the silence of the medical establishment about doctors' involvement at Guantanamo to South African physicians who covered up the torture of anti-apartheid activist Steve Biko.
If US physicians are educated about military medical ethics - especially the Geneva Conventions - they could lead calls for humane treatment of prisoners, regardless of their legal status. Doing so might begin to heal our country and to restore the United States' position as a moral agent in the world.
Dr. J. Wesley Boyd is a psychiatrist at Cambridge Health Alliance/Harvard Medical School. Send comments to firstname.lastname@example.org.