The profession of medicine has developed codes of ethical conduct for
thousands of years. From the Hippocratic Oath of ancient Greece onward to
modern times, a universal and central element of such codes has expressed
the imperative that a physician shall “Do no harm.”
Disclosures over the past two years regarding the treatment of
detainees by licensed medical personnel in the “war on terror”
in Iraq, Afghanistan, and Guantánamo Bay, Cuba, have revealed
undeniable breaches of medical ethics among U.S. military healthcare
personnel involved at those sites. Articles published in some of the most
esteemed medical journals, including the New England Journal of
Medicine and the Lancet, have documented and decried such
practices. 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 American Medical Association's Code of Medical
Ethics states that “ethical obligations typically exceed legal
duties” (and also prohibit physician participation in capital
punishment, even when legally performed). 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 the threat of such harm.
Those who have served in the U.S. military know that there is a
documented chain of command for each action. Healthcare personnel serving
in the military are all working under the authority of licensed military
physicians, who are responsible for actions performed under their
authority.
As the Nuremberg trials following World War II taught us, the extreme
circumstances of times of war, declared or not, do not excuse physicians
and other healthcare professionals from their ethical
responsibilities.
We therefore call upon, and urge the American Medical Association to
also request, that the relevant authorities act, at a minimum, as
follows:
- The military must provide full disclosure of all medical personnel
involved in, directly or by chain of command, the treatment of detainees
in Iraq, Afghanistan, and Cuba—and elsewhere if relevant—since
September 11, 2001.
- The records and behaviors of these personnel should be reviewed by
the medical licensing boards and/or other responsible licensing
authorities in each state where the military physicians are licensed.
Independent expertise in bioethical standards should be sought in the
conducting of these reviews.
- Appropriate disciplinary action should be taken based upon the
results of these reviews, and those actions made publicly available.
