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The war on terror and medical ethics

Meena Menon

The happenings at Abu Ghraib and Guantanamo Bay have served to draw attention to the need for stern action against doctors who violate ethical codes.

DOES THE war on terror justify a dilution of medical ethics? This question has been raised frequently since the world press reported news of torture from Abu Ghraib and Guantanamo Bay. It was also discussed at a recent conference on health and human rights in Mumbai. It will be taken up at the World Medical Association (WMA) meeting in Chile later this month.

Last year, the American Medical Association, prompted by the British Medical Association (BMA) and others, demanded an investigation into whether doctors were involved in the torture of Iraqi and Afghan prisoners. Michael Wilks, chairperson, medical ethics committee of the BMA, was in Mumbai recently for a conference "Engendering Health and Human rights," organised by the International Federation of Health and Human Rights Organisations (IFHHR) and the Centre for Enquiry Into Health and Allied Themes (CEHAT). He is among those spearheading the need to tighten international declarations on medical ethics during conflict.

In a presentation at the conference, he said the International Committee of the Red Cross (ICRC) had concluded that medical personnel at Guantanamo Bay did share medical records with army units that planned the interrogation. Worse, he said, was a U.S. Government memo which stated that physicians assigned to military intelligence had no doctor-patient relationship with detainees and in the absence of life threatening emergency, had no obligation to offer medical aid.

Dr. Wilks traced the roots of the role of physicians in human rights abuse to the Second World War and said there was a depressing repetition in Afghanistan and in Abu Ghraib and Guantanamo Bay. As with the doctors in the Nazi regime, he said there was total acceptance of state ideology, scapegoating, fear of reprisal, and poor understanding of medical ethical principles.

More serious was the U.S. contention that "none of the provisions of the Geneva Convention apply to our conflict with Al-Qaeda in Afghanistan or elsewhere in the world" (U.S. Presidential memo February 7, 2002). Dr. Wilks, a forensic physician, said that even the concept of torture was redefined in August 2002 by the U.S. Justice Department to mean "for an act to constitute torture ... it must inflict pain that is difficult to endure. Physical pain amounting to torture must be equivalent in intensity to the pain accompanying serious physical injury, such as organ failure, impairment of bodily function, or even death."

Dr. Wilks pointed out that medical ethics in times of armed conflict are identical to medical ethics in times of peace and although in these situations physicians will have conflicting loyalties, their primary obligation is to their patients. The Geneva Declaration clearly says that doctors must maintain utmost respect for human life even under threat and that they will not use medical knowledge contrary to human rights, civil liberties, and the laws of humanity.

International declarations state clearly that medical expertise cannot be used for torture. The Declaration of Tokyo, for instance, says that doctors shall not use, nor allow to be used, medical knowledge or skills or health information specific to individuals to facilitate or otherwise aid any interrogation legal or illegal, among other things. Interrogations are a police procedure, not a medical one and provide no benefit to the patient. Doctors should be particularly careful when providing medical assistance to detenus or prisoners who are or who could later be under interrogation to ensure the confidentiality of all personal medical information. In addition, it specifies that medical knowledge can be used to train interrogators but not to train those who could torture.

A WMA working group has been formed to close loopholes in international declarations on medical ethics during armed conflict. Julian Sheather, senior ethics advisor of the BMA, said the medical community could not use its skills to abet interrogation in conflict situations. The existing norms would have to be tightened to make the provisions explicit. There is a tendency worldwide to ignore the importance of medical ethics. The U.S. violations have served to draw attention to the need for stern action against doctors who violate ethical codes with impunity, even if it is with state backing.

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