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 Responding to criticism from the medical community, the U.S.
military recently cut back on use of psychologists to assist in
interrogations or provide mental health care at facilities like the
prison at Guantanamo Bay, Cuba.
The Department of Defense (DoD) should go further and prohibit
military health personnel from participating in interrogations or
force-feeding hunger strikers, according to Leonard Rubenstein, a
public health and ethics researcher at Johns Hopkins University in
Baltimore, and colleagues, writing in the journal PLoS Medicine.
“Policies barring participation in interrogation and force feeding
are necessary to enable health professionals to fulfill ethical
obligations adopted by the health professions to avoid inflicting
harm, to be loyal to their patients, and to exercise independent
professional judgment,” Rubenstein said by email.
“Adherence to these ethical standards protects the rights of members
of the military and detainees in military custody and also makes our
military stronger by avoiding a gulf between military and civilian
medicine that could impair recruiting of well qualified health
professionals,” Rubenstein added.
In their essay, Rubenstein and colleagues highlight recommendations
from the Defense Health Board, a federal advisory committee to the
Secretary of Defense that provides independent guidance on health
matters.
A review last year by the board noted that military doctors often
face “dual loyalty” conflicts between their ethical responsibilities
and their obligations to the military. The board recommended that
the DoD ensure its policies, guidelines and instructions let
clinicians make the patient their top ethical priority, Rubenstein
and colleagues note in their essay.
Mandatory pre-deployment ethics training and improvements to
existing ethics courses recommended by the board might help achieve
this goal, the essay’s authors argue. Enhanced protections for
military physicians whose commanders order them to breach
professional ethics might also help, they say.
The essay notes that the board stopped short, however, of calling
for an end to clinician involvement in force-feeding or tending to
prisoners on hunger strikes or participation in interrogations.
Representatives of the Defense Health Agency and the Defense Health
Board didn’t respond to emails seeking comment.
Changes are necessary because participation in interrogations and
force-feeding “violate(s) the basic principals of medical ethics
including `do no harm’ and beneficence,” said Dr. Stephen Xenakis, a
retired Army Brigadier General who wasn’t involved in the essay.
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“Military clinicians, particularly senior medical officers, justify
participation in interrogations and force-feeding by asserting that
the patient they’re responsible for is the nation and government and
not the individual they are supposed to be helping,” Xenakis said by
email. “This assertion, or rationalization, absolutely violates all
principles of clinical medicine and healthcare.”
Many health organizations – including the American Medical
Association (AMA) – consider force-feeding a form of torture. The
process involves supplying nutrients through a plastic feeding tube
passed through the nose or mouth into the stomach, and has been used
by the U.S. military in response to hunger strikes by detainees at
the Guantanamo Bay prison.
The essay’s authors say the need for new policies is also reinforced
by a 2015 investigation showing that the DoD worked with the
American Psychological Association (APA) to get approval for the
participation of psychologists in interrogations. The APA changed
its position, and the military recently curtailed use of
psychologists in this role as a result, Rubenstein said.
“The order represents a recognition that Guantanamo commanders were
demanding activities by psychologists incompatible with the ethics
of the psychological profession,” Rubenstein said. “That is not the
end of the story regarding health professional participation in
interrogation, though, as the directives that establish standards
for health professionals throughout the military and which allow
health professional participation in interrogation remain in place.”
SOURCE: http://bit.ly/1SxqXXL PLoS Medicine, online January 5, 2016.
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