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Why abandon medical ethics in the face of the War on Terror?

By Michael Cook - posted Wednesday, 23 June 2004

Now that an Australian military lawyer has been implicated in the shameful treatment of prisoners at Abu Ghraib, the government had better ensure that its medical personnel have had absolutely nothing to do with torture, either actively or passively.

American health personnel have probably colluded in torture. None of them has been charged so far, but Army medics, and possibly prison doctors, must surely have been aware that prisoners were subject to the "sadistic, blatant and wanton criminal abuses" that went on in Abu Ghraib, to use the words of the official report.

Why didn't they blow the whistle? Their duty to do so is crystal clear.


More than 20 years ago, in 1982, the United Nations (UN) General Assembly approved common-sense principles of medical ethics for treating prisoners and detainees. These stressed - if anyone who had taken the Hippocratic Oath needed to be told - that prisoners must be treated as patients.

It declared that a fundamental rule of health ethics was violated when doctors were "involved in any professional relationship with prisoners or detainees the purpose of which is not solely to evaluate, protect or improve their physical and mental health".

Unhappily, the United States government appears to have involved at least some doctors in behaviour which their colleagues would condemn as unethical - even if international law doesn't.

For instance, according to the Nobel-laureate lobby group Physicians for Human Rights, the US Army's interrogation manual says that "keeping prisoners hungry must be supervised by medical personnel" and that "wounded or medically burdened detainees must be medically clear prior to interrogation". And in April 2003, the US Defense Department approved physically and psychologically stressful interrogation methods at Guantanamo Bay - which could only be used with "appropriate medical monitoring".

In other words, it seems that health personnel are cooperating in ill-treatment. Similar guidelines were approved by the US for "high-value detainees" in Iraq, The Washington Post has reported, although it is not known whether they extended to Abu Ghraib.

Somewhere out there in the shadows, then, there are Allied medics and doctors using their expertise to harm their patients. Even "torture-lite" techniques such as beatings, prolonged sleep deprivation, binding in painful positions, extreme heat and cold, denial of food and water require professional advice from a doctor. And if the worst happens, someone has to sign death certificates.


Coincidentally, only a few weeks before the Abu Ghraib porn-fest was plastered over the front pages of the world's newspapers, the Journal of the American Medical Association published a survey of medical ethics under Saddam Hussein. It found that a large number of Iraqi doctors had cut off ears, removed organs without consent, falsified medical-legal reports and even administered "mercy bullets" to finish off survivors of torture.

But nearly all of these doctors had taken a solemn oath as graduating medical students not to harm patients intentionally, amongst a clutch of other noble principles. Under duress, however, these unfortunates crumbled and reneged on their oath. "At that time, I only did my job," one doctor told interviewers. "I didn't ask [the cause of a patient's trauma] to protect myself."

It's hard to blame terrorised Iraqi doctors. But we have to ensure that no Australian doctor is ever exposed to similar pressures. President Bush and Prime Minister Howard have told us that the war on terror could last as long as the Cold War - for decades, if not for generations. After 9/11 the world is a different place for all of us, including doctors. As the pressure increases, will Australians be more virtuous than their Iraqi colleagues?

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About the Author

Michael Cook edits the Internet magazine MercatorNet and the bioethics newsletter BioEdge.

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