Government and Regulations

Essay Advocates for Ethical Clarity for Military Detainees’ Health Care Providers

Health professionals caught between military and professional obligations need greater guidance and ethical standards and should never be asked or directed to violate their professional ethics.


Medical ethics of the DoD and Central Intelligence Agency (CIA) concerning military detainees deteriorated after 9/11 according to evidence presented in a medical essay by researchers Leonard S. Rubenstein, Scott A. Allen, and Phyllis A. Guze.

The Institute on Medicine as a Profession assembled an independent task force composed of 20 experts in military medicine, human rights, and bioethics to review the conduct of medical personnel in detention facilities. The report found that the DoD and CIA required physicians, psychologists, and other health care providers to act against their professional obligations, by approving and monitoring torturous methods of interrogation, setting disruptive conditions of confinement, and force-feeding hunger strikers.

Outraged medical groups responded with further clarification of their ethical obligations and reinforced that physicians have no legitimate role in monitoring interrogations or participating in pain-causing acts for nonclinical reasons. According to the Defense Health Board, military medical personnel’s first loyalty is to the patient. Ethically, a physician can only assess whether the patient is on a hunger strike, determine their capacity to make rational health decisions, counsel on the risks and benefits of certain decisions, and provide medical care to the patient with their consent.

In January 2013, the Under Secretary of Defense to the Defense Health Board sent a formal request to investigate how military medical personnel balance their dual roles as military officers and health care providers and how much leeway can be given to personnel for excusal from military operations with which they have ethical reservations.

The board’s Medical Ethics Subcommittee was charged with the investigation and found “the DoD does not have an enterprise-wide, formal integrated infrastructure to systematically build, support, sustain, and promote an evolving ethical culture with the military health care environment.” Along with its other findings, the subcommittee recommended establishing a code of conduct for military medical personnel. In addition to adopting all subcommittee’s recommendations, the board made its recommendations to help strengthen the framework of military medical ethics by providing more efficient training and support of health professionals, enforcing the tightening of standards of medical confidentiality, and enhancing the protection of medical personnel confronted by unethical demands from commanders.

The Secretary of Defense adopted and implemented these recommendations with the support of the medical community, but in 2015 an independent investigation showed that the American Psychological Association (APA) approved the participation of psychologists in counter-terrorism interrogations with the DoD. As a result, the APA changed its stance, and currently no professional organization finds ethical basis for participating in interrogations or reason to waiver their ethical standards, based on the professional’s role.

Rubenstein, Scott, and Guze urge all health professional organizations to adopt the Defense Health Board’s recommendations “as part of their task to stand for the moral values underlying health practice,” and encourage these groups to seek congressional oversight in the reform process to ensure the integrity of military medical ethics.

Rubenstein LS, Allen SA, Guze PA. Advancing Medical Professionalism in US Military Detainee Treatment. PLoS Med. 13(1):e1001930.
doi: 10.1371/journal.pmed.1001930.

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