America's wrenching debate over what constitutes torture and whether the nation practices it is beginning to involve a group you'd think would be above such things: the medical profession. According to a new survey of more than 1,700 students from eight medical schools, an alarming number of future physicians may not be familiar enough with the Geneva conventions to recognize torture. Worse, even some who do know what it is may be willing to inflict it anyway.
Dr. J. Wesley Boyd, a psychiatrist with the Harvard-affiliated Cambridge Health Alliance, started the study after hearing media reports that U.S. doctors had been complicit in intense interrogations, torture and other abuses. Among the allegations: they let jailers know if prisoners were fit enough to survive abuse, shared medical information such as phobias or other vulnerabilities and altered the death certificates of detainees who died from mistreatment.
Boyd's survey found that 94% of medical students received less than one hour of instruction about military medical ethics in school. More than a third didn't know that the Geneva conventions say doctors should "treat the sickest first, regardless of nationality" or that it prohibits them from threatening prisoners or depriving them of food or water for any length of time.
Students did no better when asked if they, as physicians, should obey any of three hypothetical orders: to threaten a detainee with psychotropic drugs that would not actually be given; to give detainees a shot of harmless saline solution that they've been led to believe is a lethal injection; to kill a detainee with a genuine lethal injection. More than a quarter of the respondents said they would do the first two but not the third. Six percent said they would do any of the three. The right answer, according to the Geneva conventions, as well as the American Medical Association, is none of the above.
The scant attention civilian med schools give the question of torture is troubling, since about 70% of military doctors are recruited from those institutions in exchange for scholarships. There could be even more civilian docs in the military, thanks to the "doctor draft," a 1987 congressional authorization that lets the military call up civilian doctors in case of a wartime shortage. Preparing doctors for the possibility of service would not have to demand much of a med school's curriculum. "It doesn't have to be a full class," says Boyd. "Even five lunchtime talks would make the difference."
Dr. Steve Miles, a medical ethicist and the author of Oath Betrayed: Torture, Medical Complicity and the War on Terror, says it may not be necessary to teach every medical student the specifics of torture. Rather, there's a more general skill all doctors need: push back--the ability to say no, whether it's to a commander who wants a prisoner tortured or an HMO that wants the potential benefits of an expensive treatment concealed. "Every doctor is going to wind up in a dual-loyalty situation," Miles says. The answer is to remember that a doctor's first objective is to relieve suffering--not to cause it.