Medical ethics and Guantanamo Bay: Time for reform

July 23, 2009

A Viewpoint in this week's Lancet proposes reforms at the Guantanamo Bay detention centre, with respect to medical ethics and the medical status of detainees. The Viewpoint highlights the problem of the US Armed Forces investigating themselves, and is written by Professor George Annas, Boston University School of Public Health, Boston, MA, USA and Leonard Rubenstein, Physicians for Human Rights, Cambridge, MA, USA and United States Institute of Peace, Washington, DC, USA.

The Viewpoint refers to a report commissioned by US President Barack Obama to investigate current practices in Guantanamo Bay. The report was led by Admiral Patrick Walsh, the Vice Chief of Naval Operations. The Viewpoint raises a number of concerns regarding the report's approval of continued use of medical personnel to force-feed detainees engaged in hunger strikes, among them flouting of ethical standards that prohibit physicians from force-feeding competent prisoners; use of a classified medical protocol to authorise force-feeding; non-physicians (the base commander) making treatment decisions, and use of restraint chairs. It also notes that Admiral Walsh's team failed to challenge the authorisation by the Administration of former President George Bush of participation of physicians and other health professionals in interrogation of detainees, despite international and domestic ethical standards condemning the practice.

Admiral Walsh's team concluded that "the scope, quality and documentation of care provided to detainees are similar and in most cases identical to care received by US Armed Forces personnel", and that the mental health of detainees compared favourably to inmates in U.S. domestic prisons. Yet Walsh's team did not conduct independent medical examinations of detainees and the Department of Defense has refused any independent medical or psychological assessments of detainees there. Independent examinations of released detainees show severe psychological damage from the experience of detention.

The authors say: "In conclusion, the difficulties posed when the Department of Defense investigates itself are evident in the report by Walsh's team. This report does not vindicate the many military physicians and psychologists who acted with honour and integrity. The quandary of dual loyalty in military medicine is not addressed by the report. The issue of how to determine when, if ever, military physicians need not follow basic principles of medical ethics is not confronted in the report. Three actions are needed. First, the Department of Defense should abandon practices, including employing physicians to support interrogation and force-feeding of competent individuals on hunger strike, that are inconsistent with medical ethics. The rule in the US military should be that military physicians never have to compromise medical ethics to serve their country. Second, the Department of Defense should permit independent medical reviews of the physical and mental health conditions of the prisoners at the detention centre in Guantanamo Bay and other US military prisons. Third, an independent commission should be established to review not only the entire regime of detention and interrogation of terror suspects by the USA, with emphasis on the role of physicians and psychologists, but also the Department of Defense's protocol for management of prisoners on hunger strike."
Professor George Annas, Boston University School of Public Health, Boston, MA, USA. T) +1 617 638-4626 E)

Leonard Rubenstein, United States Institute of Peace, Washington, DC, USA. T) +1-703-217-2991 E)

For full Viewpoint, see:


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