Protect and serve

August 01, 2003

US military physicians involved in the "war on terror" should put their responsibility for the care of patients before duty to their country, according to an article published today in BMC Medical Ethics.

Jerome A Singh, a senior lecturer in law and bioethics at the Howard College School of Law, University of Natal, South Africa, warns of the dangers of the "unlawful combatants" status bestowed on Al Qa'eda and Taliban prisoners by the US Government. He cautions that this may lead to situations where doctors are involved in, or witness, treatment of detainees that goes against the ethical code of the medical profession.

According to Singh in such situations, "the duty of care must supercede any blanket notion of loyalty, obligation, allegiance or patriotism."

Under the 1949 Third Geneva Convention, all lawful combatants in the hands of an enemy should be considered prisoners of war, entitling them to basic human rights. Singh says, "the American government has side-stepped these obligations by labelling many Afghan war detainees and terrorist suspects "unlawful combatants"."

As this label is unrecognised in International Humanitarian Law, Singh warns that detainees classified as unlawful combatants may not be protected from "questionable interrogation techniques" or that their captors could "potentially subject detainees to poor detention conditions with a sense of impunity."

Singh refers to the questionable interrogation techniques reported in a December 2002 Washington Post article, and the deaths of two detainees in Afghanistan in March 2003. While he makes clear that there has been no proof of US military physician complicity in the alleged detainee abuse Singh asserts that "if physicians witness or suspect the abuse of detainees, they should consider it their ethical duty... to document and report such abuse."

He warns that "the American government's openly negative views towards terror suspects and the Afghan detainees could influence state physicians to not want to provide reasonable care to, or protect the interests of, such detainees. This mindset could conflict with the physician's ethical duty."

Singh's concern is that doctors, like members of the public, are susceptible to "a loss of moral perspective". He warns against the moral disengagement that can come from the negative labelling or devaluing of a group because of their political culture, and against "victim-blame" where detainees in pain or suffering are considered to be responsible for their own fate. He warns that, "moral disengagement and victim-blame were factors that facilitated the abuse of detainees under apartheid in South Africa."

In summing up, Singh comments that if US physicians face a conflict between choosing to comply with national policies based on unilateralism or universally-embraced multilateral principles of International Humanitarian Law and medical ethics, they should feel ethically bound to adhere to the latter.

In 2002, Cofer Black, then head of the CIA Counterterrorist Center, said, "After 9/11 the gloves come off". Singh concludes that military physicians should "keep theirs on" and "practice ethics-based medicine."
Upon publication this article will be freely available online, according to BioMed Central's policy of open access to research articles.

Full journal reference:
American physicians and dual loyalty obligations in the "war on terror"
BMC Medical Ethics 2003, 4:4 (1 Aug 2003)
Jerome A. Singh

Please quote the URL in any article, so that your readers can read the original article.

For more information about this article, contact Grace Baynes by email at or by phone on 44-0-20-7631-9988

Alternatively, please contact the author Dr Jerome A Singh by email at

BMC Medical Ethics is a peer-reviewed journal that publishes original research articles on the ethics of medical research and practice.

BMC Medical Ethics is published by BioMed Central (, an independent online publishing house committed to providing immediate free access to peer-reviewed biological and medical research. This commitment is based on the view that open access to research is essential to the rapid and efficient communication of science. In addition to open-access original research, BioMed Central also publishes reviews and other subscription-based content.

BioMed Central

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