The war on ethics
By Michael Cook
Australian Doctor, 15 June 2004

NOW that an Australian military lawyer has been linked to the shameful treatment of prisoners at Abu Ghraib, the Federal Government had better ensure that its medical personnel have had nothing to do with torture, either actively or passively.

US 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" - to quote the official report - that went on in Abu Ghraib.

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

In 1982, the UN General Assembly approved commonsense principles of medical ethics for treating prisoners and detainees. These stressed 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 US Government appears to have involved at least some doctors in behaviour that their colleagues would condemn as unethical - even if international law doesn't.

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 co-operating in ill treatment.

The Washington Post reported that the US approved similar guidelines for "high-value detainees" in Iraq. However, it is not known whether the guidelines extended to Abu Ghraib.

Somewhere 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 revelations, the Jour nal 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 medicolegal reports and even administered "mercy bullets" to finish off survivors of torture.

It's hard to blame terrorised Iraqi doctors. But we have to ensure that no Australian doctor is ever exposed to similar pressures.

President George Bush and Prime Minister John 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. As the pressure increases, will Australians be more virtuous than their Iraqi colleagues?

Comments on the Iraqi survey by leading US bioethicist Dr Edmund Pellegrino shed light on how difficult it will be for them.

"Character formation is, in the end, the surest way to inculcate the virtues," he wrote. "This cannot occur unless the culture of the profession is itself ethically rigorous. Even the most virtuous physicians need a supportive culture to remain virtuous."

If Australian doctors are ethical in civilian life, then, it's unlikely they will be suborned by the war on terror.

While my crystal ball doesn't show Australian doctors amputating ears, some perform cosmetic surgery for trivial reasons, some can be bribed by drug companies, some do research without informed consent, and some euthanase their patients. There's no room for complacency.

Any temptation that undermines the fundamental duty of doctors to evaluate, protect and improve the health of their patients must be taken seriously by the profession and the public. Otherwise the lives of prisoners in the war on terror could well be at risk.

References available on request.

Mr Cook is editor of bioethics e-mail newsletter BioEdge