Medical Ethics at Guantanamo Bay and Abu Ghraib: The Problem of Dual Loyalty

Abstract

Although knowledge of torture and physical and psychological abuse was widespread at both the Guantanamo Bay detention facility and Abu Ghraib prison in Iraq, and known to medical personnel, there was no official report before the January 2004 Army investigation of military health personnel reporting abuse, degradation or signs of torture. Military medical personnel are placed in a position of a "dual loyalty" conflict. They have to balance the medical needs of their patients, who happen to be detainees, with their military duty to their employer. The United States military medical system failed to protect detainee's human rights, violated the basic principles of medical ethics and ignored the basic tenets of medical professionalism.

The right to practice medicine without repercussions: ethical issues in times of political strife

“…For example, Clark argues that in these cases, physicians were placed in a dual loyalty conflict between the needs of their patients, who were political detainees, and their employer, the military. Clark concludes that the “United States military medical system failed to protect detainee’s human rights, violated the basic principles of medical ethics and ignored the basic tenets of medical professionalism [16]. ” A similar conclusion was reached by Professor Steven Miles in a 2004 Lancet article [17].…”

The New Military Medical Ethics: Legacies of the Gulf Wars and the War on Terror

“…Once the health-regarding medical ethic was subordinated to military mission, dual-loyalty ethics devolved to Wonderland injunctions to waterboard with isotonic saline to decrease the chance of coma-inducing hyponatremia or to ensure that resuscitation teams were standing by to perform emergency tracheotomies should laryngospasm close the airway. 39 A revitalized medical ethic would assert the centrality of the physician's duty to the health of soldiers, prisoners, and non-combatants. 40 In this framing, the military physician would retain the core obligations of being a physician including the duty to act as a kind of human rights monitor with regard to endangered health interests.…”

Organizational imbalance of welfare and justice: A commentary on Candilis and Neal

“…Conflict in dual roles occurs when psychologists balance the needs of their clients (the treatment provider role) against that of their employer (the organizational consultant role). An imbalance of these ethical obligations leads to the risk of violating human rights, ethics, and professional principles (Clark, ). As is well‐documented, psychologists were engaged in cruel and inhumane treatment and torture against detainees after the terror attacks against the United States in September 2001 despite several international declarations and conventions signed and enacted by the United States (see Coalition for an Ethical Psychology).…”