Med students don't know ethics of military medicine

Few can identify violations of Geneva Conventions

A survey of 5,000 U.S. medical students reveals that just over one-third understand the Geneva Conventions as they apply to military medical ethics; underlying that finding is the additional revelation that very few receive any medical school instruction in military medical ethics.

J. Wesley Boyd, MD, PhD, a psychiatry instructor and psychiatrist with Cambridge Health Alliance in Cambridge, MA, spearheaded a look into medical students' knowledge of military medical ethics after hearing reports that physicians were implicated in torture and abusive interrogations of jailed suspected terrorists.1

To start with, the Internet-based survey established that 94% of those medical students who responded had received less than one hour of instruction about military medical ethics. And only 3.5% knew that there exists a "doctor's draft" to ensure there are enough physicians in the military.

When it came to Geneva Conventions regarding the treatment of prisoners, 37% knew the conditions under which the Conventions apply, but fewer — 33.8% — knew that the Conventions require physicians to treat the sickest patients first, regardless of nationality.

As for medical students' understanding of a military physician's role in the mistreatment of prisoners, 37% said they did not know that the Geneva Conventions prohibit threatening or demeaning prisoners or depriving them of food or water, and nearly 34% said they did not know the conditions under which the Conventions would require them to disobey an unethical order.

For example, the survey posed the following hypothetical question:

"If a prisoner is refusing to answer questions about a recent battle or skirmish in which over 50 U.S. soldiers died, under the Geneva Conventions it is permissible to:

a) Deprive him of food or water for a period not to exceed 24 hours.

b) Expose prisoners to physical stresses such as heat, cold, and uncomfortable positions, as long as such exposure causes only minor tissue damage (i.e., medical intervention not required, and full healing takes place within 48 hours).

c) Threaten prisoners with physical violence, so long as such threats are not carried out.

d) All of the above.

e) None of the above.

The answer? "None of the above." Prisoners of war who refuse to answer questions may not be threatened, insulted, or exposed to harsh treatment, according to the Geneva Conventions.

Boyd writes that when asked about three hypothetical orders and whether they, as physicians, should obey any of them, the students fared no better. When asked if they should comply with an order to threaten a prisoner with psychotropic drugs that would not actually be given, to give a prisoner a shot of harmless saline solution that he had been led to believe is a lethal injection, or to actually kill a detainee with a genuine lethal injection, more than 25% said they would comply with the first two orders but not the third; 6% said they would comply with all three orders. The Geneva Conventions prohibit any of the actions.

Reference

  1. Boyd JW, Himmelstein DU, Lasser K, et al. U.S. medical students' knowledge about the military draft, the Geneva Conventions, and military medical ethics. Int J Health Serv 2007;37:643-650.