Ethics Abandoned

November 4, 2013

By Leah Ramsay

Should health professionals working in national security and intelligence be held to different ethical standards?  No, according to an independent task force of military, ethics, medical, public health and legal experts.

The Task Force on Preserving Medical Professionalism in National Security Detention Centers has charged the U.S. military and intelligence agencies with directing physicians and psychologists to violate standard medical ethics principles in a report titled Ethics Abandoned: Medical Professionalism and Detainee Abuse in the War on Terror.

Specifically, the report charges that since September 11, 2001, the Department of Defense (DoD) and CIA improperly demanded that their health professionals design, participate in and enable “torture and cruel, inhumane and degrading treatment” of detainees.

Len Rubenstein, JD, a faculty member of the Johns Hopkins Berman Institute of Bioethics, was a co-chair of the 19-member task force and a principal author of its report.  He says, “There is a disturbing legacy in the distortion of medical ethics standards and appropriate professional roles in military detention of terrorist suspects. The DoD has rewritten standards in a way that undermine core duties of beneficence, non-maleficence, use of independent professional judgment.”

The task force’s report details how DoD and CIA policies institutionalized breaches of medical ethics by military and intelligence agency physicians and psychologists, including:

  • Involvement in abusive interrogation; consulting on conditions of confinement to increase the disorientation and anxiety of detainees
  • Using medical information for interrogation purposes
  • Force-feeding of hunger strikers

In addition to this active breach of ethical standards, the report also says that DoD policies and practices impeded the ability to provide detainees with medical care, and vary greatly from the standards that apply to civilian health professionals.

Specifically, Rubenstein highlights the continued protocols that require health professionals to participate in the force-feeding of detainees. “Force-feeding by physicians in violation of ethical standards is illustrative of a much broader legacy in which medical professionalism has been undermined,” he says, according to a press release issued by the Institute on Medicine as a Profession, which supported the task force, along with the Open Society Foundations.

Earlier this year, Rubenstein spoke out against force-feeding policies at Guantanamo Bay Prison after reviewing the Standard Operating Procedure for hunger strikers, saying, “It is a very frightening idea that the medical staff is an adjunct of the security force.  The clinical judgment of a doctor or a nurse is basically trumped by this policy and protocol. Doctors are not acting with the kind of professional medical independence [they should].”

Among its recommendations, the task force calls on the DoD to establish new guidelines for responding to detainee hunger strikes, in line with the World Medical Association’s Declaration of Malta, “including the use of their independent medical judgment in assessing detainee competence to make decisions.”

Other recommendations include:

  • Require states to make it explicit that health professionals who support interrogation and participate in torture or cruel, inhumane or degrading treatment be disciplined.
  • Urge professional medical associations to strengthen their ethical standards around interrogation and detention of detainees and take proactive steps to foster compliance.
  • Require military medical training programs, including pre-deployment training, to include human rights and professional ethical principles regarding treatment of detainees.

For copies of Ethics Abandoned: Medical Professionalism and Detainee Abuse in the War on Terror, visit the IMAP website at

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Leah Ramsay
Leonard Rubenstein

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