AMA Takes a Stand: Physicians NOT to be Involved in Interrogation of Prisoners

I have previously posted about the ethical issues related to physicians’ conflict of interest by “wearing two hats”. Currently in the news is the issue of physicians who are involved in caring for those imprisoned in Guantanamo Bay by the U.S.Government. The basic requirement to preserve the ethics of the profession of medicine is that physicians must not engage in interrogation or contribute to the interrogation of prisoners.


Matthew K. Wynia, MD, MPH, FACP, Director, The Institute for Ethics at the American Medical Association has provided me and other subscribers to a bioethics listserv the following policy, developed and recommended by American Medical Association (AMA) Council on Ethical and Judicial Affairs and which was adopted yesterday by the American Medical Association, regarding physicians and interrogation. The AMA now has officially taken a stand, which is similar to that of the World Medical Association and the American Psychiatric Association. ..Maurice.

For this report, we define interrogation as questioning related to law
enforcement or to military and national security intelligence gathering,
designed to prevent harm or danger to individuals, the public, or national
security. Interrogations are distinct from questioning used by physicians to
assess the physical or mental condition of an individual. To be appropriate,
interrogations must avoid the use of coercion-that is, threatening or causing
harm through physical injury or mental suffering. We define a "detainee" as a
criminal suspect, prisoner of war, or any other individual who is being held
involuntarily by legitimate authorities.



Physicians who engage in any activity that relies on their medical knowledge and
skills must continue to uphold ethical principles. Questions about the
propriety of physician participation in interrogations and in the development of
interrogation strategies may be addressed by balancing obligations to
individuals with obligations to protect third parties and the public. The
further removed the physician is from direct involvement with a detainee, the
more justifiable is a role serving the public interest. Applying this general
approach, physician involvement with interrogations during law enforcement or
intelligence gathering should be guided by the following:



(1) Physicians may perform physical and mental assessments of detainees to
determine the need for and to provide medical care. When so doing, physicians
must disclose to the detainee the extent to which others have access to
information included in medical records. Treatment must never be conditional on
a patient's participation in an interrogation.



(2) Physicians must neither conduct nor directly participate in an
interrogation, because a role as physician-interrogator undermines the
physician's role as healer and thereby erodes trust in the individual
physician-interrogator and in the medical profession.



(3) Physicians must not monitor interrogations with the intention of intervening
in the process, because this constitutes direct participation in interrogation.



(4) Physicians may participate in developing effective interrogation strategies
for general training purposes. These strategies must not threaten or cause
physical injury or mental suffering and must be humane and respect the rights of
individuals.



(5) When physicians have reason to believe that interrogations are coercive,
they must report their observations to the appropriate authorities. If
authorities are aware of coercive interrogations but have not intervened,
physicians are ethically obligated to report the offenses to independent
authorities that have the power to investigate or adjudicate such allegations.