Cambridge, Mass. – U.S. graduate students in psychology receive little instruction in military medical ethics and are largely unaware of their duties under the Geneva Conventions despite both the longstanding ties between the American Psychological Association (APA) and the military and the fact that psychologists were the architects of the “enhanced interrogation” programs used at Abu Ghraib, Guantanamo, and elsewhere. Those are some of the findings of a study by researchers at Harvard Medical School/Cambridge Health Alliance and other Boston-area institutions published today in the International Journal of Health Services.
The researchers surveyed 185 students at 20 different graduate programs in clinical psychology. They found that 74 percent of students had received less than one hour of instruction about military medical ethics, and 97 percent had received five hours of instruction or less.
Likely as a result, only 37 percent of the students correctly said that the Geneva Conventions apply irrespective of whether war has formally been declared. Forty-three percent did not know that the Geneva Conventions state that physicians should “treat the sickest first, regardless of nationality,” and 50 percent did not know that the Geneva Conventions prohibit ever threatening or demeaning prisoners, or depriving them of food or water for any length of time.
Forty-eight percent of the students could not state when they would be required to disobey an unethical order from a superior. Confusion on this matter may stem, the authors believe, from two contradictory, co-existing policy documents backed by the APA: a 2005 presidential task force report that in essence allows psychologists to use the so-called Nuremberg defense, i.e. the argument that a person was merely following orders in carrying out an unethical act (which was only repealed last year), and a 2008 APA policy referendum affirming that psychologists must strictly adhere to international human rights conventions.
Only five percent of the students were aware that, beginning in 1987, Congress authorized the Health Care Personnel Delivery System (HCPDS), which established a specific process for drafting psychologists and other health care personnel in time of military need. If they desired, Congress and the president could activate the HCPDS and begin drafting civilian psychologists for military service in a matter of weeks.
The authors argue that given the existence of the HCPDS and the extensive involvement of psychologists in every aspect of recent U.S. military interrogations and torture, all clinical psychologists need to be knowledgeable about the Geneva Conventions and military medical ethics. They also urge further scientific study of these matters.
“The abuses at Abu Ghraib and Guantanamo galvanized much of the world against the United States,” said lead author J. Wesley Boyd, MD, PhD, a psychiatrist at Cambridge Health Alliance and an assistant clinical professor of psychiatry at Harvard Medical School. “The fact that Guantanamo is still open and continues to flout international law – most recently by force-feeding detainees – will likely go down as one of our country’s most egregious ethical lapses.”
He continued: “Psychologists need to know about these matters to ensure they don’t inadvertently become pawns of the U.S. military establishment and also to hold their colleagues who have committed crimes in the name of patriotism accountable for their actions.”
Cambridge Health Alliance is a vital and innovative community health system that provides essential services to Cambridge, Somerville, and Boston’s metro-north communities. It includes three hospital campuses, a network of primary care and specialty practices, and the Cambridge Public Health Dept. CHA is a Harvard Medical School teaching affiliate and is also affiliated with Harvard School of Public Health, Harvard School of Dental Medicine, and Tufts University School of Medicine.
J. Wesley Boyd, MD, PhD, Alice LoCicero, MD, Monica Malowney, MPH, Rajendra Aldis, MD, and Robert Marlin, MD, PhD, MPH. “Failing Ethics 101: Psychologists, the U.S. Military Establishment, and Human Rights.” International Journal of Health Services, Vol. 44, No. 3. Published online on August 6, 2014.