Study by CHA Researchers Finds Lack of Military Medical Ethics Training

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October 29, 2007

Doctors, Torture, and War

New Study by Harvard Medical School Researchers at Cambridge Health Alliance finds US Medical Students Receive Negligible Instruction about Military Medical Ethics and are Ignorant about the Geneva Conventions

Cambridge, MA - A new study by Harvard Medical School researchers who are also clinicians at Cambridge Health Alliance (CHA) found that medical students receive very little teaching about military medical ethics and are ignorant about a physician's ethical duties according to the Geneva Conventions. The study, entitled "Medical Student Knowledge Regarding the Military Draft, the Geneva Conventions, and Military Medical Ethics," appears in the current issue of the International Journal of Health Services.

Students at 8 medical schools from around the country were surveyed, and 94% of them had received less than one hour of instruction about military medical ethics during medical school. Only 37% could correctly identify that the Geneva Conventions apply irrespective of whether war had formally been declared; 33.8% did not know that the Geneva Conventions state that physicians should "treat the sickest first, regardless of nationality;" 37% did not know that the Geneva Conventions prohibit ever threatening or demeaning prisoners as well as depriving them of food or water for any length of time; and 33.9% could not state when they would be required to disobey an unethical order from a superior.
Lead author J. Wesley Boyd, MD, PhD, an attending psychiatrist at CHA, said that the impetus to survey students on these matters began a couple of years ago when he and colleagues in the Department of Medicine were discussing how insulated civilian physicians seem to be from the war in Iraq as well as allegations that military physicians have abetted abuses at Abu Ghraib and Guantanamo.

Boyd states, "The abuses at Abu Ghraib and Guantanamo have galvanized much of the world against the US. Those abuses, in part abetted by physicians, will likely go down as one of our century's most egregious ethical lapses. The dearth of teaching about these issues in medical schools is a travesty, and medical schools need to begin teaching military medical ethics to ensure all physicians have a solid understanding of their ethical obligations in times of war."

The authors emphasize that knowledge of the Geneva Conventions is especially important given that, in 1987, Congress authorized the Health Care Personnel Delivery System (HCPDS), which established a specific process for a doctor draft. In the case of a shortage of military physicians-and currently the military is having significant trouble meeting its physician recruitment goals-Congress and the President could activate the HCPDS and begin drafting civilian physicians in a matter of weeks. Only 3.5% of the students surveyed were aware of the HCPDS.

The authors hope that their findings will inspire medical schools to begin teaching military medical ethics and the Geneva Conventions, so that physicians who eventually serve in the military are properly educated before they enter the disorienting climate of war and so that all physicians can lead the call for humane treatment of prisoners, regardless of their legal status or designation.

J. Wesley Boyd, MD, PhD is Attending Psychiatrist at Cambridge Health Alliance, on the faculty in Psychiatry at Harvard Medical School, and an Associate Director of Physician Health Services (a subsidiary of the Massachusetts Medical Society) in Massachusetts. Dr. Boyd graduated with a BA from Yale in philosophy, and then received an MA in Philosophy, a Ph.D. in Religion and Culture, and an MD at the University of North Carolina at Chapel Hill. Following graduate school and medical school, he completed a residency in psychiatry at Cambridge Hospital and also, during his residency, completed a Fellowship in Medical Ethics through the Department of Social Medicine at Harvard Medical School. He has taught medical ethics as well as the humanities in various venues, including Smith College and Harvard Divinity School. He writes for both lay and academic audiences on issues of health care justice as well as humanistic aspects of medicine.

THE STUDY: Boyd JW, Himmelstein DU, Lasser KE, McCormick D, Bor DH, Cutrona S, Woolhandler S. U.S. Medical Student Knowledge Regarding the Military Draft, the Geneva Conventions, and Military Medical Ethics. International Journal of Health Services. 37 (4): 643-650 - all of the authors are physicians at Cambridge Health Alliance and hold faculty appointments at Harvard Medical School.

Cambridge Health Alliance is an innovative, award-winning health system that provides high quality care in Cambridge, Somerville, and Boston's metro-north communities. It includes three hospital campuses, more than 20 primary care and specialty practices, the Cambridge Public Health Dept., and the Network Health plan. 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. Visit us online at http://www.challiance.org.