Future doctors flunk military medical ethics test

Physician service during the war on terror presents a dual-loyalty dilemma that medical schools should address, experts say.

By Kevin B. O'Reilly, AMNews staff. Dec. 17, 2007.

Medical students get a failing grade on their knowledge of physicians' ethical obligations during wartime, according to a new study authored by a team of Harvard Medical School physicians.

The authors said their study, published in October in the International Journal of Health Services, should prompt medical schools to educate future doctors more thoroughly on the ethical questions they could face in an age of terror and torture.

But experts said that although medical curricula could cover military medical ethics, such instruction should be folded into discussions about the broader problem of dual loyalty -- when doctors' advocacy for the patient conflicts with other institutional or societal objectives.

Medical students should be taught how they can -- and should -- stand up to health plans, drugmakers, the government or any other entity that asks physicians to violate medical ethics.

The American Medical Association supports comprehensive medical education that keeps pace with the ethical challenges facing physicians, AMA Board of Trustees Chair Edward L. Langston, MD, said in a statement responding to the study.

"Although relatively few physicians will face situations where they need to know the specific terms of the Geneva Conventions," Dr. Langston added, "the rules of military medical ethics provide important guidance on how physicians should handle situations of dual loyalties, which can affect all physicians."

About a third of students who responded to the researchers' survey did not know that under the Geneva Conventions, physicians are obligated to treat the sickest individuals first, regardless of nationality, and should refrain from participating in coercive interrogations or depriving prisoners of food and water. Almost two-thirds of the nearly 1,800 students from eight U.S. medical schools who took the quiz did not know that the Geneva Conventions apply to all signatories, regardless of whether they declare war officially.