Singh Jerome Amir
Howard College School of Law, King George V Ave, University of Natal, Durban, 4041, South Africa.
BMC Med Ethics. 2003 Aug 1;4:E4. doi: 10.1186/1472-6939-4-4.
Post-September 11, 2001, the U.S. government has labeled thousands of Afghan war detainees "unlawful combatants". This label effectively deprives these detainees of the protection they would receive as "prisoners of war" under international humanitarian law. Reports have emerged that indicate that thousands of detainees being held in secret military facilities outside the United States are being subjected to questionable "stress and duress" interrogation tactics by U.S. authorities. If true, American military physicians could be inadvertently becoming complicit in detainee abuse. Moreover, the American government's openly negative views towards such detainees could result in military physicians not wanting to provide reasonable care to detainees, despite it being their ethical duty to do so.
This paper assesses the physician's obligations to treat war detainees in the light of relevant instruments of international humanitarian law and medical ethics. It briefly outlines how detainee abuse flourished in apartheid South Africa when state physicians became morally detached from the interests of their detainee patients. I caution U.S physicians not to let the same mindset befall them. I urge the U.S. medical community to advocate for detainee rights in the U.S, regardless of the political culture the detainee emerged from. I offer recommendations to U.S physicians facing dual loyalty conflicts of interest in the "war on terror".
If U.S. physicians are faced with a conflict of interest between following national policies or international principles of humanitarian law and medical ethics, they should opt to adhere to the latter when treating war detainees. It is important for the U.S. medical community to speak out against possible detainee abuse by the U.S. government.
2001年9月11日之后,美国政府将数千名阿富汗战争被拘留者列为“非法战斗人员”。这一标签实际上剥夺了这些被拘留者根据国际人道主义法本应作为“战俘”获得的保护。有报道称,在美国境外的秘密军事设施中被关押的数千名被拘留者正遭受美国当局可疑的“压力和胁迫”审讯策略。如果情况属实,美国军方医生可能会在不经意间成为被拘留者虐待行为的同谋。此外,美国政府对这类被拘留者公开持否定态度,可能导致军方医生尽管有道德义务为被拘留者提供合理治疗,但却不愿这么做。
本文根据国际人道主义法和医学伦理的相关文书,评估医生治疗战争被拘留者的义务。简要概述了种族隔离时期的南非,当国家医生在道德上背离被拘留者患者的利益时,被拘留者虐待行为是如何泛滥的。我告诫美国医生不要重蹈覆辙。我敦促美国医学界在美国为被拘留者的权利发声,无论被拘留者来自何种政治文化背景。我为面临“反恐战争”中双重忠诚利益冲突的美国医生提供建议。
如果美国医生在遵循国家政策还是国际人道主义法及医学伦理原则之间面临利益冲突,那么在治疗战争被拘留者时,他们应选择坚持后者。美国医学界公开反对美国政府可能出现的被拘留者虐待行为非常重要。