Medical Ethics and Detainees

APA President Steven Sharfstein, M.D.'s column “Medical Ethics and the Detainees at Guantanamo Bay” in the November 18 issue raises many important issues. I agree that physicians should never assist in torture or humiliation of prisoners. It is an abomination to prescribe medications in order to render a person sane enough to be executed. Helping interrogators develop new methods of “breaking down a suspect” is a shameful misuse of our skills. However, we also have an obligation to save lives.

Suppose a suspect may have information about a plot to blow up a large building, refinery, or tunnel. If we advise detectives on how to establish rapport, develop a relationship with a suspect, and thereby gain information that would save hundreds of lives, then we have done the right thing. But if prosecutors subsequently use that information to secure a death sentence for the suspect, then we are no longer strictly healers. We have then become both healers and executioners. If we are to work with law-enforcement agencies, we will have to develop contracts that clearly specify that information gained as a result of our work will be used to protect the public, but not to prosecute the individual who provided that information.

That individual may deserve to be sentenced to 10 years of hard labor in a bug-infested toxic dump. But his punishment will come at a cost to the public health. To the extent that our public image is that of a healer, patients will be willing to come to us. If our image becomes a combination of a healer and a prosecutor, some patients will avoid treatment. They and their families will suffer needlessly.

Let's continue the dialogue.