Alarming Number Of U.S. Medical Students Lack Knowledge Of Wartime Ethics
We posted a clip of NBC's Law & Order SVU last week that dealt with the issue of physician-assisted torture in Iraq and I came across this article by Health Day. According to them, an alarming number of U.S. physicians are given inadequate training (as little as one hour total) on medical ethics as they relate to war and the Geneva Conventions:
Too few American medical students receive adequate instruction about military medical ethics and a physician's ethical duties under the Geneva Conventions, say Harvard Medical School researchers.
"The abuses at Abu Ghraib and Guantanamo have galvanized much of the world against the U.S. Those abuses, in part abetted by physicians, will likely go down as one of our country's most egregious ethical lapses," lead author Dr. J. Wesley Boyd said in a prepared statement.
- Only 37 percent of medical students could correctly identify that the Geneva Conventions apply irrespective of whether war had formally been declared.
- 33.8 percent didn't know that the Geneva Conventions state that physicians should "treat the sickest first, regardless of nationality."
- 37 percent didn't know that the Geneva Conventions prohibit ever threatening or demeaning prisoners, or depriving them of food or water for any length of time.
- 33.9 percent couldn't state when they would be required to disobey an unethical order from a superior. Read on...
![President Bush accuses UK journalist of "slander[ing] America" for mentioning Guantanamo, Abu Ghraib abuses](http://cdn.crooksandliars.com/files/nodeimage/21/21305.jpg)
Unsurprised
Sadly, it is now clear how important this kind of instruction is. And it ain't just for medical students either.
Money is the God. Not ethics or integrity.
And I wonder what they're teaching kids about the Geneva Conventions at universities like Liberty and Regent? Probably something similar to what they teach about the Constitution. After all, the only document that should be taken literally is the Bible.
12:30pm Chicago time
David Shuster just asked Lyndsey Graham if waterboarding is torture.
Graham said yes.
The entire edjumacation system in this country is broken. Our students rank 29th in the world in math and reading!
not surprising
is right
nobody but nobody
could have foreseen the evilness
of these bush thugs
heh...
Fascist States of America @ 5:
So will he vote against the AG nominee????????
The United States has become a 3rd rate, back water, banana republic. It's over people. O V E R. And lest you think I exaggerate . . . look at what the Dems have done to stop this mess. They have done N O T H I N G and won't once they win the Presidency. Think of the worst of the worst that other countries do to their people and others in the world . . . we do em all.
Later America. Nice run . . . well, til about the 1980s.
other possible names for this thread:
--alarming number of americans are wholly without ethics
--alarming number of americans are too addicted to celebri-puff to know what is being done in their names. and, guess what, they don't give a flying fuck either (ok, that name is too long)
--alarming number of republicans are open to dictatorship
--alarming number of democrats are open to allowing the GOP to estab a dictatorship
we are a society that profits from, is dependent on, and addicted to war. our media glorifies and supports war-without-end. our culture, from birth on, indoctrinates us to not only accept war, but also get a sexual rush from armed conflict.
as long as our economy is dependent on war. as long as we are a society of sheep. as long as our political system is dominated on by one party with two wings (dem and rep) things will continue to spiral out of control.
I don't see this as a problem for 2 reasons:
1. If the students don't realize that they should not assist in torture, then they are retards since the first thing they are taught as a medical doctor is Primum non nocere (do no harm). If they cannot follow a fundamental principal of medicine, then they should not be a doctor.
2. The small percentage of doctors that will ever even be involved in a wartime situation is so minute, that I would say an hour on this subject would be adequate.
Of course we would like to think that our doctors are well versed in every single aspect of medicine, but when it comes down to it, not everything can be taught in a classroom.
Someone needs to explain to me why these statements to basic human decency need to be taught. I would think that 70% of the students would come to these conclusions by themselves. It makes me further think that the destruction of the human race is more and more likely and maybe not such a bad idea.
Scytherius @ 9:
Dems are going to be busy "reshaping the environment". We'll be able to increase our TV watching from the current average of 35 hours a week to 45 and the increased availability of cheap 700 calorie cheeseburgers only a 10-minute drive away will create a new economic boom.
RayC @ 12:
Exactly.
L.A. Confidential @ 13:
LOL Well said. Sad but true.
A new video game comes out today, I don't know the name, but it's supposed to be the most violent yet and involves not just murder, but torture as well.
ysbaddaden @ 16:
We need to prepare the minds of those 8-9-and 10 year olds for the future.
ysbaddaden @ 16:
"Manhunt 2" - they trimmed it back until they finally got the Mature rating.
Mengele material...
I'm a med student, and while I agree with the article (haven't read the study yet), there are a couple of caveats. Unless the student is a hard-core conservative idiot - there are out there, trust me - none of us believe torture is necessary for anything. Heck, we have to report suspicion of abuse to the police, let alone torture. This is a test question that is on every single board, i.e. you suspect abuse, you report it to the authorities ASAP. Most future docs are afraid of doing the wrong thing because of litigation, so those idiots I mentioned are in for a shock when they discover that "Jack-Bauer techniques" are not an acceptable way of obtaining a medical history!
The second point is that this is more applicable to military med students, i.e. those studying directly on an Armed Forces school, and those that have grants with the Army, Navy, etc. That being said, we do get a lecture or two on bio-terrorism, so a lecture on the Geneva conventions, and human rights in general, would be very welcome! Also, I agree with the above comments that most of this stuff is common sense to decent individuals who have a neuron or two, that torturing anyone is simply wrong.
In my experience med students are too tired, stressed and overworked to be aware of ANY issue. After witnessing the results of seeing a room full of med students' stunned reaction to seeing the movei "And the Band Played On" (about AIDS), I'd say that parsing it down to one in particular is understating the problem.
I will bet anything that they will get much more time to study how to maxamize their income. I have a nephew who is a doctor.
Hello, those are not just Geneva conventions, they are medical ethics, period. There's this little matter of the hippocratic oath, which includes, "first, do no harm." Have any of these bozos ever heard of it?
Blue Lensman @ 18:
Tapadh leat.
L.A. Confidential @ 17:
Lets not go to far with this video game BS, I was raised with the 3 stooges and I don't slap my friends in the forehead or poke them in the eyes.
Buddy, med students, while notoriously overworked, are kicking butt when it comes to advocacy. We are way ahead of the professional medical organizations on this. Visit the website of the American Medical Student Association, and check out our section on Universal Health Care.
http://www.amsa.org/uhc/
We've been at this for YEARS, before Michael Moore or anyone else decided to care for it. We even lobbied John Conyers, who as you know co-sponsored a bill for it.
Give us credit, we are working OVERTIME on changing the system!!
RayC @ 25:
I don't think anyone is claiming such entertainments cause violent action, but causes a desensetizing to such actions. Polls show too many Americans are okay with torture. Once desensitization sets in others might engage in such practices. But that might not be until one or two generations.
the cons want every student to think "24" is the norm. The Geneva Convention is "quaint" to them
Ignorance of the law is no excuse.
RayC @ 25:
Funny how that's almost a crucifixion pose.
But I guess you had to be there.
This is concerning, but not overly so. Most med students will never be in a position to evaluate torture (inshallah,) and the wording of these questions put things in the abstract. If you ask someone if the Geneva Conventions require a certain thing, its not the same as asking someone, "if you are in this situation, what do you do?"
I know it looks like there are a lot of medical doctors who place profit above all else, but from what I've seen, those people are in the tiny minority. There are a lot easier ways of makng money than becoming a doctor, and most doctors go into the field out of a sense of service.
Remember the Milgram Experiment where people were told to give someone they couldn't see a shock? It was alarming how many people did it just because they thought they were supposed to. I'd like someone to replicate that today by telling the subject that the person they were shocking either:
A) had middle-eastern sympathies
B) think that it was the U.S.'s fault that 9/11 happened
... you get the point. Of course, good luck to any scientist getting a grant for such a thing during this administration.
I have never put any formal study in the Genevas honestly. But to me, all four of the questions above relate more to common sense and human decency. A guess, even an uneducated one, should yield the correct answer on all of these questions, whether "adequate training" was given or not.
PurplePatriot @ 33:
Good luck to a scientist trying to get any grant during this administration. Except maybe these folks: http://www.rhythmism.com/forum/showthread.php?t=17604
No W Now @ 34:
Not if the question is phrased:
I'm just saying...
This is just Bush's legacy of perverting the conception of humane values. What an embarrassing President not only for this day and age, but he will be throughout history.
this is MY quote
Agreed, but I actually heard a public official blaming a rise in the crime rate in Palm Beach County on “the thug lifestyle, hip-hop music and violent video games”.
RayC @ 12:
The problem is not that they are plain vanilla "students" but rather, that they are medical students. One would assume that people who are training to become a doctor some day would be somehow biased towards the humanitarian end in their responses... thus even if they did not know the correct answer they would have scored far higher than those percentages just based on plain human decency as their guesstimator.
Sadly, after my experience teaching as a grad student plenty of pre-med students... in the US of A humanitarian reasons seem to be the last thing in the minds of future doctors.
Why is this alarming? Medical School is 4 years of intense studying. Information is coming at the students like a fire hose. When are they going to teach war ethics? They can shorten anatomy or physical examination or physiology to teach war ethics.
Errington Thompson, MD
it's no surprise. Everyone has an excuse these days.
I'm sure they all have time to attend the "Managing your Finances" course.
Truly Equal @ 20:
I agree with Truly Equal, that is the most important point. I was one of those med students several years ago and I had many hours of training (classroom and fieldwork) on the Geneva Conventions. Every physician in the military receives extensive training on these issues.
That being said, training is training, and real-world is real-world. In my experience, military training did not seem to correspond very well with how things were actually done. I am not surprised that military physicians have taken part in the un-ethical (criminal?) ongoings at Guantanamo. However, it isn't because of lack of training, it is a deeper problem of human nature. Physicians are quite a diverse group of people, and if you select them well, who knows what you can get them to do.
ecthompson @ 40:
I am not a doctor, but I am married to one and we survived med school together :-). But I think that it all depends on how the test was administered, if it was a true/false or multiple choice (most likely) survey... then I would be scared about the lack of humanity in the guesstimations of med students.
And honestly, humanity seems to be in sort supply among med students. Also there is a significant percentage of med students that are either straight ROTC or are getting some sort of subsidy via being in the reserves...
Dr. Who @ 39:
You mean like these medical doctors?
http://www.filmreference.com/images/sjff_01_img0077.jpg
Baaaaaaaaaaaaaaaaa! Baaaaaaaaaaaa! (returns to eating grass)
j swift @ 46:
I much prefer smoking it.
ecthompson @ 40:
War ethics? How about ethics, period. One of the statements was even about field triage (treat the sickest first regardless of nationality) which could be applied to a national disaster situation. I guess we have been truly lucky that we have never fought a war on our soil so our doctor's can be so far removed as to not even have a basic knowledge of their treatment responsibilites of prisoners of war.
Fanon, BSN,RN
I hate to tell ya, but unless the med student comes from a military family, they have no intention of serving in the military and believe they will have no use for any war ethics. Just as our non military service Administration has no war ethics or conventions.
This reminds me of a joke:
What do you call a guy who graduates at the bottom of his class in med school?
Doctor
Fanon @ 48:
Actually, in a war triage situation, you let the sickest ones die and treat the minor injuries first. The people writing this article don't even know the basics of military medical triage, so you have to question their research. And I can also tell you that almost everyone I knew would have ignored that Geneva Convention provision to treat ALL patients equally. They told us that, but almost everyone disagreed with it.
I can also tell you that most of the physicians in the military would NEVER disobey an order, however unlawful. It takes a great deal of personal fortitude and strength to go against that tide, few have the required courage. If you have never been in that situation, then you don't know anything about it and should not be the judge of anyone. I have never found myself in that situation either, but even speaking up in a meeting with a Colonel can get you in hot water (and I do have experience with that).
I am also sick and tired of the disparaging comments about physicians. If you don't think we are ethical or humanitarian, then stop asking us for help.
This doesn't surprise me in the least. We're schooling, and giving degrees to, a whole new generation of little fascists who never even obtained a moral compass - let alone suffer from a broken one. I recall a survey done a year or two ago, of High School students asked how much freedom the press should have. A whopping half of them said that the government should take over the press "to keep us safe".
If that doesn't give you night sweats, nothing will.
God help us if this is the best and brightest. We are doomed.
Think about watching an episode of MASH where every character is Frank Burns.
some dude named steevo @ 51:
Actually, Your assessment of triage isn't true, either. You don't treat "minor" injuries first. You treat first priority as immediate life saving but with decent chance of survival, second priority urgent but not life threatening and third minor. The fourth category is treat last as unlikely to survive. In a heat of battle scenario you may resort to treating minor first so they can return to battle.
Folowing orders is a bullshit excuse for doing something unconscienable.
Thirdly, boo hoo, so many disparaging comments made about physicians. Maybe you shouldn't take it so personally. But, don't worry, you may soon get your wish about people not coming to you for help anymore. Since you have priced yourselves right out of the internal medicine field you will soon be replaced by NP's and PA's. Hope you have a specialty, son.
What class in med school, aside from my upcoming medical jurisprudence course, would one pick up the medical/medico-legal aspects of the Geneva conventions? None...is it realistically even important in light of the thousands of other-things-to-remember-so-as-not-to-kill-your-real-patient? Would a firm grounding in "Christian" values from a proposed "Christian" nation be sufficient to answer all of those questions?
WWJD?
Apparently he was too busy blowing up abortion clinics and trying to stop gay marriage to answer some real pressing questions.
I betcha the students would remember the Geneva Conventions and study hard if the pharma companies made a cash incentive out of it. They'd remember every damn line.
Am I allowed to say that Fanon has some asshole, wrong-haired ideas, and thinks like a punk?
Curiously akin to Bush's numbers.
Fanon @ 55:
The categories are Immediate, Delayed, Minimal, or Expectant. And I was talking about military triage in a battle situation. Minimal are treated first, then Immediate, Delayed next, and Expectant are made comfortable and given pain meds (if the meds can be spared).
Yeah, I wasn't providing an excuse to anyone, I was trying to provide understanding. I agree it is a bullshit excuse, but the world is not black and white. History is full of examples of good people in groups perpetrating horrific actions.
If people want inferior care, then that is their choice. But just as there is a shortage of nurses, there is also a shortage of primary care physicians. This is especially true in rural areas, which are great places to live and work. I am not worried about being replaced.
I am also not defending these military physicians who participated in torture, and I am sure some of them did. I hope they face disciplinary action. However, don't underestimate the power of group conditioning to affect the minds of even the most intelligent people. Over time anyone can be broken - just apply enough pressure for enough time and you can do it.
For example, we were constantly told we were "Military Officers first, Physicians second" - and every single time someone told me this, I raised my hand and disagreed. Physicians MUST be physicians above all else (except for father or husband). We are conditioned for this type of duty. I knew that someday I would no longer be an officer, but I would always be a physician. Well, let's just say I had a brief and non-distinctive career in the military. I also refused to wear my Global War on Terror ribbon (also not a very popular career move on my part).
Being a physician in the military is an ethical minefield. I realized that before I joined, and I came to terms with it. There are a few primal contradictions between the roles of military officer and physician. Those who chose to follow the physician's path to the detriment of the officer's path, as I did, pay a price. But I am exceptionally stubborn and I can look back without shame.
The military uses the word Honor quite a bit, but very few people in the military understand the real meaning of the word.
--Only 37 percent of medical students could correctly identify that the Geneva Conventions apply irrespective of whether war had formally been declared.
--33.8 percent didn’t know that the Geneva Conventions state that physicians should “treat the sickest first, regardless of nationality.”
--37 percent didn’t know that the Geneva Conventions prohibit ever threatening or demeaning prisoners, or depriving them of food or water for any length of time.
--33.9 percent couldn’t state when they would be required to disobey an unethical order from a superior.
Geneva Conventions or not, any person with a heart and soul would behave thus. What is wrong with people?
ecthompson @ 40:
Errington Thompson? That might be one of the most republican sounding names I've ever heard. How are things down at the yacht club, Errington?
Yours truly,
J. Danforth Quayle
just kidding
Big whoop! Most US doctors are from India or Korea so 37% is quite generous.
Has anyone here been to Bengaluru lately?
I am not surprised by this,although it is disturbing.The name of their game is medical practice.The practice of medicine is just that--practice.As Chris Rock said about ten years ago,"They ain`t cured nothing since polio."
Another alarming fact is that they take one three hour course on alcoholism/addiction throughout the course of Med school.Addiction is the third leading cause of death in this country.(I think it is #1.) They put many deaths that should be attributed to addiction in ther heart disease columnMy father and two brothers died from addictive disease.Heart disease was listed as cause of death for each.
The difference between God and a Doctor is that God knows He`S NOT a Doctor.
You can't have a Fourth Reich without breaking a few ethics...
they will be too busy dealing drugs for big pharma to deal with these matters.
PurplePatriot @ 61:
No Yacht or jet. Wish I had one though.
E
.. and these students probably think "Nuremberg Code" is the name of a new thriller novel.
We are sunk.
It is a heavy burden these days to be an empath, but worth it -- If irony is your forte.
I wonder how many commenters so far can tell us about the Geneva Convention without googling it? There have been several parts to the treaty (which is law in the United States, by the way, look it up in the Constitution) and it has evolved into a complex document over the years. In order to have a complete knowledge of the treaties you would have to read them and then have someone help you interpret them. The authors of the paper did ask treaty specific questions. As far as I can tell they did no survey the students about the ethics of torture. If I asked you to tell me all about the ethics of the Law of the Sea treaty and you failed a test on the specifics, what would this say about your ethical compass?
Those who have need for the fine points of the Geneva Conventions include military officers, International Red Cross workers, Doctors Without Borders, and anyone in a position to effect or be affected by war, insurgence, and the other entities covered by the treaty.
The comment made by the lead author:
"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"
might make sense if every physician was drafted to go to war. Those students who are at the military medical school do get that lecture as part of being an officer (as do those on military scholarships.)
For the most part, those who go to war do not include medical students, psychologists, policemen, lawyers, EMTs, most physicians, and a host of administrators and others in this country. There is no reason to specifically teach the Geneva Conventions in medical school, law school, or library administration school unless the graduates are going to be involved directly in the ajudication or implementation of this treaty. If they are, the orgainizations involved have an obligation to make sure that the knowledge is disseminated.
There is a reason to teach ethics in medical school (and other professional schools) and most of that is common sense: you don't facilitate torture just as you don't facilitate child or elder abuse (which are taught in ethics classes throughout physicians careers since there are laws in each state and it is the right thing to do) nor do you take advantage of patients in any way. The specifics of the laws of each state are important in order to help the process of protecting those who are not able to protect themselves.
Numerous professional organizations have condemned the behaviour of those members of the professions who have participated in the tortures (if you read the article, it links to the clear AMA position.) Within the military there are brave career soldiers who have spoken out at the risk of their pensions (JAG and miltary judges are a terrific example of this) because they have taken specific courses in the Geneva Convention (all soldiers do.) But to expect a medical student to know the specifics of a complex and lengthy treaty is not any more reasonable than to ask them to quote the Bible (which has a lot to say about ethics, too) or to take Bible classes in addition to the other classes that they take.
God help me if I ever really need a doctor!
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