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A stronger ethical culture within the US military health care environment is needed


The health professional community should urge the United States Secretary of Defense to adopt and implement the recent recommendations of the Defense Health Board, and in addition rescind directives authorizing participation of health professionals in interrogation and force-feeding because they are inconsistent with professional ethics according to Leonard Rubenstein, from Johns Hopkins Bloomberg School of Public Health, and Berman Institute of Bioethics, Baltimore, and colleagues in a new Essay published this week in PLOS Medicine.

In their Essay the authors highlight recommendations made by the United States Defense Health Board in its review of the ethical guidelines and practices for United States military medical professionals that was published in March 2015. The review recognized that military physicians often face "dual loyalty" conflicts between ethical duties and organizational requirements and concluded that codes established by medical professional organizations are applicable to the health care practiced by military personnel in the military health system. The review also urged the Department of Defence to ensure that the military health care professional's first ethical obligation is to the patient via its policies, guidance, and instructions.

The authors noted some limitations to the Board's recommendations, "[i]t did not address the inconsistency between Department of Defense directives for health professional involvement in hunger strikes and interrogation and the principles it cited. In our view, the Board's failure to call for a prohibition of any military health professional involvement in interrogation or force-feeding hunger strikers in its recommendations is a serious deficiency. It should also have recommended transparency and oversight in the reform process."

The authors conclude, "[n]otwithstanding their limitations, the recommendations by the Board warrant support of the medical community and adoption and implementation by the Secretary of Defense as a means of enabling military health professionals who interact with detainees to act in accordance with the ethical obligations of their profession."


Funding: No funding was received for this work.

Competing Interests: I have read the journal's policy and we have the following conflicts: SAA and LSR served on the Institute on Medicine as a Profession Task Force on Preserving Medical Professionalism in National Security Detention Centers. SAA is a consultant to the Department of Homeland Security. LSR provided input to the medical ethics subcommittee of the Defense Health Board.

Citation: Rubenstein LS, Allen SA, Guze PA (2016) Advancing Medical Professionalism in US Military Detainee Treatment. PLoS Med 13(1): e1001930. doi:10.1371/journal.pmed.1001930

Author Affiliations:

Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America,

Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland,United States of America, University of California at Riverside School of Medicine, Riverside, California, United States of America



Leonard S. Rubenstein
Johns Hopkins Bloomberg School of Public Health/Johns Hopkins Berman Institute of Bioethics

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