Guantánamo medical providers face dilemma

The Constitution Project was recently released to the public. According to this report, the torture and abuse of enemy combatants detained in Guantánamo was “unquestionably” committed. In this report, physicians, nurses and other healthcare providers who serve the United States in uniform were also implicated in doing harm.

It is time to stop placing our dedicated military healthcare providers who serve in Guantánamo in the middle of a national security dilemma. It is not possible for the military healthcare professional to ethically serve both detainee patients and the state in the unique circumstances presented by Guantánamo. The individual human-rights of a rational detainee, including the right to die if he so chooses, should not be subordinated to the interests of the state.

There are a number of enemy combatants on a hunger strike in Guantánamo. Some of those detainees participating in this hunger strike are forced, against their will, to submit to the insertion of a tube, via their nose and into their stomach, so that nutrient substances can be administered. An intravenous solution may also be administered via a catheter inserted into a vein. These are interventions done in large measure to prevent death.

Herein, lays the dilemma of dual loyalties for physicians and other healthcare providers who have as a most basic tenet of their profession ‘to do no harm’ to the individual human being. Some health professionals take the Hippocratic Oath that states that their professional purpose is to “do good” and to assist the patient in healing. Other professionals may not take a specific oath but also have an obligation “to do no harm.” Essentially, this means in most all areas of healthcare delivery, treatments or therapies administered to the patient only follow the oral and written consent of that patient.

The Hippocratic Oath does not draw distinctions between classes of people.

A healthcare professional who serves this nation in our armed forces also takes an oath of office when receiving a commission — an oath to the U.S. Constitution. The oath obligates the officer to support and defend the Constitution; and to bear true faith and allegiance to the same; and that officer will faithfully discharge the duties of the office that is about to be entered. Essentially, this means that the medical officer will follow the legal orders of those who are of a senior rank even though that officer is not a subject matter expert in medicine.

Additionally, a healthcare professional is eligible for a commission in the armed forces because of certain requirements that must be met in order to obtain a state license to practice medicine, nursing, psychology, etc. The state in which the commissioned healthcare professional is licensed has oversight of the healthcare professional in the area of ethical practice.

In the context of Guantánamo, it is not ethically possible for our military healthcare providers to best serve the interests of the individual detainee, the interests of the nation or the state of licensure. Based upon these complex issues alone, closing Guantánamo should be high on the administration’s agenda.

These opinions are mine alone and do not reflect the opinion of the Naval War College, the U.S. Navy, the Department of Defense, or the U.S. Government.

Albert J. Shimkus, Jr., a professor of national-security affairs at the Naval War College in Newport, R.I., is the former commanding officer and chief surgeon for both of the Naval Hospital at Guantánamo Bay and Joint Task Force 160, which administered healthcare to detainees.

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