American physicians and dual loyalty obligations in the "war on terror".

"How classifying captured detainees as "unlawful combatants" can give rise to conflicts of interest for the military physician In October 2001 there were at least 4 603 physicians in the U.S. Reserves and National Guard. [13] Their breakdown was as follows: Army Reserve: 1738; Naval Reserve: 1044; Air Reserve: 754; Army National Guard: 628; and Air National Guard: 439. History has shown that physicians of the detaining power are not above being complicit in detainee abuse. [14] "Prisoner of war" status entitles detainees to basic rights under several international treaties, including the 1949 Third Geneva Convention. The American government has side-stepped these obligations by labeling many Afghan war detainees and terrorist suspects "unlawful combatants". To assess the legitimacy of this classification one must distinguish between using the words ["unlawful" combatant] to denote a concept / notion and using the term ["unlawful combatant"] to denote a distinct label. The use of the term "unlawful combatant" to classify the above persons into a distinct category of detainees is problematic for two reasons. First, while the notion of an "unlawful" combatant is arguably recognized in international law (for example, it could be said that those who commit war crimes lose some of their protected status as they are "unlawful" combatants) this is not applicable to the Afghan detainees and other terror suspects (who have neither been charged with, nor found guilty of, war crimes). Second, the use of this particular classification as a distinct label is unrecognized in international law. Disregard of international humanitarian law can easily lead to degrading and/or abusive treatment of detainees. This could impact negatively on the mental and physical health of detainees. The term "unlawful combatant" could potentially give rise to two disturbing possibilities: (a) detainees classified as such would arguably not be protected from questionable interrogation techniques considered unlawful in international law; [15] and (b) detaining authorities could potentially subject detainees to poor detention conditions with impunity. These scenarios could conceivably cause at least two different conflicts of interests for military physicians treating detainees classified as such. If the detainee is being subjected to poor detention conditions or "robust interrogation" by the detaining power, state physicians could experience a conflict of interest between: (a) their duty to care for, and protect, a legally unprotected detainee (according to the American position) against abusive treatment (which would ideally require the physician to actively protest against, or report, such treatment to the appropriate authorities); and (b) their patriotic duty to protect and serve the interests of their country (which might arguably require the physician to remain silent about such treatment). Conversely, the American government's openly negative views towards terror suspects and the Afghan detainees could influence state physicians to not want to provide reasonable care to, or protect the interests of, such detainees. This could conceivably occur where physicians come to believe (rightly or wrongly) in the detainee's complicity or guilt in actual, inchoate, or prospective crimes against their country. This mindset could conflict with the physician's ethical duty to care for the detainee. Competing interests None declared."