Medical Students Ignorant Of Military Medical Ethics

The findings in a survey of medical students indicated that few received adequate training in military medical ethics, many were ignorant of a physician's responsibilities under the Geneva Conventions, and the overwhelming majority failed to realize that civilian physicians are subject to being drafted.

Dr. J. Wesley Boyd and his colleagues at Harvard Medical School, Boston, and the Cambridge (Mass.) Health Alliance, contacted 5,000 medical students at eight U.S. medical schools by e-mail and invited them to participate in the survey.

Overall, 1,756 students (35%) completed the survey, and of those, a little more than 5% reported having served in the military or having an obligation to serve in the future (Int. J. Health Services 2007;37:643–50).

Of the total, 94% had received less than 1 hour of instruction during medical school about the ethical obligations of the physicians serving in the military, 4.3% received 1–5 hours of instruction, and 1.5% received more than 5 hours of training.

About 6% of the students reported being “very familiar” with the Geneva Conventions, whereas 66% reported being “somewhat familiar” with them. However, despite this high level of stated familiarity, only 37% of the students correctly answered that the conventions apply regardless of whether or not one's country has formally declared war.

About two-thirds of students correctly stated that wounded individuals should be treated in the order of severity regardless of their nationality, but 27% incorrectly stated that they should treat their own soldiers according to the level of severity and only then tend to the wounded enemy.

Thirty-seven percent of the students did not know that the Geneva Conventions state that it's never acceptable to deprive prisoners of war of food or water, expose them to physical stresses such as heat, cold, and uncomfortable positions, or threaten them with physical violence even if those threats are not carried out.

The investigators asked the students under what circumstances an officer is ethically required to disobey a direct order from a superior: “when ordered to threaten a prisoner with injection of a psychoactive drug that will not actually be administered,” “when ordered to inject a harmless bolus of saline into a prisoner who fears he is receiving a lethal injection,” “when ordered to inject a lethal drug into a prisoner,” “all of the above,” or “none of the above.” Although 66% correctly answered “all of the above,” 27% thought that they were only required to disobey when actually injecting a lethal drug, and 6% said “none of the above.”

Congress approved the Health Care Personnel Delivery System in 1987, thereby establishing a specific process for drafting physicians that Congress and the president could activate within a matter of weeks. Only 3.5% of the students were aware of this system, and only 23.8% thought that a medical draft was more likely than a general draft. Less than 50% of the students would willingly serve in such a draft, with 34% saying that they would use all legal means to avoid service, about 7 % saying they would consider emigration, and just under 14% saying that they would refuse military induction as an act of civil disobedience.

“The fact is that most physicians–let alone medical students–are not familiar with the code of medical ethics,” Dr. Abraham L. Halpern said in an interview. “I feel that any course in medical ethics should absolutely include the worldwide acceptance of the Geneva Conventions.”

Dr. Halpern, who was not involved in the survey, is professor emeritus of psychiatry at New York Medical College, Valhalla. He said that when he has instructed medical students in ethics, he noticed that many of the seats in the lecture hall were empty, which he thinks shows that the students knew that they would never be tested on the material.

All medical ethics courses should include 'worldwide acceptance ofthe Geneva Conventions.' DR. HALPERN

The findings in a survey of medical students indicated that few received adequate training in military medical ethics, many were ignorant of a physician's responsibilities under the Geneva Conventions, and the overwhelming majority failed to realize that civilian physicians are subject to being drafted.

Dr. J. Wesley Boyd and his colleagues at Harvard Medical School, Boston, and the Cambridge (Mass.) Health Alliance, contacted 5,000 medical students at eight U.S. medical schools by e-mail and invited them to participate in the survey.

Overall, 1,756 students (35%) completed the survey, and of those, a little more than 5% reported having served in the military or having an obligation to serve in the future (Int. J. Health Services 2007;37:643–50).

Of the total, 94% had received less than 1 hour of instruction during medical school about the ethical obligations of the physicians serving in the military, 4.3% received 1–5 hours of instruction, and 1.5% received more than 5 hours of training.

About 6% of the students reported being “very familiar” with the Geneva Conventions, whereas 66% reported being “somewhat familiar” with them. However, despite this high level of stated familiarity, only 37% of the students correctly answered that the conventions apply regardless of whether or not one's country has formally declared war.

About two-thirds of students correctly stated that wounded individuals should be treated in the order of severity regardless of their nationality, but 27% incorrectly stated that they should treat their own soldiers according to the level of severity and only then tend to the wounded enemy.

Thirty-seven percent of the students did not know that the Geneva Conventions state that it's never acceptable to deprive prisoners of war of food or water, expose them to physical stresses such as heat, cold, and uncomfortable positions, or threaten them with physical violence even if those threats are not carried out.

The investigators asked the students under what circumstances an officer is ethically required to disobey a direct order from a superior: “when ordered to threaten a prisoner with injection of a psychoactive drug that will not actually be administered,” “when ordered to inject a harmless bolus of saline into a prisoner who fears he is receiving a lethal injection,” “when ordered to inject a lethal drug into a prisoner,” “all of the above,” or “none of the above.” Although 66% correctly answered “all of the above,” 27% thought that they were only required to disobey when actually injecting a lethal drug, and 6% said “none of the above.”

Congress approved the Health Care Personnel Delivery System in 1987, thereby establishing a specific process for drafting physicians that Congress and the president could activate within a matter of weeks. Only 3.5% of the students were aware of this system, and only 23.8% thought that a medical draft was more likely than a general draft. Less than 50% of the students would willingly serve in such a draft, with 34% saying that they would use all legal means to avoid service, about 7 % saying they would consider emigration, and just under 14% saying that they would refuse military induction as an act of civil disobedience.

“The fact is that most physicians–let alone medical students–are not familiar with the code of medical ethics,” Dr. Abraham L. Halpern said in an interview. “I feel that any course in medical ethics should absolutely include the worldwide acceptance of the Geneva Conventions.”

Dr. Halpern, who was not involved in the survey, is professor emeritus of psychiatry at New York Medical College, Valhalla. He said that when he has instructed medical students in ethics, he noticed that many of the seats in the lecture hall were empty, which he thinks shows that the students knew that they would never be tested on the material.

All medical ethics courses should include 'worldwide acceptance ofthe Geneva Conventions.' DR. HALPERN

The findings in a survey of medical students indicated that few received adequate training in military medical ethics, many were ignorant of a physician's responsibilities under the Geneva Conventions, and the overwhelming majority failed to realize that civilian physicians are subject to being drafted.

Dr. J. Wesley Boyd and his colleagues at Harvard Medical School, Boston, and the Cambridge (Mass.) Health Alliance, contacted 5,000 medical students at eight U.S. medical schools by e-mail and invited them to participate in the survey.

Overall, 1,756 students (35%) completed the survey, and of those, a little more than 5% reported having served in the military or having an obligation to serve in the future (Int. J. Health Services 2007;37:643–50).

Of the total, 94% had received less than 1 hour of instruction during medical school about the ethical obligations of the physicians serving in the military, 4.3% received 1–5 hours of instruction, and 1.5% received more than 5 hours of training.

About 6% of the students reported being “very familiar” with the Geneva Conventions, whereas 66% reported being “somewhat familiar” with them. However, despite this high level of stated familiarity, only 37% of the students correctly answered that the conventions apply regardless of whether or not one's country has formally declared war.

About two-thirds of students correctly stated that wounded individuals should be treated in the order of severity regardless of their nationality, but 27% incorrectly stated that they should treat their own soldiers according to the level of severity and only then tend to the wounded enemy.

Thirty-seven percent of the students did not know that the Geneva Conventions state that it's never acceptable to deprive prisoners of war of food or water, expose them to physical stresses such as heat, cold, and uncomfortable positions, or threaten them with physical violence even if those threats are not carried out.

The investigators asked the students under what circumstances an officer is ethically required to disobey a direct order from a superior: “when ordered to threaten a prisoner with injection of a psychoactive drug that will not actually be administered,” “when ordered to inject a harmless bolus of saline into a prisoner who fears he is receiving a lethal injection,” “when ordered to inject a lethal drug into a prisoner,” “all of the above,” or “none of the above.” Although 66% correctly answered “all of the above,” 27% thought that they were only required to disobey when actually injecting a lethal drug, and 6% said “none of the above.”

Congress approved the Health Care Personnel Delivery System in 1987, thereby establishing a specific process for drafting physicians that Congress and the president could activate within a matter of weeks. Only 3.5% of the students were aware of this system, and only 23.8% thought that a medical draft was more likely than a general draft. Less than 50% of the students would willingly serve in such a draft, with 34% saying that they would use all legal means to avoid service, about 7 % saying they would consider emigration, and just under 14% saying that they would refuse military induction as an act of civil disobedience.

“The fact is that most physicians–let alone medical students–are not familiar with the code of medical ethics,” Dr. Abraham L. Halpern said in an interview. “I feel that any course in medical ethics should absolutely include the worldwide acceptance of the Geneva Conventions.”

Dr. Halpern, who was not involved in the survey, is professor emeritus of psychiatry at New York Medical College, Valhalla. He said that when he has instructed medical students in ethics, he noticed that many of the seats in the lecture hall were empty, which he thinks shows that the students knew that they would never be tested on the material.

All medical ethics courses should include 'worldwide acceptance ofthe Geneva Conventions.' DR. HALPERN