(Page 2 of 5)
P.H.: You write at length about the doctor-patient relationship and confi dentiality in your 2005 New England Journal of Medicine editorial. In what situations is it acceptable for doctors to breach confi dentiality and relay information they obtain from a patient to intelligence offi cials?
Bloche: The guarantee of confidentiality is not absolute either ethically or legally in the U.S. or abroad. It is well established in this country that a psychotherapist whose patient declares intent to seriously harm another person has an obligation to alert the police. In Tarasoff v. Regents of the University of California (1976), the Supreme Court of California affirmed the duty of a therapist to warn law enforcement. That duty has spread across the country and the world. There are all sorts of circumstances where physicians perform evaluations meant for third parties. An example is forensic psychiatry. To say that medical information should never be used for anything other than therapy would discount the entire fi eld of forensic psychiatry as unethical. Contrary to the literal language of the Hippocratic Oath, the use of medical information for non-therapeutic purposes is pervasive. In some cases, including interrogation at Guantánamo Bay, such use of medical information can be intentionally harmful.
P.H.: What is the response from the medical community to statements like that of Deputy Assistant Secretary of Defense David Tomberg saying that physicians have no doctor-patient relationship with detainees?
Bloche: The administration, especially Mr. Rumsfeld, has taken the position that the physician is not acting as a physician. Whether the position will change given Rumsfeld’s resignation remains to be seen.
Tomberg made the analogy that a physician who has learned
to fly can operate as a bomber pilot. I would agree with Tomberg
that a physician who fl ies as a bomber pilot has no additional
ethical obligations beyond those of any other bomber
pilots. His status as a physician is irrelevant because he is not
using his medical skill, judgment, knowledge, or aura of medical authority to fly his F-16. An error in this analogy arises
when a physician uses clinical skills, psychiatric training, or
medical knowledge to function as an advisor to interrogation
or as a gatekeeper to aggressive interrogation. In that case,
the physician uses his knowledge, judgment, and clinical aura
of humanity to harm a patient. To say that a physician is not
acting as a physician in this case is contradictory.
<<Previous | 1 | 2 | 3 | 4 | 5 | Next>>