October 1st, 2014

Military medical ethics instruction lacking

Researchers say U.S. graduate students in psychology aren’t receiving enough instruction in military medical ethics.

Researchers at Harvard Medical School/Cambridge Health Alliance and other Boston-area institutions surveyed 185 students from 20 clinical psychology graduate programs; 74 percent had received less than one hour of instruction about military medical ethics, 97 percent received five hours or less.

Among study participants, 37 percent knew that the Geneva Conventions apply whether or not war has formally been declared. Forty-three percent didn’t know that the Geneva Conventions state that physicians should “treat the sickest first, regardless of nationality” and half didn’t know that the Geneva Conventions prohibit threatening or demeaning prisoners or depriving them of food or water.

Study co-author and psychologist Alice LoCicero, Ph.D., MBA, believes many people don’t understand the importance of this subject matter.

“Any clinical psychologist could be drafted at any time, even in the absence of a draft,” LoCicero says. LoCicero is referring to the Health Care Personnel Delivery System (HCPDS), authorized by Congress in the late 80s that established a process for Congress and the president to draft psychologists and other health care personnel for military service in time of need. Only five percent of students surveyed knew of the HCPDS.

Also, LoCicero says about one in eight psychologist members of the American Psychological Association are employed by or are working directly with the Department of Defense (DOD) or the Veterans Association (VA). “There are many, many psychologists who have reason to understand these ethics,” she says. The VA is the largest provider of clinical psychology internships in the U.S. and the APA cited the DOD and VA as “growth areas” where more psychologists will be needed, she says.

“One of the most difficult to treat forms of PTSD is when PTSD is experienced by someone who has a belief that they have behaved in a way that was against their own morals and ethics toward others,” she says. “Those are very hard cases of PTSD for people to recover from. So it’s important to know if you are working for the VA what the ethics should be.”

Additionally, “It is very likely many of us in clinical practice will work with returning veterans,” she says.

It’s important for psychologists to know when they, or the people they are working with, have violated the Geneva Conventions, she says. During this summer’s APA convention, LoCicero facilitated a discussion on “Doctors of the Dark Side.” “The film talks about doctors – including psychologists – who were involved in torture and degrading treatment at Guantanamo,” she says.

In the study, 48 percent of students could not state when they would be required to disobey an unethical order from a superior.

Study authors say they believe confusion on this matter may stem from what they say are contradictory policy documents from the APA: a 2005 presidential task force report that allowed for psychologists to participate in interrogations and “adhere to the requirements of the law” if there is a conflict between ethics and the law (this report was rescinded in 2013); and a 2008 APA policy referendum affirming that psychologists may not work in settings where persons are held outside of, or in violation of, either International Law or the U.S. Constitution unless they are working directly for the persons being detained or for an independent third party working to protect human rights.

The authors are calling for significantly increased education about human rights during psychology training to ensure psychologists are not susceptible to succumbing to public opinion or political pressure.

Study lead author J. Wesley Boyd, M.D., Ph.D., a psychiatrist at Cambridge Health Alliance and an assistant clinical professor of psychiatry at Harvard Medical School, says it’s important to educate psychologists early in their careers about what is right and wrong, and waiting for someone to actually be working in the military “may be too late.”

“I would like to see formal instruction beyond an hour or two in graduate programs in psychology everywhere,” he says. “And I would like to highlight the relationship between the military and psychology so all psychologists, irrespective of where they work, understand that the stakes are pretty darn high.”

By Pamela Berard

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