With the escalation of terrorism worldwide in recent years, situations arise in which the perpetration of violence and the defense of human rights come into conflict, creating serious ethical problems. The Geneva Convention provides guidelines for the medical treatment of enemy wounded and sick, as well as prisoners of war. However, there are no comparable provisions for the treatment of terrorists, who can be termed unlawful combatants or unprivileged belligerents. Two cases of severely injured terrorists are presented here to illustrate (...) the dilemmas facing the medical staff that treated them. It is suggested that international legal and bioethical guidelines are required to define the role of the physician and auxiliary medical staff vis a vis injured terrorists. There are extreme situations where the perpetration of violence and the defense of human rights come into conflict, leading to serious ethical and psychological discord. Terrorists, using violence to create fear in order to further their political objectives, might require life-saving medical care if injured during the course of their terror activities. (shrink)

In March 2004, the European Court of Human Rights awarded Carol Glass and her son David 10 000 Euros compensation after doctors treated David contrary to his mother’s wishes, without a court order.1 Although dismissed by UK courts, the ECHR held that David’s article 8 right to privacy, and in particular his right to physical integrity, had been breached.Born in 1986, David Glass is severely mentally and physically disabled, requiring 24 hour care. In July 1998 after surgery to alleviate an (...) upper respiratory tract obstruction, David became critically ill and was put on a ventilator. Doctors thought he was dying. His condition improved briefly and he returned home only to be readmitted a few days later when doctors discussed the option of morphine to alleviate his distress. His mother refused, believing it would compromise his chance of recovery. She also made clear that she wanted David resuscitated if his heart stopped. Although the doctor managing David’s care noted the possible need for a court order in such cases of total disagreement, no order was sought. On 20 October 1998, diamorphine was administered to David and a DNAR notice placed on his medical notes. Relations between the Glass family and the doctors deteriorated rapidly, culminating in a fight in which two doctors were injured. Ms Glass applied unsuccessfully for a judicial review of the hospital’s decisions and was refused permission to appeal. Subsequently, the General Medical Council found the doctors innocent of serious professional misconduct and the Crown Prosecution Service declined to bring charges against them. Ms Glass then took her case to the European Court of Human Rights.The Glass family argued that when the dispute arose, the hospital should have involved the courts to clarify whether, despite his mother’s objections, the …. (shrink)

This article examines why U.S. healthcare professionals became involved in “enhanced interrogation,” or torture, during the War on Terror. A number of factors are identified including a desire on the part of these professionals to defend their country and fellow citizens from future attack; having their activities approved and authorized by legitimate command structures; financial incentives; and wanting to prevent serious harm from occurring to prisoners/detainees. The factors outlined here suggest that psychosocial factors can influence health professionals’ ethical decision-making.