When the health care professional has duties both to the person being treated or evaluated and to an authority such as a military command.

When a superior gives a health care professional an order that conflicts with ethical practice.

In the name of mission priorities or security, superiors may give orders that violate health professional ethics and standards of good care, and the health care professional is confronted with whether to disobey the order.

Diagnostic training and experience can be invaluable for assessing evidence of torture, for example, depression and post-traumatic stress disorder (PTSD) may be signs of severe abuse and long solitary confinement.

Health care professionals who witness torture or its signs and/or are told by patients about being tortured are faced with difficult questions about how to report it.

Professional associations advise health care professionals to report inmate torture, but mandatory reporting is not currently enforced by the associations or state licensing boards.

Q 1 Name four positions that are likely to involve dual loyalities.

A 1 +Military or prison physician, psychologist, nurse, medic +Physician expert witness +Police psychologist

Q 2 Give an example of a serious dual loyalty conflict.

A 2 + Doctor ordered to force feed prisoners against their will. + Health insurance doctor required to disallow claims for emerging therapies. + Researcher working for company minimizing disclosure of drug risks.

Q 3 Give an example of dealing with a dual loyalty conflict by addressing it before treatment starts.

A 3 +A prison doctor explains that he/she must report information important for maintaining inmate or staff safety. +A psychotherapist in private practice explains how insurance reporting may affect confidentiality.

Q 4 A Is a military doctor ethically required to disobey when ordered to threaten a prisoner with injection of a psychoactive drug that will not actually be administered?

Q 4 B Is a military doctor ethically required to disobey when ordered to inject a harmless bolus of saline to a prisoner who fears he is receiving a lethal injection?

Q 4 C Is a military doctor ethically required to disobey when ordered to inject a lethal drug into a prisoner?

A 4 A, B, C All of the Above must be disobeyed Adapted from J. Wesley Boyd, et al, (2007)

Q 5 When do you think solitary confinement is torture?

A 5 a The United Nations Rapporteur on Torture has declared that Solitary Confinement + can amount to torture for juveniles and persons with mental disabilities and should be abolished for them

A 5 b The United Nations Rapporteur on Torture has declared that Solitary Confinement + can be a breach of article 1 or 16 of Convention against Torture depending on reasons, conditions, length

A 5 c The United Nations Rapporteur on Torture has declared that Solitary Confinement + should be used only in very exceptional circumstances for as short a time as possible, and with numerous safeguards or it can become abusive*

Q 6 A Would this procedure be an effective way to report abuse in a military prison and why? + Report to the Army Inspector General.

Q 6 B Would this procedure be an effective way to report abuse in a military prison and why? + Speak with International Committee of the Red Cross (ICRC) inspectors.

Q 6 C Would this procedure be an effective way to report abuse in a military prison and why? + Contact a well-regarded investigative journalist

Q 7 Bills before two state legislatures require that health providers report torture of prisoners and other vulnerable patients under penalty of loss of license. Guidelines and whistleblower protections are provided. What is the value of such bills?