Preparing Physicians to Contend with the Problem of Dual Loyalty

Dual loyalty is defined as, particularly as it pertains to the field of medicine, a conflict or potential conflict between a healthcare professional’s simul- taneous obligations–expressed or implied–to a patient and to a third party. Dual loyalty situations often compromise physicians’ ethical behavior, lead- ing them to participate, either knowingly or unknowingly, in human rights violations perpetrated by a third party, often the state. Classic dual loyalty situations include the participation of physicians in state-sanctioned torture or the death penalty. However, there are a number of other dual loyalty scenarios that arise routinely in clinical practice in both closed institutions such as prisons, psychiatric facilities, and the military and in open societies promulgated by discriminatory practices, policies, and laws that can lead physicians and other health care professionals to contribute to the viola- tion of individuals’ human rights. Healthcare professionals are, for the most part, not formally trained to contend with these dual loyalty conflicts. While physicians routinely learn about bioethical frameworks to assist them in resolving difficult clinical dilemmas created, for example, by mod- ern technology that extends life or by limited resources, few are taught a human rights framework that can assist them in protecting patients’ human rights in cases of dual loyalty. This paper presents a case-based approach that utilizes a human rights framework for teaching dual loyalty in the undergraduate medical education curriculum. The medical profes- sion is in dire need of training its workforce to grapple with the myriad dual loyalty issues that confront the profession today, and must institute curriculum reform to prepare future health care professionals to deal with dual loyalty scenarios that threaten individuals’ human rights

Weaponizing Tear Gas: Bahrain’s Unprecedented Use of Toxic Chemical Agents Against Civilians.

The Bahraini government’s response to the early 2011 pro-democracy protests was brutal, systematic, and violent. In addition to birdshot and rubber bullets, government law enforcement attacked unarmed protestors with toxic chemical agents including tear gas. The government’s crackdown on the medical profession was especially harmful, as security forces arrested and detained doctors, raided health facilities, and obstructed patients from receiving necessary care. This report’s findings are based on field research that the authors conducted in Bahrain (April 2012) to investigate excessive use of force by law enforcement officials since June 2011—the end of Bahrain’s state of emergency. The medico-legal team conducted 102 in-depth interviews with Bahrainis who reported human rights violations, corroborating eyewitnesses to these alleged events, civil society leaders, and government officials. Other forms of corroboration that the team conducted or utilized in this study include: Physical examinations, evaluation of medical records, and review of radiographic, photographic, and video evidence. In addition, this report contains results from an analysis of 28 countries whose security forces have deployed toxic chemical agents against civilians in situations of civil unrest. This report documents two interconnected means by which the Bahraini government unlawfully uses toxic chemical agents against civilians: (1) Government authorities have routinely violated every U.N. principle governing police use of force. (2) Bahraini law enforcement officials have also effectively transformed toxic chemical agents into weapons used to assail Shi’a civilians

Stereospecific Opiate Binding in Human Erythrocyte Membranes and Changes in Heroin Addicts

Stereospecific opiate binding has been demonstrated in human erythrocyte membranes, having a Kd of 9-10(-9) M. In most respects the binding characteristics resemble those of synaptic membranes. These included the correlation of binding affinity and pharmacological potency of opiates; competition by naloxone; inhibition by Ca2+ and Na+; and sensitivity to phospholipases and trypsin. A comparison of stereospecific opiate binding in control human subjects and heroin addicts revealed a 43% increase in the addict group

Patterns of Anti-Muslim Violence in Burma: A Call for Accountability and Prevention

In this report, the authors documents how persecution of and violence against the Rohingya in Burma has spread to other Muslim communities throughout the country. Physicians for Human Rights conducted eight separate investigations in Burma and the surrounding region between 2004 and 2013. PHR’s most recent field research in early 2013 indicates a need for renewed attention to violence against minorities and impunity for such crimes. The findings presented in this report are based on investigations conducted in Burma over two separate visits for a combined 21-day period between March and May 2013

Developing Physician Educational Competencies for the Management of Female Genital Cutting: A Call to Action

Female genital cutting (FGC), also called female genital mutilation, is defined as “all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious, or other nontherapeutic reasons.” FGC can have significant health consequences, including multiple physical and psychological complications, throughout the life course. Despite violating numerous human rights and existing legal prohibitions, the practice continues. In the United States, FGC is becoming increasingly prevalent, however, physicians are not routinely trained to care for these patients. Despite the evidence of the need, there is a woeful lack of training regarding FGC in undergraduate, graduate, and continuing medical education programs. Furthermore, many health care providers (HCPs) are unaware of their mandatory reporting obligations regarding FGC under current state laws. There are no established educational competencies or training guidelines for incorporating FGC into all levels of medical education. This article establishes the need to develop competencies and underscores that models exist for undertaking this work. It also aims to engender dialog about FGC education and calls for launching an initiative to develop educational competencies to train HCPs about FGC. By integrating comprehensive, evidence-based education and training at all levels of medical education, HCPs will be able to provide high-quality, team-based, culturally sensitive care to the hundreds of thousands of affected women and girls in the United States, and work to prevent the practice from being carried out on girls who are at risk but have not yet been cut

Adolescent Girls, Human Rights and the Expanding Climate Emergency

Many adolescent girls—the poorest girls in the poorest communities—already live in an “emergency.” Humanitarian crises only amplify the call on their coping and caring capacities, while exacerbating their vulnerabilities. The frequency and intensity of emergencies, including natural disasters, conflicts, and infectious disease outbreaks such as Ebola, appear to be growing.1 These emergencies threaten entire communities and whole countries, often with global implications. Many become virtually permanent. The authors urge key actors responding to both the threats and opportunities that climate change poses to understand adolescent girls as exceptionally at risk on the one hand, and as exceptionally resilient and underengaged on the other. As a global community, we should be investing now in adolescent girls and centrally anchoring them in climate adaptation strategies. It may be one of the places where we can have the greatest effect on the future

Massacre in Central Burma: Muslim Students Terrorized and Killed in Meiktila

This report details the results of a Physicians for Human Rights (PHR) investigation into the March 20 and 21, 2013, attacks on Muslim students, teachers, and residents in the Mingalar Zayyone quarter of Meiktila, a small town in central Burma. A two-person team, the authors of the report, from PHR conducted 33 interviews about the attacks, which resulted in the deaths of at least 20 children and four teachers. The report details the attacks by the Buddhist mobs, provides evidence that local police officers were complicit in the crimes, and lists policy recommendations for the Burmese government and the international community

Under the Gun: Ongoing Assaults on Bahrain’s Health System

In February 2011, the Government of Bahrain began targeting health professionals who treated protesters. In April 2012, PHR\u27s Richard Sollom, Deputy Director, and Holly Atkinson, MD, FACP, past President of PHR\u27s Board and volunteer expert, authored a report showing the devastation on Bahrain\u27s health system that have resulted from the Government of Bahrain’s continued assault on doctors, patients, and the healthcare system

Adolescent Girls, Human Rights and the Expanding Climate Emergency

In recent history, the number and scale of natural disasters, one of the major causes of humanitarian emergencies, have increased markedly. From 2000 to 2009, compared with the period from 1980 to 1989, there were 3 times more natural disasters across the globe, with climate-related events accounting for nearly 80% of the increase. Since 2008, natural disasters such as floods, storms, and earthquakes have displaced an average of 26.4 million people per year. Even after adjusting for growth in population, the likelihood of being displaced by a disaster today is 60% higher than it was 40 years ago