What Med Students Don’t Know About the ‘Doctor Draft’

Medical students are ill informed about military medical ethics, the Geneva Conventions, and laws governing the drafting of doctors, according to a study from the Cambridge Health Alliance.

The Internet-based questionnaire surveyed 1,756 medical students at eight medical schools across the country. Of those, about 94 percent replied that they had received less than one hour of instruction about military medical ethics and only 3.5 percent were familiar with legislation regarding the “doctor draft.” In 1987, Congress approved the draft plan, called the Health Care Personnel Delivery System (HCPDS), which gives the legislative and executive branches the power to begin drafting civilian physicians within a matter of weeks of implementing the authorized HCPDS plan.

“The HCPDS allows few exemptions and assumes a priori that physicians practicing in the civilian sector are physically fit for military service,” the study reports; it appears in the current quarterly issue of International Journal of Health Services.

Nearly 34 percent of respondents were unaware that the Geneva Conventions mandate that physicians “treat the sickest first, regardless of nationality,” and the same percentage could not state when it would be appropriate to disobey an unethical order.

“Medical students should be taught more about respect for human rights in general and military medical ethics in particular,” said Wesley Boyd, lead author of the study and an HMS clinical instructor in psychiatry at Cambridge Hospital. Steffie Woolhandler, HMS associate professor of medicine at Cambridge Hospital and Massachusetts General Hospital, is the senior author.

Approximately five percent of those surveyed had past, current, or future military obligations. Of this group, about 15 percent were aware of HCPDS. More of those with military obligations than those without said they were very familiar with the Geneva Conventions. Yet their answers revealed they were no more informed than their classmates.

“One surprising finding is that over six percent of our respondents said they would be willing to kill a detainee with a lethal injection and would not countermand an order to do so,” Boyd said.

Responses did not vary significantly by gender, expected year of graduation, expected choice of medical specialty, or medical school.