Investigations
Dual Loyalty
Health professionals must serve–-without hesitation or compromise–-the best interest of their patients. Dual loyalty, resulting from third-party pressure to compromise this obligation, can create an ethical conflict for the practitioner and place the patient's human rights in jeopardy. Dual loyalty arises frequently in states that demand health professionals' complicity in the machinery of repression, but it also occurs in open societies, such as current US policies involving health professionals in coercive interrogations.
PHR has documented examples of health professionals subordinating the human rights of patients to perceived or real state interests. Health workers cross that bright ethical line when they:
- determine fitness of detainees to withstand torture;
- skew medical evaluations of refugees to support governments' interest in repatriation;
- deny information on reproductive health to women; and
- provide a lower standard of health care to members of disfavored ethnic or racial groups.
As a convener of an international working group of medical ethicists, human rights experts, and health practitioners, PHR explored how to structure a relationship between medical practice and the state that protects the independence of health professionals and promotes their ability to recognize and resist unethical demands and pressures.
The group's report, Dual Loyalty and Human Rights in Health Professional Practice: Proposed Guidelines and Institutional Mechanisms, created practical guidelines tailored to difficult settings when health professionals face the greatest risk of participation in human rights violations, such as when treating prisoners, members of the military, workers, immigrants and refugees, or when they provide medical evaluations for courts, administrative bodies, and employers.
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