Air force doctor imprisoned for refusing third tour in Iraq
BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7547.931-c (Published 20 April 2006) Cite this as: BMJ 2006;332:931All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
There are good ethical arguments for UK military personnel to now
refuse to participate in the military involvement in Iraq as highlighted
by the case of Kendall-Smith [1]. But are there major ethical problems
with any association with the British military? Its possession of nuclear
weapons and its failure to make substantive progress phasing these out
[2], despite disarmament being legally required by Article VI of the
Nuclear Non-Proliferation Treaty (NPT), begs this question. Such a
requirement has also been reinforced by the International Court of Justice
ruling on the illegality of using nuclear weapons. Indeed, there are
concerns that rather than disarming, the UK Prime Minister favours
building a new generation of nuclear weapons to replace the Trident system
[3].
The Mutual Defence Agreement (MDA) between the US and the UK can be
considered to support nuclear proliferation by facilitating UK weapons
development. Furthermore, a legal opinion from respected UK lawyers has
concluded that: “In our view, it is strongly arguable that the renewal of
the MDA is in breach of the NPT” [4].
With the world facing such critical issues such as climate change,
environmental damage and poverty, are the huge sums involved in nuclear
military expenditure also unethical? For nuclear weapons this resource use
is massive with the UK Government recently announcing it intends to spend
more than £1 billion during the next three years to ensure the continued
reliability of the existing Trident warhead stockpile [2].
For these reasons, health workers with any links to the UK military
(and indeed all military personnel) should question their association from
an ethical perspective. Health professional organisations should also
consider isolating nuclear-capable militaries in the same way they have
worked to isolate other industries that cause widespread harm, such as the
tobacco industry.
References
[1] Dyer O. Air force doctor imprisoned for refusing third tour in
Iraq. BMJ 2006;332:931.
[2] Norris RS, Kristensen HM. British nuclear forces, 2005. Bulletin
of the Atomic Scientists 2005;61(6):77-79.
http://www.thebulletin.org/article_nn.php?art_ofn=nd05norris
[3] Marjorie Thompson M, Lewis J. A New Generation of Nuclear
Weapons? Guardian 2005(July 4):20.
http://politics.guardian.co.uk/foreignaffairs/comment/0,11538,1520673,00...
[4] Singh R, Chinkin C. Mutual Defence Agreement and the Nuclear Non-
Proliferation Treaty: Joint Advice. BASIC, the Acronym Institute for
Disarmament Diplomacy and Peacerights. 2004.
http://www.basicint.org/nuclear/MDAlegal.htm
Competing interests:
The author is chair of the New Zealand Affiliate of the International Physicians for the Prevention of Nuclear War (IPPNW)
Competing interests: No competing interests
I am a South African psychiatrist, living in South Africa. I have
read with great distress of the very recent sentencing of Flight Lt
Malcolm Kendall-Smith of the Royal Air Force for refusing to serve in
Iraq.
As a young white man in South Africa during the 1980's, I was subject
to compulsory military service - summoned to defend the apartheid
government through occupation of black townships and illegal invasion of
neighbouring states in Southern Africa. Like many others of conscience, I
objected and refused to participate in an unjust war. Many white South
African men went to jail as conscientious objectors, including several
doctors.
The British Government and Armed Forces are once again following the
lead of Bush and the American Right - this time disregarding
internationally recognised moral and ethical principles that bind doctors
to certain courses of action. In this way they are comparable to the
abhorent apartheid regime that almost destroyed South Africa. Thankfully,
in our case, the international community condemned and helped bring to an
end the regime. One wonders what has become of these strong moral voices
now that we again witness immoral leadership in powerful nations.
Flight Lieutenant Kendall-Smith is a physician who has encountered
abusive acts in the Gulf, committed by governments and military forces
with which he is associated. In terms of international codes of medical
ethics, he (and all his other medical military colleagues) are required to
take a moral stand. The World Medical Association (WMA) Declaration of
Tokyo, October 2004, (signed by both the UK and USA), states that "the
physician shall not countenance, condone or participate in the practice of
torture or other forms of cruel, inhuman or degrading procedures ... in
all situations, including armed conflict and civil strife." To be
associated with an armed force which has been found culpable of gross
violations of human rights, is unacceptable for a morally conscious
doctor. Medical ethics require the physician to defy orders if they are
contrary to the Hippocratic injunction to 'first do no harm.' Kendall-
Smith is not trying to be hero or "martyr" (as the tribunal alleged). He
is simply taking his ethical commitments as a doctor seriously.
The WMA Declaration also states that it is "the responsibility of the
organised medical profession:
1) to encourage doctors to honour their commitment as physicians to
serve humanity and to resist any pressure to act contrary to the ethical
principles governing their dedication to this task;
2) to support physicians experiencing difficulties as a result of
their resistance to any such pressure or as a result of their attempts to
speak out or act against such inhuman procedures."
In my view, medical professionals and the organised structures of the
medical profession (such as the WMA and the British Medical Association)
are morally obliged to stand by Kendall-Smith. If we are truly serious
about our ethical beliefs and pronouncements then we should together, and
with a sense of outrage, denounce this legal decision and protest loudly
this injustice against one of our colleagues. If we do not take up this
battle and fight for true justice, then we may as well throw our
Declarations in the rubbish bin and bow our heads in shame.
Competing interests:
None declared
Competing interests: No competing interests
It does seem fitting that UK authorities should choose Easter to
castigate someone who has sincere beliefs at variance with theirs about
the morality of their actions and his willingness to comply with them.
Kendall-Smith may be wrong in law but can be comforted that precedent
suggests history will remember his role much more favourably than that of
his judge and prosecutor.
Competing interests:
None declared
Competing interests: No competing interests
RAF doctor
Sorry, have sympathy but he took the Queens Shilling. As a medical
student 40 years ago I was tempted when a fellow student afforded an MGA
twin cam and I the train etc. We were supposed to be the top 3/4% schools
output in those days for nouse, I realised then, that the choice of an
MGA/being shot at and the train was no contest. If you can't stand the heat
stay out of the kitchen. He's probably too young to know of these old
sayings !
Competing interests:
None declared
Competing interests: No competing interests