Tuesday, August 21, 2007

Bad Apples or the Whole Bunch?

A week or so ago I posted an entry about what looked to be a very interesting article, "The Role of the Physician: Eugene Sanger and a Standard of Care at the Elmira Prison Camp," in the most recent issue of The Journal of the History of Medicine and Allied Sciences.

I was especiialy struck by a very provocative statement in the abstract:

"This article places his actions at Elmira in the context of medical ethics, Army orders, and Northern opinion in 1864, and it will argue that the lack of Federal response to Eugene Sanger's poor record while serving at the prison set a precedent for inferior medical care of POWs by American military physicians."

Since then, I was able to obtain a copy of the article and have read it, and provide a few comments below.

In the main - as suggested by the title - the article is an estimable wartime biography of Dr. Eugene Sanger, the first Union surgeon at the Civil War POW camp at Elmira, New York. The author, Dr. Jesse Waggoner, a recent graduate of Duke University School of Medicine, used a variety of sources, including the Official Records, published prisoner memoirs (e.g., Anthony Keiley's 1866 memoir In Vinculis), period newspapers (e.g., Elmira Daily Advertiser), and Sanger's personal papers.

The article also touches on the unique role of the military physician and the corresponding unique moral dilemma that they face in wartime, what has been called "dual loyalty" - that is, the conflict between the duty as a patriot and the duty to assuage suffering, even of the enemy. This is a well-studied subject in medical ethics, and - as Waggoner points out - has received recent attention due to the abuses at Abu Grahib and Guantanamo. Recently, the Surgeon General's Office published a two-volume treatise on the subject, Military Medical Ethics, which includes essays in which professionals argue both sides of the question of whether the conflicts that arise between the ethos of their professions make it morally possible (or impossible) for physicians to serve in the military.

However, on his provocative premise that Sanger's behavior at Elmira "set a precedent for inferior medical care of POWs by American military physicians," Dr. Waggoner comes up short, and admits:

"it would be a mistake to draw a direct connection between the actions of Eugene Sanger at Elmira and those of American physicians in the prisons of Iraq, Cuba, and Afghanistan. Historical work on other POW camps in other American wars is needed to establish what links, if any, connect U.S. Army medical practices from one war to the next."

Still, he does draw the important conclusion that "the role of the physician in the POW camp setting was at least as ambivalent in 1864 as it is today."

I'm hoping to arrange an interview ith Dr. Waggoner to dig deeper into his interests, research, and conclusions.

Best Regards,

Jim Schmidt

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