How death should be measured was a subject of intense debate during the late 1960s, and one in which transplant surgeons had a particular interest. Legislation required a doctor to first pronounce ‘extinct’ the patients from whom ‘spare parts’ were sought for grafting. But transplant surgeons increasingly argued the moment of death was less important than was the moment of establishing that a patient was beyond the point of no return in dying, at which time she or he should be passed to the transplant team. This raised concerns that people identified as being a potential source of organs might not be adequately cared for in their own right. In 1968 the World Medical Association issued an international statement on death at its meeting in Sydney, Australia following a debate between delegates about how and by whom death should be assessed prior to organ removal. Soon afterwards Australian surgeons performed two of the one hundred and five heart transplants carried out around the world that year, dubbed by the New York Times to be one during which an ‘international epidemic’ of such grafts were carried out. This essay examines debates about death and transplanting, then analyses the pioneering Australian heart transplants, in the context of the Declaration of Sydney and continuing international discussions about whether these operations were moral and legal.

This article describes the role of transnational anti-apartheid activism in South Africa, Britain and the United States in generating international moral outrage over the readmission of the Medical Association of South Africa (MASA) to the World Medical Association (WMA), which had taken place in 1981 after it had withdrawn from that body in 1976. It discusses an example of a controversy where an international health organisation (IHO) lost moral authority as a result of being accused of white supremacy and a pro-American engagement in Cold War politics. At the time of its readmission to the WMA, the MASA was controversial because of its failure to strike off its membership roll one of the doctors implicated the death in detention of Black Consciousness leader Steve Biko in 1977. It details how these activists viewed the American Medical Association as having campaigned for the MASA’s readmission. The WMA’s readmission of the MASA cost the former its relationships with the World Health Organisation (WHO) and the British Medical Association – a dispute which continued until South Africa’s democratic transition of 1994. With its focus on transnational activism in relation to the WMA and the effects of activists’ allegations of racism on its internal politics, this article contributes to the literature on the history of IHOs. Ultimately, this controversy shows the deficiency of international medical professional associations as ethical arbitrators of last resort.

Physicians and other licensed health professionals are involved in force-feeding prisoners on hunger strike at the US Naval Base at Guantanamo Bay (GTMO), Cuba, the detention center established to hold individuals captured and suspected of being terrorists in the wake of September 11, 2001. The force-feeding of competent hunger strikers violates medical ethics and constitutes medical complicity in torture. Given the failure of civilian and military law to end the practice, the medical profession must exert policy and regulatory pressure to bring the policy and operations of the US Department of Defense into compliance with established ethical standards. Physicians, other health professionals, and organized medicine must appeal to civilian state oversight bodies and federal regulators of medical science to revoke the licenses of health professionals who have committed prisoner abuses at GTMO.

DoughertySM, LeaningJ, GreenoughPG, BurkleFMJr. Hunger Strikers: Ethical and Legal Dimensions of Medical Complicity in Torture at Guantanamo Bay. Prehosp Disaster Med. 2013;28(6):1-9.