November 18, 2013
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If you thought the U.S.’s involvement in the torture of prisoners
detained in the “war on terror” was limited only to U.S. military
personnel, intelligence officers, wrongheaded prison guards, or, through
“extraordinary rendition,” handled by foreign proxies, think again. A
new report from The Task Force on Preserving Medical Professionalism in
National Security Detention Centers has found that since 9/11, “Military
and intelligence-agency physicians and other health professionals,
particularly psychologists, became involved in the design and
administration of that harsh treatment and torture — in clear conflict
with established international and national professional principles and
laws.”
According to the recently issued
Ethics Abandoned: Medical Professionalism and Detainee Abuse in the War on Terror,
medical practitioners were involved in such activities as “designing, …
and enabling torture and cruel, inhumane and degrading treatment” of
detainees. And while the DoD has claimed that it has taken steps to
remediate the problems, “including instituting a committee to review
medical ethics concerns at Guantanamo Bay Prison,” the report’s authors
say that these efforts fall far short of being meaningful.
The
report pointed out that in 2010, the institute on Medicine as a
Profession (IMAP) and the Open Society Foundations convened the Task
Force on Preserving Medical Professionalism in National Security
Detention Centers “to examine what is known about the involvement of
health professionals in infliction of torture or cruel, inhuman, or
degrading treatment of detainees in U.S. custody and how such deviation
from professional standards and ethically proper conduct occurred,
including actions that were taken by the U.S. Department of Defense
(DoD) and the CIA to direct this conduct.”
“The American public
has a right to know that the covenant with its physicians to follow
professional ethical expectations is firm regardless of where they
serve,” said Task Force member Dr. Gerald Thomson, Professor of Medicine
Emeritus at Columbia University. “It’s clear that in the name of
national security the military trumped that covenant, and physicians
were transformed into agents of the military and performed acts that
were contrary to medical ethics and practice. We have a responsibility
to make sure this never happens again.”
A broad array of “health
professionals” and/or “medical personnel,” including physicians,
psychologists, registered nurses, nurse practitioners, physician
assistants, corpsmen (U.S. Navy or Marine-trained enlisted medical
personnel), medics (U.S. Army-enlisted medical personnel), and
technicians, participated in, or enabled, torture of detainees.
The
Task Force found that post-9/11, U.S. government actions included
“three key elements affecting the role of health professionals in
detention centers”:
1.“The declaration that as part of a ‘war on
terror,’ individuals captured and detained in Afghanistan, Pakistan, and
elsewhere were ‘unlawful combatants’ who did not qualify as prisoners
of war under the Geneva Conventions. Additionally, the U.S. Department
of Justice approved of interrogation methods recognized domestically and
internationally as constituting torture or cruel, inhuman, or degrading
treatment.”
2. “The DoD and CIA’s development of internal
mechanisms to direct the participation of military and
intelligence-agency physicians and psychologists in abusive
interrogation and breaking of hunger strikes. Although … the military
and the CIA, … facilitated that involvement in similar ways, including
undermining health professionals’ allegiances to established principles
of professional ethics and conduct through reinterpretation of those
principles.”
3. In 2004-2005, “leaked documents began to reveal
those policies” that had previously been secret. “Secrecy allowed the
unlawful and unethical interrogation and mistreatment of detainees to
proceed unfettered by established ethical principles and standards of
conduct as well as societal, professional, and nongovernmental
commentary and legal review.”
To set the U.S.
government’s torture policy into motion, it disregarded previous
established interrogation guidelines, and violated the Geneva
Conventions and the Convention Against Torture and Other Cruel, Inhuman
or Degrading Treatment and Punishment, treaties that the U.S. was “bound
to follow.”
According to Ethics Abandoned, “officials at the
highest levels of the government rejected these guidelines, however,
stating that they believed traditional methods of interrogation were too
time-consuming to prevent feared imminent attacks. As a result, almost
immediately after 9/11, the U.S. government adopted abusive methods of
interrogation.”
Torture of prisoners began in earnest in late
2001, when those detained “at detention facilities at Bagram Air Base
and in Kandahar, [were subject] to beatings, exposure to extreme cold,
physical suspensions by chains, slamming into walls, sleep deprivation,
constant light, and forced nakedness and others forms of humiliating and
degrading treatment.”
What started as trial by torture – a little
of this and a little of that – soon developed into “a theory of
interrogation … that was based on inducing fear, anxiety, depression,
cognitive dislocation, and personality disintegration in detainees to
break their resistance against yielding information.”
While
torture methods were being experimented with and developed, Bush
Administration officials began laying “the legal groundwork for a policy
that would abandon restrictions on torture and cruel, inhuman, or
degrading treatment imposed by treaty obligations and U.S. criminal
law.” By early 2002, in a monumental decision, ”the White House counsel
declared that the Geneva Conventions did not apply to detainees at
Guantánamo.”
A secret memorandum from the Justice Department’s
Office of Legal Counsel, issued in response to a CIA request, “claimed
that an initial core set of 10 ‘enhanced’ methods could be used legally
as part of the interrogation program designed for Abu Zubaydah, a
designated high-value detainee. The memorandum restricted the definition
of severe mental or physical pain or suffering in a manner that
permitted draconian interrogation methods, including attention-grasping
(grasping a detainee with both hands and drawing him toward the
interrogator), throwing a detainee repeatedly against a wall, facial
holds (forcibly holding the head immobile), facial slaps, cramped
confinement, wall-standing (forcing a detainee to support his weight on
his fingers against a wall), stress positions, sleep deprivation, use of
insects, and waterboarding.”
The limited role for health
professionals during CIA-run torture sessions grew. By 2005, the initial
set of 10 “enhanced” methods grew to 14. Time for sleep deprivation
increased from no more than 48 hours to 180 hours: “Detainees were kept
awake by being shackled in a standing position, hands to the ceiling and
feet to the floor, fed by detention personnel and diapered so that
nothing interfered with the standing position.”
The detainees were
nude; cold water-dousing of nude prisoners, not included in the 2002
memo, was now allowed; and waterboarding “described only briefly in
2002, [as aiming] … to induce the feeling and threat of imminent death,”
was described in 2005 “as causing the sensation of drowning and
carrying risks of aspiration, airway blockage, and death from
asphyxiation.”
From the early round up of prisoners in Afghanistan
and Iraq to the establishment of Guantanamo, medical care, particularly
mental health care was woefully inadequate: In Iraq and Afghanistan,
evidence shows that clinical medical personnel were not isolated from
interrogations as at Guantánamo; they engaged in various aspects of
interrogation as well as other security functions. Physicians reportedly
monitored interrogations and psychiatrists signed off on interrogation
plans involving sleep deprivation.”
Prisoner abuse went routinely
unreported by medical personnel. The report points out that “Even as the
use of torture by the military began to decline in 2005 and 2006 when a
new DoD interrogation field manual was issued that prohibited the use
of many (but not all) highly coercive methods, physicians and nurses
became involved in unethical force-feeding and use of restraint chairs
in breaking hunger strikes.”
The Department of Defense instituted
three “changes in ethical standards and policies to rationalize and
facilitate medical and psychological professionals’ participation in
interrogation.” Do no harm descended into avoid or minimize harm.
Another DoD change “involved conflating ethical standards for health
professionals involved in interrogation with general legal standards.”
As
hunger strikes -- defined as total fasting with only water ingested for
more than 72 hours by a mentally competent, non-suicidal person for the
purpose of obtaining an administrative or political goal rather than
self-harm – became a weapon of the detainees, more health professional
became involved in force-feeding sessions.
Ethics Abandoned points
out that “International ethical standards and guidelines for treatment
established by the World Medical Association and U.S. national medical
practice standards guide both physicians and detention facilities
responses to hunger strikes. Physicians have the ethical responsibility
to determine if a prisoner’s action is indeed a hunger strike; ensure
the hunger striking individual’s well-being; determine the individual’s
competence to make informed decisions; counsel the individual regarding
the consequences and risks of extended food refusal and the options he
or she has; determine whether the individual’s decisions are made freely
and without coercion; and see to the medical care of the individual
during the hunger strike.”
Instead of advocating for the hunger
strikers, many of the health providers became involved with
force-feeding in restraint chairs, an often violent and painful method.
According to the report’s authors, “the force-feeding policies undercut
necessary, ongoing physician-patient relationships and independent
medical judgment,” and as of the writing of the report, they had not
been able to ascertain current policy of hunger strikes, which are
continuing.
"We now know that medical personnel were co-opted in
ways that undermined their professionalism," said Open Society
Foundations President Emeritus Aryeh Neier. "By shining a light on
misconduct, we hope to remind physicians of their ethical
responsibilities."
Bill Berkowitz is a freelance writer covering conservative movements and politics.
