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BY BILL BERKOWITZ

Doctors Enabling Torture

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.

17 NOVEMBER 2013

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 [1],

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

SUBJECTS (S.CATTORI)degrading treatment of detainees in U.S. custody and howsuch deviation from professional standards and ethicallyproper conduct occurred, including actions that were taken bythe U.S. Department of Defense (DoD) and the CIA to directthis conduct.”

“The American public has a right to know that the covenantwith its physicians to follow professional ethical expectationsis firm regardless of where they serve,” said Task Forcemember Dr. Gerald Thomson, Professor of MedicineEmeritus at Columbia University. “It’s clear that in the name ofnational security the military trumped that covenant, andphysicians were transformed into agents of the military andperformed acts that were contrary to medical ethics andpractice. We have a responsibility to make sure this neverhappens again.”

A broad array of “health professionals” and/or “medicalpersonnel,” including physicians, psychologists, registerednurses, nurse practitioners, physician assistants, corpsmen(U.S. Navy or Marine-­trained enlisted medical personnel),medics (U.S. Army-­enlisted medical personnel), andtechnicians, participated in, or enabled, torture of detainees.

The Task Force found that post-­9/11, U.S. governmentactions included “three key elements affecting the role ofhealth professionals in detention centers”:

1.“The declaration that as part of a ‘war on terror,’ individualscaptured and detained in Afghanistan, Pakistan, andelsewhere were ‘unlawful combatants’ who did not qualify asprisoners of war under the Geneva Conventions. Additionally,the U.S. Department of Justice approved of interrogationmethods recognized domestically and internationally asconstituting torture or cruel, inhuman, or degrading treatment.”

2. “The DoD and CIA’s development of internal mechanismsto direct the participation of military and intelligence-­agencyphysicians and psychologists in abusive interrogation andbreaking of hunger strikes. Although … the military and theCIA, … facilitated that involvement in similar ways, includingundermining health professionals’ allegiances to establishedprinciples of professional ethics and conduct throughreinterpretation of those principles.”

3. In 2004-­2005, “leaked documents began to reveal thosepolicies” that had previously been secret. “Secrecy allowedthe unlawful and unethical interrogation and mistreatment ofdetainees to proceed unfettered by established ethical

principles and standards of conduct as well as societal,professional, and nongovernmental commentary and legalreview.”

To set the U.S. government’s torture policy into motion, itdisregarded previous established interrogation guidelines, andviolated the Geneva Conventions and the Convention AgainstTorture and Other Cruel, Inhuman or Degrading Treatmentand Punishment, treaties that the U.S. was “bound to follow.”

According to Ethics Abandoned, “officials at the highest levelsof the government rejected these guidelines, however, statingthat they believed traditional methods of interrogation were tootime-­consuming to prevent feared imminent attacks. As aresult, almost immediately after 9/11, the U.S. governmentadopted abusive methods of interrogation.”

Torture of prisoners began in earnest in late 2001, whenthose detained “at detention facilities at Bagram Air Base andin Kandahar, [were subject] to beatings, exposure to extremecold, physical suspensions by chains, slamming into walls,sleep deprivation, constant light, and forced nakedness andothers forms of humiliating and degrading treatment.”

What started as trial by torture – a little of this and a little ofthat – soon developed into “a theory of interrogation … thatwas based on inducing fear, anxiety, depression, cognitivedislocation, and personality disintegration in detainees tobreak their resistance against yielding information.”

While torture methods were being experimented with anddeveloped, Bush Administration officials began laying “thelegal groundwork for a policy that would abandon restrictionson torture and cruel, inhuman, or degrading treatmentimposed by treaty obligations and U.S. criminal law.” By early2002, in a monumental decision, ”the White House counseldeclared that the Geneva Conventions did not apply todetainees at Guantánamo.”

A secret memorandum from the Justice Department’s Officeof Legal Counsel, issued in response to a CIA request,“claimed that an initial core set of 10 ‘enhanced’ methodscould be used legally as part of the interrogation programdesigned for Abu Zubaydah, a designated high-­valuedetainee. The memorandum restricted the definition of severemental or physical pain or suffering in a manner that permitteddraconian interrogation methods, including attention-­grasping(grasping a detainee with both hands and drawing him towardthe interrogator), throwing a detainee repeatedly against a

wall, facial holds (forcibly holding the head immobile), facialslaps, cramped confinement, wall-­standing (forcing a detaineeto support his weight on his fingers against a wall), stresspositions, sleep deprivation, use of insects, andwaterboarding.”

The limited role for health professionals during CIA-­run torturesessions grew. By 2005, the initial set of 10 “enhanced”methods grew to 14. Time for sleep deprivation increasedfrom no more than 48 hours to 180 hours: “Detainees werekept awake by being shackled in a standing position, handsto the ceiling and feet to the floor, fed by detention personneland diapered so that nothing interfered with the standingposition.”

The detainees were nude;; cold water-­dousing of nudeprisoners, 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,” wasdescribed in 2005 “as causing the sensation of drowning andcarrying risks of aspiration, airway blockage, and death fromasphyxiation.”

From the early round up of prisoners in Afghanistan and Iraqto the establishment of Guantanamo, medical care,particularly mental health care was woefully inadequate: InIraq and Afghanistan, evidence shows that clinical medicalpersonnel were not isolated from interrogations as atGuantánamo;; they engaged in various aspects ofinterrogation as well as other security functions. Physiciansreportedly monitored interrogations and psychiatrists signedoff on interrogation plans involving sleep deprivation.”

Prisoner abuse went routinely unreported by medicalpersonnel. The report points out that “Even as the use oftorture by the military began to decline in 2005 and 2006 whena new DoD interrogation field manual was issued thatprohibited the use of many (but not all) highly coercivemethods, physicians and nurses became involved inunethical force-­feeding and use of restraint chairs in breakinghunger strikes.”

The Department of Defense instituted three “changes inethical standards and policies to rationalize and facilitatemedical and psychological professionals’ participation ininterrogation.” Do no harm descended into avoid or minimizeharm. Another DoD change “involved conflating ethicalstandards for health professionals involved in interrogationwith 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 | November 16, 2013

[1] http://hrp.law.harvard.edu/wp-­content/uploads/2013/11/IMAP-­EthicsTextFinal2.pdf

Source:

http://www.smirkingchimp.com/thread/bill-­berkowitz/52728/doctors-­

enabling-­torture