The ‘Stain’ of Torture

The “Torture Report” is finally public, at least much of it, and it's been front-page news, and it is horrible, disgusting, shameful and embarrassing. Other nations not known for their respect for human rights such as China and Pakistan have already seized on the report's findings to point out that the U.S. no longer has any claim to higher moral ground on anything, and that's now become an even tougher charge to rebut than before. The report's appalling evidence is also really no surprise at all to anybody who has been following this sordid story. And for some, one of the worst aspects of all is the complicity of those in the “healing” professions. Remember the photos from Abu Ghraib, showing humiliating and pointless abuse of prisoners in the “war on terror"? And then last year, a front page New York Times story titled “Medical Ethics Violated at Dention Sites, A New Report Says"? That “blistering” report, from a committee of leading medical experts, found that, “Among the abuses cited in the report are doctors' force-feeding of hunger strikers by pushing feeding tubes into their noses and down their throats. The task force also suggested that medical personnel ignored their duty to report evidence of beatings or torture of detainees, and that the Defense Department “improperly designated licensed health professionals to use their professional skills to interrogate detainees as military combatants, a status incompatible with licensing"; and that “CIA medical personnel were present during waterboarding.”

The CIA and Defense Department denied all this, unsurprisingly. They've repeatedly classified all such actions as secret, to avoid too much sunlight. They also say that revealing what “we” have done would put more people in the field at risk, as if that has not already been one effect of torture. For other reports and even a United States judge have already called what the United States has done to detainees undeniable “torture.”

This is now a long and ugly story, but the healthcare professional sub-story is a bit less convoluted. One of the authors of the new report, Steven Miles MD, authored an entire book in 2006 taking the medical and psychological professions — and our government — to task for allowing and covering up torture. Even worse, as he noted, such “enhanced interrogation” techniques do not even “work,” but do increase the risk of backlash. Reviewing Miles' book for the San Francisco Chronicle, I concluded with a question: “Miles likens our nation's use of torture to a scourge that has infected us; he's now diagnosed it. Will denial continue, or will treatment and prevention follow?”

We now have a conclusive answer, at least regarding what has — or rather, has not — occurred up to now. Senator Dianne Feinstein fought long and hard, against even spying on her and her staff, to bring the new report to light at last. It confirms our worst fears and shames. Despite cries of political partisanship from Republicans and other apologists, a former senior CIA representative has confessed in a New York Times op-ed that, yes, he did torture; John McCain has risen above party lines to condemn all involved in such abuse, confirming that it does not elicit any desired information; two psychologists were paid over $80 million dollars — our tax dollars at work — to devise ways to abuse prisoners. And as it turns out, many of those prisoners were completely innocent.

Almost a decade back, in 2005, appalled by what had already come to light, I co-authored a letter to the New England Journal of Medicine noting that all military physicians are licensed by somebody and should be investigated if there were any suspicions of participation in torture, however defined. My co-author included a famed physician leader in the response to AIDS and a former United States Assistant Secretary of Health and Chancellor of UCSF, one of the world's leading medical centers. Our letter as published:

Participation of Health Care Personnel in Torture and Interrogation

To the Editor:

The profession of medicine has developed codes of ethical conduct over thousands of years. A central element of such codes is expressed in the imperative to “do no harm.” Disclosures with regard to the treatment of detainees by licensed medical personnel in the “war on terror” in Iraq, Afghanistan, and Guantanamo Bay, Cuba, have revealed undeniable breaches of medical ethics among U.S. military health care personnel involved at these — and perhaps other — sites. The International Red Cross has charged that some of the physical and emotional tactics used constitute cruel and unusual punishment.

 The Geneva Convention provides that medical personnel “shall not be compelled to perform or carry out work contrary to the rules of medical ethics.” The Code of Medical Ethics of the American Medical Association (AMA) states that “ethical obligations typically exceed legal duties.” The World Medical Association, of which the AMA is a member, prohibits participation even as a monitor in torture or abuse. The Uniform Code of Military Justice proscribes U.S. forces from engaging in cruelty, maltreatment, or oppression of prisoners and even from the threat of such harm. As the Nuremberg trials after World War II taught us, the extreme circumstances of times of war, whether declared or not, do not excuse physicians and other health care professionals from their ethical responsibilities.

Those who have served in the U.S. military know that there is a documented chain of command for every action. Health care personnel serving in the military all work under the authority of licensed military physicians, who are responsible for actions performed under their authority. We therefore call on the AMA and the American Psychological Association to request that relevant authorities act, at a minimum, as follows. First, the military must provide full disclosure of all medical personnel involved, directly or by chain of command, in the treatment of detainees in Iraq, Afghanistan, and Cuba — and elsewhere if relevant — since September 11, 2001. Second, the records and conduct of these personnel should be reviewed by the medical licensing boards, other responsible licensing authorities in each state where the military physicians are licensed, or both. Independent expertise in bioethical standards should be sought in conducting these reviews. Third, appropriate disciplinary action should be taken on the basis of the results of the reviews, and these actions should be made publicly available.

— Philip R. Lee; Marcus Conant ,University of California, San Francisco; Steve Heilig, Cambridge Quarterly of Healthcare Ethics

And the response? Although the NEJM is perhaps the most widely-read medical journal in the nation, if not the world, it seems we, along with Dr. Miles and all the others vocal in denouncing torture and calling for corrective action, were ignored. Now we have another compelling case for justice, and another chance to hopefully redeem some of the reputation of our healing professions and even our nation. Senator Feinstein has called for “reform.” Hopefully denial will not be the response this time. But I'm not holding my breath.