Wednesday, May 6, 2009

Health professionals and torture

A new report by Congress finds that health professionals helped design coercive interrogating practices, including techniques like water-boarding, considered to be torture under U.S. and international law.

According to the Senate Armed Services Subcommittee "'interrogation team psychologists' [at Guantanamo Bay] discussed interrogation approaches, including use of 'religious oriented superstitions, varied schedules, shame, various disruptions of daily routines, and using ethnic interrogators.'" And this: "Two psychologists [named in the report] reviewed the materials, and generated a paper on al Qaeda resistance capabilities and countermeasures to defeat that resistance."

ACP's ethics manual states that:

"Physicians must not be a party to and must speak out against torture or other abuses of human rights ... Under no circumstances is it ethical for a physician to be used as an instrument of government to weaken the physical or mental resistance of a human being, nor should a physician participate in or tolerate cruel or unusual punishment or disciplinary activities beyond those permitted by the United Nations Standard Minimum Rules for the Treatment of Prisoners ... Interrogation is defined as a systematic effort to procure information useful to the purposes of the interrogator by direct questioning of a person under the control of the questioner. Interrogation is distinct from questioning to assess the medical condition or mental status of an individual."

In keeping with the obligation of physicians to "speak out against torture", ACP wrote to President Bush in October, 2003, to call for investigations into allegations that the U.S. may have engaged in unlawful interrogations including torture. ACP sent a follow up letter, on May 17, 2004. The White House responded as follows:

"As the President has said, Americans stand against and will not tolerate torture. American personnel are required to comply with all applicable United States laws, including the Constitution, Federal Statutes, and our treaty obligations with respect to treatment of detainees ... The United States will continue to take seriously the need to question terrorists who have information that can save lives, but will not compromise the rule of law or the value and principles that make our country strong. Torture is wrong no matter where it occurs, and under President Bush's leadership, the United States will continue to lead the fight to eliminate it everywhere."

In 2004 and 2005, ACP introduced two resolutions to the AMA House of Delegates to ask the AMA to support investigations into alleged torture and to reaffirm the AMA's opposition to physician involvement in unlawful interrogations. Both resolutions were adopted by the AMA with some modifications. The AMA's Council on Ethical and Judicial Affairs has issued an opinion that states, among other things, that "Physicians must neither conduct nor directly participate in an interrogation, because a role as physician-interrogator undermines the physician's role as healer and thereby erodes trust in the individual physician-interrogator and in the medical profession."

ACP also submitted comments to revisions in the Department of Defense's field manual on lawful interrogations, and also supported an amendment by Senator John McCain (R-AZ) to ban torture. The McCain amendment subsequently was enacted into law by Congress.

On March 3 of this year, ACP joined with the American Medical Association and American Psychiatric Association to support President Obama's executive order to ban torture.

So far, there has been no documented evidence that physicians (MDs/DOs) were "used as an instrument of government to weaken the physical or mental resistance of a human being," which speaks well of the medical profession. Yet it remains deeply disturbing to find that the U.S. government did engage in interrogation tactics that U.S. and international law define as torture, and that some non-physician health professionals were a party to it.

I know that some ACP members will question why the College involves itself in controversial issues like torture, especially given the risk our opinions will be politicized. But I think that it is admirable that ACP speaks out on human rights issues that are central to what it means to be a health care professional. And what is more central to professionalism than honoring physicians' ethical obligation to speak out against torture?

Today's question: What do you think?


PCP said...

Doctors should not torture. They should outright reject any participation in such activities.
The mission of our profession is to use our knowledge and skills to heal. "Do no harm" is our first principle. If we lose sight of this, then we start down the road of losing our patients trust.

Unknown said...

Unfortnately, there is evidence that MDs have participated in torture. I refer readers to the Qhatani interrogation log as one example
Countless others including failing to record torture related injuries, sending prisoners back to the custody of those who tortured them, making false statements about the cause of death, delaying finalization of death certificates of torture related homicides also occured and are documented in government records.
Steven Miles
Author: Oath Betrayed: America's Torture Doctors