Thursday, December 11, 2014

Health Professionals and Torture (revisited)

What ever happened to “first, do no harm?”

One of the findings included in a Senate investigative committee’s report on the US government’s post-9/11 torture program was that it was designed by two psychologists.  They were paid “$80 million to develop torture tactics that were used against suspected terrorists in the wake of the September 11 attacks on the Pentagon and the World Trade Center”—including “waterboarding and mock burial on some of the CIA’s most significant detainees.”  (This isn’t the first time that the involvement of these two psychologists has been made public, but the new report provides more detail on their role—and the methods used).

The idea that a healthcare professional designed—and reportedly, personally helped administer—the torture of detainees would appear to me to be an appalling violation of professional ethics.

In 2009, I wrote in this blog about the ACP’s efforts to pressure the U.S. government to prohibit torture of detainees.  I noted then that the College’s ethics manual clearly 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."

I also reported that, in 2003, ACP wrote to then-President George W. Bush to urge his administration to investigate allegations that the U.S. may have engaged in unlawful interrogations including torture, and again, in a follow up letter dated May 17, 2004.  This is what the White House told us in response:

“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."

We now know from the Senate report that the White House response to us does not square with the facts.

I am proud of the ACP’s role in speaking out against torture, which also included introducing a resolution to the AMA House of Delegates, and supporting an amendment by Senator John McCain to codify a ban on torture.  And, on March 3 of 2009, we joined with the American Psychiatric Association to support President Obama’s executive order banning torture.

But it is disheartening to find that despite our efforts, torture was used against prisoners detained by the U.S. government, and that the program itself was designed by mental health professionals. Yes, it is true that they were psychologists, not MDs or DOs, so arguably, they are not governed by the ACP’s code of ethics, or that of the American Psychiatric Association.

But they should have been expected to honor the American Psychological Association’s standards of ethics, which clearly states that “Any direct or indirect participation in any act of torture or other forms of cruel, degrading or inhuman treatment or punishment by psychologists is strictly prohibited. There are no exceptions. Such acts as waterboarding, sexual humiliation, stress positions and exploitation of phobias are clear violations of APA's no torture/no abuse policy.”  

Moreover, the psychologists’ association has just released a statement on the Senate report, in which it states that “two psychologists mentioned prominently in the report under pseudonyms, but identified in media reports as James Mitchell and Bruce Jessen, are not members of the American Psychological Association. Jessen was never a member; Mitchell resigned in 2006. Therefore, they are outside the reach of the association’s ethics adjudication process. Regardless of their membership status with APA, if the descriptions of their actions are accurate, they should be held fully accountable for violations of human rights and U.S. and international law.”

Good for them!  The question is, will these psychologists be able to keep their licenses? Will they be held accountable for violations of human rights and U.S. and international law?

Today’s questions:  What is your reaction to the report on the U.S. torture program?  Are physicians and other health professionals doing enough to speak out against torture?  And what do you think should be done to hold the two psychologists involved accountable for their actions?

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