First Do Some Harm

Mohammed, a 36-year-old graduate of Baghdad University's College of Art, says he was examined by an American physician in a detention facility near Baghdad International Airport shortly after being arrested in late 2003. “The doctor said, ‘Maybe you have a bullet wound you are not aware of,'” recalls Mohammed, sitting in a hotel room in Amman, Jordan, with a journalist and two American attorneys a year later. “I said, ‘Do you want me to take off my pants?' He said, ‘No, I'll just lift up your pant leg.'”

The physician pronounced Mohammed fit and ready for interrogation. But if the physician had been familiar with the ethical guidelines of the American Medical Association (AMA), he would have known that what he'd done was in violation of the AMA code, which states that “physicians should not treat individuals to verify their health so that torture can begin or continue.” And if the physician had remained in the vicinity after conducting a medical exam, he would have heard the screech of a horn blasted next to Mohammed's ear. Mohammed, who was released without charge on January 6, 2004, now suffers from hearing loss (his eardrum was ruptured) and has scars on his wrists from being manacled.

This physician is among dozens of doctors, psychiatrists, and psychologists who have taken on an entirely new role in the U.S. military. Their newly defined activities -- which include examining detainees before they're subjected to harsh interrogation techniques, preparing interrogation plans, and even participating in some interrogations in which detainees may be harmed -- raise questions about whether or not health professions should play such an role in the military's intelligence-gathering efforts. There has been little public discussion of the subject, and much of the debate at the AMA and at the American Psychological Association (APA) has taken place behind closed doors -- in some instances, with a number of military officers helping to guide the discussions.

* * *

Physicians in Chile, Iraq, Argentina, and other countries have been asked in past decades to participate in interrogation and torture sessions. The use of medical personnel and psychologists in U.S. interrogations, however, is a phenomenon that has emerged only in the global “war on terror.” Physicians and psychologists were initially assigned to this duty, according to a recent U.S. Army report, at Guantanamo Bay, Cuba, in 2002 and in Iraq in December 2003.

The report, which looked at detainee medical operations in Afghanistan, Iraq, and Guantanamo Bay, was based on interviews with 993 medical personnel and released by U.S. Army Surgeon General Kevin C. Kiley on July 5. Forty-eight medical personnel interviewed for the report say they were present during an interrogation in Iraq. Seven individuals say they provided medical care to an Iraqi detainee to allow the questioning to continue, including one individual who supplied IV fluids to a suspect who was dehydrated. Seventy-two medical personnel say they witnessed, documented, or were told about abuse in Iraq.

The author of the report, Major General Lester Martinez-Lopez, recommends that physicians and psychiatrists not be used in interrogations. Yet in a cover letter, Kiley rejects that recommendation. A senior Department of Defense official, speaking on background because the subject is “still under scrutiny,” says he believes physicians and psychiatrists will continue to be used in interrogations because they have special knowledge of human behavior and provide a “safety valve” for interrogations that could otherwise spin out of control. “Not to use them would be irresponsible,” he says.

It's true that the presence of physicians and behavioral scientists may help to curb any sadistic streak an interrogator might possess. In addition, the desire among physicians, psychiatrists, and psychologists to help protect the homeland from terrorist attacks is understandable. The AMA has clearly condemned the use of torture in public statements. But some human-rights activists have criticized the organization for not going far enough. “I would have liked to see the AMA take a stronger stand to address the specific allegations of medical complicity that have surfaced,” says Leonard S. Rubenstein, executive director of Physicians for Human Rights, which promotes worldwide health and human rights.

An AMA spokeswoman says she believes the association has addressed the subject forcefully. In June 2005, the AMA reaffirmed its support for the ethical treatment of detainees, she says, and encouraged medical schools to include “ethics training” on the issue. “As a result of media coverage regarding allegations, the AMA has provided its policy to the Department of Defense,” she writes in an e-mail. “AMA policy regarding physician participation in torture and/or abuse of prisoners is very clear -- it is unethical and unacceptable.”

With regard to the American Psychological Association, the situation is a bit murkier. The APA issued a report on “psychological ethics and national security” in June. The statement says psychologists can participate in interrogations if they follow military standards -- despite the fact that some experts say certain interrogative techniques used by the U.S. military violate international law.

“They say it's OK to follow the military's interpretation of the law even though the military is interpreting the law in a perverse way, allowing techniques that are considered to be torture,” says Rubenstein. Adds Robert Jay Lifton, a visiting professor at Harvard who's written extensively on the relationship of the medical professions to the state: “The statement sounds to me a bit scandalous because it fails to respect the traditional standards of being a psychologist. All this has to do with an increasing militaristic tendency in this country and a pressure on people to accept what are seen as military needs and to have them supercede ordinary ethical codes.”

Dr. Stephen Behnke, director of the APA's ethics office, sees it differently. “If you take a look at the report,” he says, “it uses four words to characterize the process: ‘Safe. Legal. Ethical. Effective.' I think people feel if the interrogation process is safe, legal, ethical, and effective, it's both appropriate to be involved and that psychologists have a role to ensure it remains that way.”

Interestingly, those same four words also appear in the Army report's description of Behavioral Science Consultation Teams, which use “forensic psychological expertise and consultation to assist the command in conducting safe, legal, ethical, and effective interrogation and detainee operations.” The echo may result from the fact that, of the task force's 10 members, five have either a national-security background or work for the Army. Colonel Morgan Banks, director of the Psychological Applications Directorate, U.S. Army Special Operations Command, at Fort Bragg, North Carolina, consults with “Army psychologists providing interrogation support,” according to a biographical statement on the APA Web site and confirmed by the military, and another, Colonel Larry C. James, chief of the Department of Psychology at Tripler Army Medical Center in Honolulu, Hawaii, served as chief psychologist at Guantanamo Bay in 2003 and as director of Abu Ghraib's Joint Interrogation and Debriefing Center in 2004.

“I'm not saying they acted in bad faith,” says Rubenstein. “But they ended up with people who were part of the interrogation apparatus.”

As long as physicians, psychiatrists, and psychologists are involved in interrogations, say human-rights experts, ethical challenges will remain, both for them and for lay people concerned about their role in society.

“I would emphasize the vulnerabilities of psychiatrists and psychologists to this kind of behavior -- both because they're sought out for it and also because they're drawn to it,” says Lifton. “Just because they're healers, not everything they do -- or are asked to do -- has a healing function.”

Tara McKelvey is a Prospect senior editor.

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