Doctors, psychologists and other medical professionals participated in the U.S. government's controversial torture and interrogation programs following 9/11, according to a new joint report from a task force funded by the Institute of Medicine as a Profession and Open Society Foundations. The report also states that although President Barack Obama has rescinded the legal memos that once justified torture, problems remain with the Department of Defense's physician policies and procedures.
The report is one of the most comprehensive publications to date that focuses exclusively on the role health professionals played in both the Department of Defense and CIA's detention and interrogation programs following 9/11. It was compiled using only publicly available information, and stresses that the picture is incomplete because so much information is still classified.
Much of the report is dedicated to the role doctors, nurses and other healthcare providers play in force-feeding detainees who engage in a hunger strike. "The DoD's policies and procedures are not completely in accord with medical ethics, principles, and guidelines," says Gerald Thomson, professor of medicine at Columbia University and a member of the task force that authored the report. He calls the Department of Defense's hunger strike policy an "egregious" violation of medical ethics, in part because "it didn't happen in secret." He adds that if the medical community and the public at large "can't do anything about that, we all become part of the problem."
The international standard on hunger strikers forbids health providers from participating in force-feeding mentally competent prisoners, as articulated by the World Medical Association's Declaration of Malta. As of November 4th, 14 detainees at the U.S. military prison at Guantanamo are designated for force-feeding.
"The policy on treatment of those not eating is focused solely on preserving the life and health of detainees in DoD custody, and is line with well-established U.S. law," says Department of Defense spokesperson Todd Breasseale. In June, a federal judge said she lacked jurisdiction to end the practice of force-feeding at Guantanamo, though she said Obama has the authority to stop it. "The Department will not knowingly allow a detainee to commit suicide," Bresseale adds. "Not by means of a weapon, medication, nor self- or peer-imposed starvation."
The report alleges that military and CIA physicians oversaw the torture of detainees to ensure they didn't suffer "severe harm" – a phrase that comes from a legal definition of torture, in contrast with the traditional professional responsibility of doctors to "do no harm." CIA medical personnel were tasked with being present for waterboarding to perform an emergency tracheotomy if interrogators damaged the detainee's windpipe. Thomson says that in his professional opinion, such guidelines are "patently ridiculous.
The report criticizes the Defense Department and CIA for asking physicians to wear two hats – that of healthcare provider and interrogation supporter. But in the early days of Guantanamo, the report indicates that medical personnel "providing clinical care were not directly engaged in interrogation support."
Albert Shimkus, a member of the task force and a retired Navy captain, says that while he oversaw the Navy's hospital at Guantanamo, he "partitioned healthcare providers away from those who participated in interrogations." He was the commander of the hospital until August 2003, and was involved in a controversial practice of giving detainees a large dose of an anti-malaria drug with potentially damaging side effects, which the report notes. The key part of the report, to him, is the call for the military to create a new education program to address the report's concerns. "That's how we can prevent these kinds of things from happening in the future," says Shimkus.
Beyond the force-feeding policies, another significant continuing problem in the eyes of the task force are techniques still permitted by the Army Field Manual, which applies to both CIA and military interrogators. The Bush administration added language to the AFM in 2006 that widened the techniques allowed on "unlawful combatants," including sleep deprivation, isolation and exploitation of fear in detainees. Numerous human rights groups have previously criticized the added techniques, found in appendix M of the manual.
While highly critical of the government's role, Thomson also says professional bodies – such as the American Medical Association and the American College of Physicians – need to do more to fight the use of torture. Says Thomson, "This is hopefully a clarion call to the profession and the public of what's expected of physicians."