04 Sep

First They Did Harm

“a level of ethical misconduct that had not previously come to light,”

By Eugene Robinson, Washington Post, Friday, September 4, 2009

For the Bush administration, torture was a delicate business. The aim was to injure but not incapacitate — to inflict precisely enough pain and terror to break a subject’s will, but no more. To calibrate the proper degree of abuse, the torturer needed an accurate sense of how much agony the subject’s mind and body can tolerate.

In the administration’s program of “enhanced interrogation,” this expertise was provided by doctors and psychologists — professionals who are supposed to heal and comfort. A new report by Physicians for Human Rights assembles the evidence and reaches a sickening but inescapable conclusion: “Health professionals played central roles in developing, implementing and providing justification for torture.”

Dwell on that for a moment, especially if you believe that the Bush administration’s decision to submit terrorism suspects to medieval interrogation practices was somehow justifiable — or even if you believe that torture was wrong, but that now we should “look forward” and pretend it never happened. This is how torture warps a society and distorts its values.

Much of the information cited by Physicians for Human Rights had previously been unearthed, but some new details were disclosed in the CIA inspector general’s report released last week — revealing “a level of ethical misconduct that had not previously come to light,” according to the human rights group.

From sources that include published reports, an inquiry by the International Committee of the Red Cross and various documents pried out of the government by organizations such as the American Civil Liberties Union, here is some of what we know:

The interrogation program — using 11 abusive “enhanced” techniques, including waterboarding — was designed by two PhD psychologists. The techniques, according to a statement released in April by American Psychological Association President James H. Bray, “are tantamount to torture as defined by APA and international law.”

Said the APA: “The central tenet of psychology’s code of ethics is, like that of medicine, to do no harm. It is unthinkable that any psychologist could assert that stress positions, forced nudity, sleep deprivation, exploiting phobias, and waterboarding — along with other forms of torture techniques that the American Psychological Association has condemned and prohibited — cause no lasting damage to a human being’s psyche.”

According to Bray, “There is one ethical response to an order to torture: Disobey the order.”

We know that medical doctors were asked to sign off on the “enhanced” techniques. We know from detainees themselves, as quoted by the International Committee of the Red Cross, that there was medical monitoring of waterboarding sessions. We know from the CIA inspector general’s report that a 2004 letter from a Justice Department official reauthorizing the use of waterboarding specified a maximum of two two-hour sessions per day, with both a doctor and a psychologist present.

From the torturer’s point of view, this probably looks like compassion — an attempt to ensure that interrogators don’t go too far, that they don’t cause permanent harm, that they stay within bureaucratic guidelines. But from any other perspective, it’s simply and starkly grotesque.

That any medical doctor would help design or review a program of torture, let alone be present when an abusive interrogation amounting to torture was being conducted, would be a gross ethical violation.

The American Medical Association’s code of ethics “forcefully states medicine’s opposition to torture or coercive interrogation and prohibits physician participation in such activities,” according to a letter AMA officials sent President Obama in April. AMA guidelines state that “physicians must neither conduct nor directly participate in an interrogation,” and that doctors “must not monitor interrogations with the intention of intervening in the process, because this constitutes direct participation.”

So how was our government supposed to conduct abusive interrogations without the guidance of psychologists to say whether it was irreparably damaging the subject’s mind or physicians to say whether it was irreparably damaging the subject’s body? It would have been impossible.

Doctors and psychologists might have been able to prevent this whole shameful episode by refusing to participate. Instead, professionals who were trained in the healing arts used their experience and skill in a way that facilitated harm. They played a vital role in enabling torture.

I like to believe that some psychologists and physicians took a stand and said no. As for those who said yes, the law should hold them accountable — just as conscience, one hopes, is already doing.


AMA Principles of Medical Ethics


The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. As a member of this profession, a physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to self. The following Principles adopted by the American Medical Association are not laws, but standards of conduct which define the essentials of honorable behavior for the physician.

1. A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.
2. A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.
3. III. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.
4. IV. A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law.
5. A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.
6. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.
7. A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.
8. A physician shall, while caring for a patient, regard responsibility to the patient as paramount.
9. A physician shall support access to medical care for all people.

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