The role that licensed health professionals played in detainee interrogations during and after the American invasions of Iraq and Afghanistan seriously undermines professional ethics standards, according to a report released in November by the Institute on Medicine as a Profession. The report calls on state licensing boards to ensure that their professional regulations are enforced for violations by licensees in the military.
The paper, Ethics Abandoned: Medical Professionalism and Detainee Abuse in the “War on Terror,” presents the findings of a task force formed by the Institute in 2010, exploring the role that licensed medical professionals played in the controversial interrogation techniques employed by the military and intelligence agencies of the United States following the attacks on the World Trade Center and the Pentagon September 11, 2001.
In its own words, the organization sought “to examine what is known about the involvement of health professionals in infliction of torture or cruel, inhuman, or degrading treatment of detainees in U.S. custody and how such deviation from professional standards and ethically proper conduct occurred.”
The interrogation methods described by the report include many that came to light in internal government memos obtained and publicized by the news media and which read as a sort of horror story: “beatings, exposure to extreme cold, physical suspension by chains . . . sleep deprivation, constant light, . . . forced nakedness . . . throwing a detainee repeatedly against a wall . . . facial slaps . . . use of insects, and waterboarding.” Sleep deprivation was, at times, approved for over a week of use on a prisoner shackled in a standing position—–naked except for a diaper–sometimes followed by another week after a short period of rest.
The report also cites documented but unacknowledged methods, primarily threats of harm to detainees and their families, intimidation with firearms, and sexual and cultural humiliation of the sort documented at the Abu Ghraib prison.
The role of medical professionals during interrogations Guidelines stated that medical professionals from the CIA’s Office of Medical Services were to be present to monitor the interrogations and intervene to prevent “serious or permanent harm.”
Such monitoring appears to have been necessary, due to the potential for harm created by interrogators. For example, one method of interrogation involved naked prisoners kept in environments with temperatures of 64 degrees and doused with water as cold as 41 degrees, conditions the paper’s authors note risked hypothermia. And, “in the case of waterboarding” —in reference to the infamous simulated-drowning technique used as an interrogation tactic—”the guidelines advised keeping resuscitation equipment and supplies for an emergency tracheotomy on hand” for patients who ceased breathing. The guidelines noted that “any subject who has reached this degree of compromise is not considered an appropriate candidate for the waterboard, and the physician on the scene cannot concur in the further use of the waterboard without . . . consultation and approval.”
Creation of interrogation techniques by medical professionals Medical professionals played a significant behind-the-scenes role in creating and developing interrogation techniques for both the CIA and Department of Defense.
The Department of Defense enlisted mental health professionals—primarily psychologists and psychiatrists—in what were called Behavioral Science Consultation Teams, which were used to develop its interrogation techniques. The teams created interrogation recommendations that included sleep deprivation, exposures to extreme noise and temperatures, and extended periods in stress positions.
The report also describes the implementation of the techniques on a detainee named Mohammed al-Qahtani, who was believed to have been linked to the September 11 attacks. Two licensed professionals, a psychologist and a psychiatrist, were involved with al-Qahtani’s interrogation, which included sexual and religious humiliation and the use of a dog to terrify al-Qahtani.
Besides advising the creation of the interrogation techniques and being present to monitor the harm being done to detainees, medical professionals took an active role in the ongoing interrogation process, using psychological evaluations of detainees’ vulnerabilities and reviews of their medical records to advise interrogators on how to successfully exploit any vulnerabilities. As a result, the report notes, many detainees declined to seek medical care, fearing—often correctly—that their medical records would be exploited during future interrogation sessions.
The report also details significant and systemic failures in medical care of the detainees, including overuse of drugs with significant mental side effects and failure to investigate pervasive “psychological deterioration” of detainees in the Guantánamo Bay prison.
Professional ethical restraints According to the paper’s authors, the Department of Defense issued its own interpretations of medical ethics rules in order to employ medical professionals in the harming of detainees. The report notes that the Department believed that a medical professional’s duty to avoid or minimize harm did not apply to professionals working in interrogation situations because the interrogations were not clinical treatment, and DoD classified licensed professionals working for the teams as “combatants,” which it claimed removed them from complying with all of their ethical duties.
“The [Department]’s position, the report notes, “undercuts the fundamental role of health professionals in society and the duties attached to that role, including non-participation in interrogation on the basis that it is inherently coercive . . . The DoD wants its behavioral science consultants to have professional qualifications, including a license for clinical practice in psychology or forensic psychiatry, but then excludes them from the full panoply of ethical norms that govern their professions and that they committed to uphold.”
The report also condemns the DoD’s practice of conflating professional responsibilities with general legal standards: “Unlike an interrogator, who may create stress for a detainee so long as he or she acts within legal standards, including those prohibiting torture and cruel, inhuman, or degrading treatment, a health professional has an obligation not to participate in acts that deliberately impose pain or suffering on a person.”
“Replacing ethical standards with a legal one—that is, only to refrain from torture and cruel, inhuman, or degrading treatment—eviscerates the ethical standards.”
Aside from urging the DoD to bring its practices in line with existing medical ethics standards, the report’s authors also called on state licensing boards to ensure that their professional regulations are enforced for violations by licensees in the military: “States’ non-enforcement of ethical obligations comes at a great cost, undermining professional standards, eroding public trust, and undercutting deterrence of future misconduct.”
“By contrast, disciplinary accountability signals to licensees and those who employ them that the profession and institutions designed to ensure adherence to ethical obligations take violations seriously. Moreover, it empowers health professionals to resist demands by authorities to engage in acts that violate their professional responsibilities and to report abuse when they believe it has occurred.”