Oath Betrayed: doctors in the war on terror

After 9/11 one of the most wrenching ethical issues faced by the American government is how to interrogate prisoners and detainees in a way which respects their dignity as human beings. In this, doctors and nurses have an especially sensitive role. In Oath Betrayed : Torture, Medical Complicity, and the War on Terror,  medical ethicist Steven Miles claims that American health personnel have been complicit in the abuse of prisoners after 9/11. In an exclusive MercatorNet interview, Dr Miles contends that torture is both unethical and unproductive.

MercatorNet: Have American doctors and other health personnel really become an integral part of military interrogations since 9/11? It's hard to believe. How many of them are participating?

Miles: The numbers and roles of various health personnel varied.

Pathologists with the Armed Forces Institute of Pathology delayed public knowledge of homicides by torture. Earlier knowledge of those abuses would have given a signal that something had gone seriously wrong in the prisons.

Physicians and psychologists helped design programs of coercive interrogation that were designed to break prisoners down; they monitored those interrogations; they culled medical records for weaknesses that could be exploited against prisoners.

The general medical staff did not report signs of abuse, did not inquire about abuse in suspicious injuries, failed to record injuries in medical records. They also allowed prisoners, especially at Abu Ghraib, to live in a prison that was regularly subject to hostile mortar, grenade, and sniper fire in violation of the Geneva Convention. In Iraq and Afghanistan, they failed to ensure that prisoners received obligatory medical care for diseases like tuberculosis, as is required by the Geneva Convention and US military regulations. The mental health needs of prisoners were largely neglected.

MercatorNet: It must have been difficult to find out exactly what is happening. Are doctors beating prisoners or putting needles under their fingernails? How did you do your research?

Miles: Oath Betrayed is a meticulously documented book that is largely based on about 35,000 pages of government and military documents that were declassified and obtained in response to a lawsuit based on the United States Freedom of Information Act that was brought by the American Civil Liberties Union. It shows that the physicians, psychologists and medics at the war on terror prisons in Iraq, Afghanistan, and at Guantanamo Bay were an integral part of the system of human rights abuses at these prisons. Medical personnel rarely directly abused prisoners, although I did identify a few instances where that happened. Instead, they actively and passively supported a system of human rights abuses that was run according to Defense Department policy.

MercatorNet: But what is torture, anyway? Some of the techniques revealed by the media -- sexual humiliation, sleep deprivation, loud music -- don’t sound like the techniques we see in old World War II movies.

Miles: The Geneva Convention is quite clear.

"The following acts are and shall remain prohibited at any time and in any place whatsoever ...: (a) Violence to life and person, in particular murder of all kinds, mutilation, cruel treatment and torture; . . . (c) Outrages upon personal dignity, in particular humiliating and degrading treatment; ... No physical or mental torture, nor any other form of coercion, may be inflicted on prisoners of war to secure from them information of any kind whatever. Prisoners of war who refuse to answer may not be threatened, insulted, or exposed to any unpleasant or disadvantageous treatment of any kind."

The United Nations’ Declaration on the Protection of All Persons from Being Subjected to Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment says that “pain or suffering . . . from prison conditions that do not comply with the Standard Minimum Rules may, in some circumstances, constitute torture."

Other documents, including the UN Convention Against Torture reaffirm this position. Some prisoners were subjected to loud music. Most of these were also subjected to degrading treatment, beatings, kickings, stress positions, sleep deprivation, etc. All of these techniques are highly coercive and violent.

MercatorNet: Why don’t you think it acceptable to use medical skills in the interest of a higher imperative -- in this case national security? After all, thousands of Americans died on 9/11 and more are going to die unless the terrorists are captured or crushed.

Miles: Oath Betrayed summarises the abundant evidence from intelligence services' research that coercive interrogation does not work. In fact it is counterproductive. It floods limited intelligence analysis systems with bad information and this results in sending troops on dangerous and futile forays and in misleading policy. For example, the information that Saddam Hussein was giving Al Qaeda bioweapons training came from a torture interrogation and was a key part of the larger policy to go to war. Torture alienates recruitable informants and enrages populations against whom it is directed.

MercatorNet: Why do you think that there is there something specially wrong about doctors having a role in torture and abuse? Do you think that they ought to more morally sensitive than the rest of us?

Miles: Physicians are front line human rights monitors. In prisons, their ethical duty to report abuses comes from their primary obligation is to the health of disarmed and captive people. Military physicians are in places where monitors from the International Committee of the Red Cross do go and they are there when human rights monitors are absent.

MercatorNet: Before 9/11 was there a different ethos amongst military health personnel?

Miles: As far as I can determine, US military physicians treated POWS well in World War II, Korea, Vietnam and Gulf War I.

MercatorNet: Is it possible for a doctor to toggle between his role as an interrogator and his role as a doctor? Can't his moral life be put in a parenthesis while he does a job for the military?

No. It is one thing for a good cross-cultural psychiatrist or psychologist to train an interrogator in techniques for establishing rapport during an intelligence interview; it is quite another for that behavioral scientist to provide advice on how to break a prisoner down.

MercatorNet: Military doctors will always have to deal with the tension of loyalty to their Hippocratic Oath and obedience to higher-ups. What is a doctor supposed to do if he is ordered, or pressured to participate?

Miles: Military health personnel are obliged to record signs of abuse, report abuse, and refuse to participate in abuse. Our professional colleagues in dictatorships have assumed grave personal risks to fight torture in their countries. No US military clinician faced the risk of disappearing, torture, or having his or her children killed for protesting these abuses. The US is paying a stunningly high price for the silence of its military health personnel.

MercatorNet: The war on terror is supposed to go on for decades -- are you optimistic about the ability of American doctors to withstand pressures to violate human rights?

Miles: Although this is outside of the scope of this book, the war on terror is misconceived. It should be understood as a long term police action against an international criminal organization.

Is highlighting medical complicity in torture playing politics? Or is it an issue that Americans of every political hue should be concerned about?

Miles: This book is about international human rights--not politics. It takes no position on the war in Iraq or Afghanistan. The timing is due to the fact that the administration played politics with the timing of releasing information that belonged in the public domain. The first large release of information was delayed until about a week before the last election--far too late to sift through it. The majority of the information, tens of thousands of pages, was not released until early 2005. This book is based on an orderly review of that material.

Steven H. Miles, M.D., is a professor of medicine at the University of Minnesota Medical School and a faculty member of its Center for Bioethics.
Michael Cook is Editor of MercatorNet.


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