by Paul D Kennedy
© Paul D Kennedy, October 2005
This article was first published in the Arab Times in the After Iftar section during Ramadan 2005.
Muslims fast throughout the day during Ramadan and Iftar is the time just after sunset when the fast is broken.
The hour or two following Iftar is considered by Muslims to be a time that should be set aside for reflection.
Evidence is emerging that doctors and medical scientists are involved in the coercive interrogation of suspected terrorists detained in US facilities in Guantanamo Bay and elsewhere. Is a core value of Western civilization being undermined by how the war on terror is being conducted?
The Hippocratic Oath enjoins physicians to apply medical knowledge only in the best interests of their patients and to refrain from doing harm. It is the ethical basis that governs the conduct of a wide range of medical personnel, including doctors, psychiatrists, psychologists and nurses. The Oath is considered one of the core values of Western civilization and is reinforced by legal obligations placed on health-care professionals.
At the Nuremberg War Crime Trials after the Second World War it was decided that medical mistreatment constitutes a crime even when carried out for reasons of national security or on the orders of a superior. Under the Declaration of Tokyo issued in 1975 by the World Medical Association (WMA), medical personnel are barred from participating in or monitoring torture or abuse and, as the American Medical Association (AMA) is a member of the WMA, US doctors must follow the WMA’s ethical standards. In addition, doctors in the USA and most other countries are obliged to obtain the informed consent of patients before they may treat them. Thus what an American doctor, psychiatrist or psychologist may or may not do, both during war and in peacetime, is perfectly clear.
But for medical personnel connected with the US military the ethical waters were muddied in June this year when the Pentagon issued revised practice guidelines entitled ‘Medical Program Principles and Procedures for the Protection and Treatment of Detainees in the Custody of the Armed Forces of the US’. Though this document states that personnel charged with the medical care of persons detained by the US military may not participate in interrogations, it also says that scientific and medical personnel who are not directly responsible for a patient’s care (so-called ‘non-treating professionals’) may take part in interrogations.
In past wars the US military has used doctors to provide soldiers with physical and mental therapy and to evaluate the combat-readiness of troops, which accords well with accepted notions of medical ethics. However reports from Guantanamo Bay and other centres where detainees in the war on terror are being held suggest strongly that these roles have been extended and teams of behavioural psychologists and psychiatrists are now being used to develop interrogation strategies and to assist interrogators. These teams of ‘non-treating professionals’ are termed Behavioural Science Consultation Teams (BSCTs) or, in the remarkable slang of the US military, ‘Biscuits’.
American scientists have been conducting research into the psychological nature of captivity for at least half a century. At the end of the Korean War, the US Air Force created a programme called SERE (which stands for survival, evasion, resistance and escape) designed to teach pilots how to resist torture and avoid divulging secrets. It does so by exposing them to brutality during training. After the Vietnam War the programme was introduced into the US Army and Navy. By its nature the SERE programme contains a vast repository of knowledge about coercive methods of interrogation.
A person’s ability to control his own behaviour, ie to resist interrogation, can be undermined when he is acutely anxious. SERE scientists have learned that acute anxiety may be induced in trainees by a variety of techniques. These include sensory deprivation and hooding, isolating subjects for long periods, disrupting their sleep patterns, keeping them hungry, stripping them, exploiting their personal phobias, exposing them to extreme temperatures and subjecting them to harsh interrogations. Creating scenarios designed to convince the subject that death or severe pain is imminent for him or his family have also been found to be effective in producing acute anxiety.
All these techniques result in causing the subject pain, physical or mental. Where they are practiced by a medical professional on some-one who does not volunteer for the experience, they obviously contravene the Hippocratic Oath, the principles laid down at Nuremberg, the Declaration of Tokyo and the requirement for informed consent.
According to Jane Mayer, a journalist writing in the New Yorker last July, psychologists versed in SERE techniques have been advising interrogators in Guantanamo Bay and elsewhere, and BSCT members and interrogators at Guantanamo have adopted coercive techniques similar to those employed in the SERE programme. She says that, on one SERE toughening course, trainees are given the choice of revealing secrets or seeing a Holy Bible being desecrated. As desecration of the Bible was found to profoundly disturb devoutly-Christian trainees, this technique provides a plausible explanation for the constant complaints from detainees at Guantanamo about abuse of the Holy Koran.
The article in the New Yorker states that in October 2002 Guantanamo officials asked the Pentagon for permission to use several specific harsh interrogation techniques on highly-resistant detainees, even though these might violate the US federal statute against torture and contravene the Uniform Code of Military Justice (UCMJ). Two months later, US Defence Secretary Donald Rumsfeld authorized the use of sixteen aggressive counter-resistance techniques not allowed by the UCMJ.
FBI agents who have been to Guantanamo Bay and officials of the Naval Criminal Investigation Service who have had access to interrogation logs in order to prepare legal cases against detainees for eventual prosecution have, according to Jane Mayer, protested that abusive techniques and coercive psychological procedures, based on the SERE programme, are being used on detainees, stating that information obtained by these methods was both unreliable and inadmissible in a court of law.
These complaints, as well as several proven cases of abuse admitted by the US government, show that there is no doubt that detainees are being subject to medical and psychological mistreatment in Guantanamo. But are members of the medical profession actually participating in interrogations in Guantanamo and elsewhere and are these interrogations coercive?
Participation is difficult to assess. A former interrogator told Jane Mayer that BSCT psychologists were heavily involved in devising and monitoring interrogation plans, which were individually designed for each detainee. Indeed, if medical personnel are not involved in interrogations, why did the Pentagon feel it necessary to provide an ethical loop-hole for non-treating professionals when it issued ‘Medical Program Principles and Procedures for the Protection and Treatment of Detainees in the Custody of the Armed Forces of the US’? The Pentagon is unlikely to have gone to the trouble of issuing such a document unless it is using medical professionals for interrogations as a matter of policy on an ongoing basis.
Non-coercive interrogators normally use ‘rapport-based’ methods, which involve trying to build personal relationships of trust with interrogatees to get them to talk. These do not require the presence of doctors nor do they require medical professionals to be involved in strategy planning and monitoring. Thus the interrogations in which medical personnel are involved can only be coercive.
It seems quite certain then that medical personnel in the US military are involved in coercive interrogations. This involvement breaches the accepted standards of medical ethics. In addition, the new guidelines issued by the Pentagon are of questionable legality when set against the Nuremberg principles and the legal requirement for informed consent. But this is by-the-way. The implications of this loosening of medical ethics in the US military for American society as a whole and its core values are profoundly disturbing and require serious reflection.
Thousands of young men and women undergo their medical education and training in the US military where they are engrained with the ethics that will govern the decisions they make throughout their professional lives. They tend to retire early and then embark on second, more lucrative, careers as medical practitioners in civilian life. It seems likely that these doctors, psychiatrists and psychologists will take back into civilian life the diluted ethical standards they internalized as members of the US military. As obedience to a system of ethical rules depends more on mental attitude than on legal obligation, this weakening of medical ethics by the Pentagon guidelines will eventually have effects on the practice of medicine that extend throughout society.
The USA is the land where the rights of the individual against society first gained their full flowering, where respect for human life is supposed to be paramount. Though America has experienced a falling off in ethical standards in several professional spheres in recent years, notably in accountancy, these failures do not strike at the heart of our most significant core value, ie respect for the individual. This is the value that distinguishes modern Western society from other developed cultures and from our own history.
The loosening of medical ethics in the USA and the implications of this for one of our core values is, for me, very perturbing.
© Paul D Kennedy, October 2005