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When Doctors Participate in Torture, The Rot Spreads

Contrary to popular opinion, the Hippocratic Oath has never contained the exact words, “First, Do No Harm.” Regardless, expressed in other words across the various codes and oaths for medical practitioners this standard is ubiquitous. Among the nine principles of medical ethics articulated by the American Medical Association, one prominently reads “A physician shall, while caring for a patient, regard responsibility to the patient as paramount.” Another reads “A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.” These principles are applied explicitly by the AMA to the conduct of torture:

Physicians must oppose and must not participate in torture for any reason. Participation in torture includes, but is not limited to, providing or withholding any services, substances, or knowledge to facilitate the practice of torture. Physicians must not be present when torture is used or threatened.

Physicians may treat prisoners or detainees if doing so is in their best interest, but physicians should not treat individuals to verify their health so that torture can begin or continue. Physicians who treat torture victims should not be persecuted. Physicians should help provide support for victims of torture and, whenever possible, strive to change situations in which torture is practiced or the potential for torture is great.

As Mark Tran, Joby Warrick and Peter Finn have documented, doctors working for the CIA have directly violated these ethical standards, participating in U.S. government acts of torture. Earlier this month, the International Committee of the Red Cross acknowledged the existence of a confidential report it submitted to the U.S. Government in 2007. This report passed on multiple observations by Red Cross workers of medical collusion in acts of torture:

* Doctors making measurements of health to refine torture methods
* Doctors treating detainee health problems in order to render them fit for torture
* Doctors employing equipment such as pulse oxymeters to measure the point of asphyxiation in suffocation torture

“I look after your body only because we need you for information,” one medical professional told a U.S. detainee, according to the Red Cross. Another medical professional threatened to withhold health care from a detainee unless he cooperated with interrogators.

The Red Cross connects the dots:

Medical ethics are based on a number of principles which include the principle of beneficence (a medical practitioner should act in the best interest of the patient — salus aegroti suprema lex), non-maleficence (first do no harm — primum non nocere) and dignity (the patient and the person treating the patient have the right to dignity). These principles guide any relationship between a medical doctor and a person whom he or she is relating to as a medical doctor.

…any interrogation process that requires a health professional to either pronounce on the subject’s fitness to withstand such a procedure, or which requires a health professional to monitor the actual procedure, must have inherent health risks. As such, the interrogation process is contrary to international law and the participation of health personnel in such a process is contrary to international standards of medical ethics. In the case of the alleged participation of health personnel in the detention and interrogation of the fourteen detainees, their primary purpose appears to have been to serve the interrogation process, and not the patient.

Ah, but that’s just the Red Cross, you say to yourself. They’re just a bunch of liberal namby-pamby bleeding hearts who have had the wool pulled over their…

… hold that thought. Newly released memos from the U.S. Government confirm the involvement of medical professionals. Bush-era Assistant Attorney General Jay Bybee noted the use of medical staff during waterboarding sessions in an August 1, 2002 memo:

We find that the use of the waterboard constitutes a threat of imminent death. As you have explained the waterboard procedure to us, it creates in the subject the uncontrollable physiological sensation that the subject is drowning. Although the procedure will be monitored by personnel with medical training and extensive SERE school experience with this procedure who will ensure the subject’s mental and physical safety, the subject is not aware of any of these precautions.

Three years later, Assistant Attorney General Steven Bradbury wrote a follow-up memo also referencing the use of waterboarding by agents of the U.S. Government:

During the use of the waterboard, a physician and a psychologist are present at all times. The detainee is monitored to ensure that he does not develop respiratory distress. If the detainee is not breathing freely after the cloth is removed from his face, he is immediately moved to a vertical position in order to clear the water from his mouth, nose, and nasopharynx. The gurney used for administering this technique is specially designed so that this can be accomplished very quickly if necessary. Your medical personnel have explained that the use of the waterboard does pose a small risk of certain potentially significant medical problems and that certain measures are taken to avoid or address such problems. First, a detainee might vomit and then aspirate the emesis. To reduce this risk, any detainee on whom this technique will be used is first placed on a liquid diet. Second, the detainee might aspirate some of the water, and the resulting water in the lungs might lead to pneumonia. To mitigate this risk, a potable saline solution is used in the procedure. Third, it is conceivable (though, we understand from OMS, highly unlikely) that a detainee could suffer spasms of the larynx that would prevent him from breathing even when the application of water is stopped and the detainee is returned to an upright position. In the event of such spasms, a qualified physician would immediately intervene to address the problem, and, if necessary, the intervening physician would perform a tracheotomy. Although the risk of such spasms is considered remote (it apparently has never occurred in thousands of instances of SERE training) we are informed that the necessary emergency medical equipment is always present — although not visible to the detainee — during any application of the waterboard.

…Our advice is also based on our understanding that interrogators who will use these techniques are adequately trained… to understand and respect the medical judgment of OMS and the important role that OMS personnel play in the program.

…The IG Report noted that in some cases the waterboard was used with far greater frequency than initially indicated, see IG Report at 5, 44, 46, 103-04, and also that it was used in a different manner. See id. at 37 (”[T]he waterboard technique … was different from the technique described in the DoJ opinion and used in the SERE training. The difference was the manner in which the detainee’s breathing was obstructed. At the SERE school and in the DoJ opinion, the subject’s airflow is disrupted by the firm application of a damp cloth over the air passages; the interrogator applies a small amount of water to the cloth in a controlled manner. By contrast, the Agency Interrogator … applied large volumes of water to a cloth that covered the detainee’s mouth and nose. One of the psychologists/interrogators acknowledged that the Agency’s use of the technique is different from that used in SERE training because it is “for real and is more poignant and convincing.”) see also id. at 14 n14. The Inspector General further reported that “OMS contends that the expertise of the SERE waterboard experience is so different from the subsequent Agency usage as to make it almost irrelevant. Consequently, according to OMS, there was no a priori reason to believe that applying the waterboard with the frequency and intensity with which it was used by the psychologist/interrogators was either efficacious or medically safe.” Id at 21 n26. We have carefully considered the IG Report and discussed it with OMS personnel. As noted, OMS input has resulted in a number of changes in the application of the waterboard, including limits on frequency and cumulative use of the technique. Moreover, OMS personnel are carefully instructed in monitoring this technique and are personally present whenever it is used. See OMS Guidelines at 17-20. Indeed, although physician assistants can be present when other enhanced techniques are applied, “use of the waterboard requires the presence of a physician.” Id. at 9n2….

Medical personnel are instructed to exercise special care in monitoring and reporting on use of the waterboard. See OMS Guidelines at 20 (”NOTE: In order to inform future medical judgments and recommendations, it is important that every application of the waterboard be thoroughly documented: how long each application (and the entire procedure) lasted, how much water was used in the process (realizing that much splashes off), how exactly the water was applied, if a seal was achieved, if the naso- or oropharynx was filled, what sort of volume was expelled, how long was the break between applications, and how the subject looked between each treatment”)

OMS, in case you were wondering, stands for Office of Medical Services. The Red Cross report and the memos by Assistant Attorney Generals Bybee and Bradbury describe physician behavior standing in diametric opposition to the ethics mandates of the American Medical Association. Where the AMA demands that “physicians must oppose and must not participate in torture for any reason,” CIA doctors from the Office of Medical Services have condoned and participated in torture, “providing and withholding services, substances, or knowledge to facilitate the practice of torture.” Where the AMA demands that “physicians must not be present when torture is used or threatened,” the presence of physicians during torture sessions is deemed essential by members of the Bush administration. Where the AMA demands that “physicians should not treat individuals to verify their health so that torture can begin or continue,” the Red Cross describes doctors who treat indefinite detainees so that they can be tortured.

The moral rot of torture by U.S. Government doctors doesn’t stop with the tortured detainees. It spreads to medical schools, which have become unwitting agents of torture by giving future CIA doctors the knowledge they need to more effectively torture inhabitants of America’s gulag archipelago. It is a subsurface rot that we must suspect but can never verify, tainting all doctors by uncertain extension; because the Central Intelligence Agency does not publicly disclose the names of doctors it employs through the OMS, we don’t know and can’t know whether the doctors in our midst are part of the scheme or not. It suggests a weakness within the medical profession, since clearly the AMA has been unable to take its fine words and successfully impress them upon the best and the brightest that America’s clandestine services have recruited. If the choice produce of American medical education has not absorbed the profession’s ethical standards, should we expect our neighborhood doctors to abide by them? This question is crucial, because successful medical treatment depends on patients confiding in their doctors, sharing sensitive personal information that they wouldn’t, shouldn’t, couldn’t expect would be turned against them. What happens to medical treatment when patients would, should and do suspect their doctors of complicity in the pursuit of some other interest besides the patient’s health?

It is in the interest of not only the AMA but state licensing bodies to preserve public trust in the profession. For that reason, it is in the interest of these state licensing bodies to pursue reports of complicity in torture by its members and to revoke the licenses of doctors who are found to be complicit. Apparently, state boards have been reluctant to do so, either out of a sense of deference to government authority or a sense of intimidation by government authority. Indifference in the face of physician-abetted torture will only encourage the rot to spread.

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