The Institute on Medicine as a Profession’s press release, below, summarizes the report “Ethics Abandoned: Medical Professionalism and Detainee Abuse in the War on Terror” that is causing a massive stir in the media. Let’s hope it ends up affecting policy…
New York, NY — An independent panel of military, ethics, medical, public health, and legal experts today charged that U.S. military and intelligence agencies directed doctors and psychologists working in U.S. military detention centers to violate standard ethical principles and medical standards to avoid infliction of harm. The Task Force on Preserving Medical Professionalism in National Security Detention Centers (see attached) concludes that since September 11, 2001, the Department of Defense (DoD) and CIA improperly demanded that U.S. military and intelligence agency health professionals collaborate in intelligence gathering and security practices in a way that inflicted severe harm on detainees in U.S. custody.
These practices included “designing, participating in, and enabling torture and cruel, inhumane and degrading treatment” of detainees, according to the report. Although the DoD has taken steps to address some of these practices in recent years, including instituting a committee to review medical ethics concerns at Guantanamo Bay Prison, the Task Force says the changed roles for health professionals and anemic ethical standards adopted within the military remain in place.
“The American public has a right to know that the covenant with its physicians to follow professional ethical expectations is firm regardless of where they serve,” said Task Force member Dr. Gerald Thomson, Professor of Medicine Emeritus at Columbia University. “It’s clear that in the name of national security the military trumped that covenant, and physicians were transformed into agents of the military and performed acts that were contrary to medical ethics and practice. We have a responsibility to make sure this never happens again.”
The Task Force report, supported by the Institute on Medicine as a Profession and the Open Society Foundations, calls on the DoD and CIA to follow medical professional standards of conduct to enable doctors and psychologists to adhere to their ethical principles so that in the future they be used to heal, not injure, detainees they encounter. The Task Force also urges professional medical associations and the American Psychological Association to strengthen ethical standards related to interrogation and detention of detainees.
The report, Ethics Abandoned: Medical Professionalism and Detainee Abuse in the War on Terror, is based on two years of review of records in the public domain by a 19-member task force. The report details how DoD and CIA policies institutionalized a variety of interventions by military and intelligence agency doctors and psychologists that breach ethical standards to promote well-being and avoid harm. These interventions included:
• Involvement in abusive interrogation; consulting on conditions of confinement to increase the disorientation and anxiety of detainees;
• Using medical information for interrogation purposes; and
• Force-feeding of hunger strikers.
In addition, the group says that DoD policies and practices impeded the ability to provide detainees with appropriate medical care and to report abuses against detainees under recognized international standards. The report explains how agencies facilitated these practices by adopting rules for military health personnel that substantially deviate from ethical standards traditionally applied to civilian medical personnel.
Shining a Spotlight on Ethical Breaches
According to the Task Force, the DoD specifically:
• Excused violations of ethical standards by inappropriately characterizing health professionals engaged in interrogation as “safety officers,” masking one of their key functions;
• Implemented rules that permitted medical and psychological information obtained by health professionals to be used in interrogations;
• Required physicians and nurses to forgo their independent medical judgment and counseling roles, as well as to force-feed competent detainees engaged in hunger strikes even though this is forbidden by the World Medical Association and the American Medical Association;
• Improperly designated licensed health professionals to use their professional skills to interrogate detainees as military combatants, a status incompatible with licensing; and
• Failed to uphold recommendations by the Army Surgeon General to adopt international standards for medical reporting of abuse against detainees.
The group also says that the CIA’s Office of Medical Services played a critical role in reviewing and approving forms of torture, including waterboarding, as well as in advising the Department of Justice that “enhanced interrogation” methods, such as extended sleep deprivation and waterboarding that are recognized as forms of torture, were medically acceptable. CIA medical personnel were present during administration of waterboarding, says the Task Force. The CIA no longer has detainees in its custody, according to official statements.
“Putting on a uniform does not and should not abrogate the fundamental principles of medical professionalism,” said IMAP President David Rothman. “‘Do no harm’ and ‘put patient interest first’ must apply to all physicians regardless of where they practice.”
Changes Don’t Go Far Enough
Despite steps by the DoD to improve treatment of detainees, the Task Force says the agency “continues to follow policies that undermine standards of professional conduct” for interrogation, hunger strikes, and reporting abuse. This includes: issuing protocols requiring doctors and nurses to participate in the force-feeding of detainees, including forced extensive bodily restraints for up to two hours twice a day; enabling interrogators access to medical and psychological information about detainees for exploitation by interrogators; and permitting clinical care for detainees to suffer from the inability or failure of clinicians to address causes of detainee distress from torture.
“Abuse of detainees, and health professional participation in this practice, is not behind us as a country,” said Task Force member Leonard Rubenstein, a legal scholar at the Center for Human Rights and Public Health at The Johns Hopkins Bloomberg School of Public Health and the Berman Institute of Bioethics. “Force-feeding by physicians in violation of ethical standards is illustrative of a much broader legacy in which medical professionalism has been undermined.”
The Task Force recommends a full investigation of medical practices in detention facilities and public release of the Senate Intelligence Committee’s review of CIA practices. It also calls for promulgation of rules that harmonize medical and psychological practices with ethical prohibitions on participation in interrogation, use of medical records for interrogation, force feeding, and abuse reporting. Among its other recommendations:
• Require military medical training programs, including pre-deployment training, to include human rights and professional ethical principles regarding treatment of detainees;
• Urge professional medical associations to strengthen their ethical standards around interrogation and detention of detainees and take proactive steps to foster compliance (This includes disciplining members who have breached standards of professional conduct and supporting state laws strengthening the authority of licensing boards to discipline health professionals who engage in torture); and
• Require states to make it explicit that health professionals who support interrogation and participate in torture or cruel, inhumane or degrading treatment be disciplined.
“We now know that medical personnel were co-opted in ways that undermined their professionalism,” said Open Society Foundations President Emeritus Aryeh Neier. “By shining a light on misconduct, we hope to remind physicians of their ethical responsibilities.”
Task Force Members:
Scott A. Allen, MD, FACP
University of California, Riverside
George J. Annas, JD, MPH
Karen Brudney, MD
Richard N. Gottfried, JD
New York State Assembly
Vincent Iacopino, MD, PhD
Physicians for Human Rights
Allen S. Keller, MD
New York University
Robert S. Lawrence, MD
Johns Hopkins University
Steven H. Miles, MD
University of Minnesota
Open Society Foundations
Deborah Alejandra Popowski, JD
Steven Reisner, PhD
Coalition for an Ethical Psychology
Hernán Reyes, MD, FMH Ob/Gyn
International Committee of the Red Cross
David J. Rothman, PhD
Leonard S. Rubenstein, JD
Johns Hopkins University
Steven S. Sharfstein, MD, MPA
Sheppard Pratt Health Systems
Albert J. Shimkus, Jr.
U.S. Naval War College
University of California, Berkeley
Gerald E. Thomson, MD
Frederick E. Turton, MD, MBA, MACP
Brig. Gen. (Ret.) Stephen N. Xenakis, MD
United States Army