Doctors without ethics
http://www.utne.com/print-article.aspx?id=2147485570
Doctors without ethics
by Justine Sharrock, from Mother Jones
The memory of detainee No. 173379 still haunts Andrew Duffy. The 24-
year-old prisoner showed up in March 2006 at Abu Ghraib, where Duffy
was stationed as a medic. His job was to treat new arrivals in an
overcrowded, sweltering tent. Then 19, Duffy handled everything from
common diseases like tuberculosis to festering gunshot wounds.
But the new prisoner stood out. He was belligerent, yelling gibberish,
and staggering like a drunk. Having witnessed this kind of behavior
before with detainees in diabetic shock, Duffy checked the mans blood-
sugar level and found it was extraordinarily high. The prisoner
explained that Iraqi soldiers had held him for five days without his
insulin. Duffy called the compounds hospital to request an immediate
transfer. It was denied. Duffys medical supervisor ordered him to
just give the guy water.
He was used to this. The prisons medical officers routinely rejected
medics requests to hospitalize sick and wounded detainees; the
general sentiment, Duffy says, was screw these guys. Once, he tried
to revive an elderly prisoner whose heart had stopped by using CPR and
mouth-to-mouth. Why did you make out with that hajji? the hospital
staffers taunted. Why didnt you just let him die?
Beyond patching up detainees, Duffy and his comrades with the 134th
Medical Company of the Iowa National Guard were ordered to soften them
up for interrogation. Duffy and an MP once restrained and hog-tied a
resisting detainee-cuffing his wrists to his crossed ankles behind his
back-so that Duffy could check his vital signs. Guards later boasted
that theyd left the man that way for 12 hours.
Throughout Duffys year at Abu Ghraib-long after the infamous photos
were published and the Pentagon vowed that detainees were no longer
abused-men were still being strapped into restraint chairs and left in
the sun for hours or locked in cells too small to lie down in. The
medics regularly found prisoners dehydrated, wrists bloody from
overtight handcuffs, ankles swollen from forced standing, joints
dislocated from stress positions. They knew to keep their written
evaluations vague, never mentioning cause of injury as a standard
medical report would. When they shuttled broken detainees to and from
the prisons interrogation rooms, the orders were explicit: Transport
only. No medical care. No paper trail. Flouting the Geneva
Conventions, Duffys platoon sergeant even ordered the medics to strip
their uniforms and ambulances of the Red Cross emblems that denoted
them noncombatants. Should anyone from the Red Cross show up to see
the prison, the soldiers were told, send them away and tell them
nothing.
For more than five decades, starting with the prosecution of Nazi
doctors during the Nuremberg trials, the Pentagon ordered its
physicians to abide by international norms. The World Medical
Association (WMA), which counts the American Medical Association (AMA)
as a member, had issued clear directives: Doctors could not assist in
torture or cruelty of any kind, and were duty bound to report abuses
they witnessed. The United Nations later clarified that the rules
apply to all medical personnel, from surgeon to nurse to psychologist
to lowly medic. Even now, the Armys Military Medical Ethics textbook
echoes the Geneva Conventions, noting that a doctor-warriors priority
is always physician first.
But even as the nation debates disbarment for the Bush administration
lawyers who green-lighted torture, the medical profession has dealt
reluctantly, if at all, with its own involvement. The indifference is
shocking, says retired Army Brigadier General Stephen N. Xenakis, a
rare outspoken critic among military doctors. Some civilian doctors
are appalled, but many say, It doesnt affect my life; Im not
involved.
Doctors were complicit in the torture strategy from the start. In
December 2002 Defense Secretary Donald Rumsfeld issued a directive
allowing interrogators to withhold medical care in nonemergency
situations-men with injuries including gunshot wounds were denied
treatment as a way to make them talk. The directive was soon revoked,
but the practice continued.
Four months later, Rumsfeld ordered that doctors had to certify
prisoners medically and operationally suitable for torture and be
present for the sessions. At Abu Ghraib, interrogations had to be
preapproved by a physician and a psychiatrist. They have the final
say as to what is implemented, Colonel Thomas M. Pappas told military
investigators.
The CIA received similar advice in 2002 and 2005 from the Justice
Department, whose torture memos recommended that physicians and
psychologists be present for the interrogation of high value al-Qaida
detainees. These doctors, the lawyers argued, would see to it that
interrogators didnt torture detainees by intentionally inflicting
serious or permanent harm.
But it was in June 2005 that the Pentagon delivered its biggest
ethical bombshell, a memo that allowed doctors to participate in
torture and share medical records with interrogators so long as the
detainee in question wasnt officially their patient. The directives
author, physician and top Pentagon health official William
Winkenwerder Jr., received an award from the AMA that year for
outstanding contributions to the betterment of the public health.
Field medics like Duffy, who were still being trained to do no harm
according to the militarys old ethical standards, faced a rude
awakening. You have all these codes you follow as a health care
worker, but then its, Now were in Iraq, forget those, Duffy
says.
Plenty of doctors in uniform felt similarly but, like Duffy, did as
they were told. A 2007 Red Cross report indicates that CIA medical
personnel presided over hundreds of waterboardings. Gitmo military
doctors twice sent alleged 9/11 planner Mohammed al-Qahtani to the
hospital after his heart rate fell to dangerously low levels, only to
send him back to the torture chamber when he improved.
Aware of the breaches, Xenakis says, a few military physicians called
for ethical reviews. But the Pentagon overruled them, and the protests
ceased. There was a blackout, he explains. Fearing for their
careers, military doctors wouldnt speak, even informally. Before
long, says M. Gregg Bloche, a Georgetown University law professor who
interviewed military physicians on condition of anonymity, the Defense
Department was screening doctors and deploying only those on board
with the program.
During the 1980s, as a symbolic show of support for doctors working
under oppressive regimes, the AMA adopted WMA guidelines that forbade
their participation in torture. But even when it became clear that
U.S. doctors were violating these rules, the association, which
represents a quarter of a million doctors and medical students, took
no steps toward censuring its wayward members. Instead, in 2004, it
released a statement pointing to its existing guidelines. The AMAs
refusal to take a stronger stand, says Penn State bioethics professor
Jonathan H. Marks, has been a source of shame for the profession.
What stood out for Steven H. Miles, a bioethicist at the University of
Minnesota Medical School, was the associations resounding silence in
February 2006, after the U.N. Commission on Human Rights condemned
American doctors for having systematically participated in detainee
abuse. It should have been a call to arms, Miles says. But the AMA
said nothing.
It wasnt until November 2006 that the association issued a statement
clarifying that doctors cannot participate in interrogations of any
kind. Xenakis, who helped shape the new policy, says most of the AMAs
military delegates resisted the move, arguing that the mission of
getting information was greater than the medical ethics they
acknowledged we were overriding. (The four military delegates
contacted for this story declined to comment.)
On at least four occasions, doctors have petitioned the AMAs leaders
to endorse an independent investigation of their colleagues role in
the abuses-only to be voted down. They said, Look, we trust our
military and we arent going to step on their toes, explains
Matthew Wynia, director of the associations Institute for Ethics.
None of the AMAs top officials would be interviewed for this story.
When spokeswoman Kate Cox was pressed on why they were so reluctant to
act, even after the complicity of doctors became apparent, she
insisted that the association has no specific knowledge of doctors
being involved in abuse or torture and that it is not equipped to
conduct the sort of investigation needed to credibly confirm such
allegations. Besides, Cox said, the AMA has fulfilled its duty simply
by setting ethical standards.
But the AMAs critics worry that its half measures have already-
perhaps irreparably-damaged the moral standing of American doctors.
It has had a corrosive effect, says Xenakis. Adds Miles, Were now
in an extremely poor position to protest abuse in other countries. It
will silence us as a medical community.
Mental health practitioners were, if anything, even more deeply
involved in the abuses. In November 2002 Gitmo commander Major General
Geoffrey Miller put together a behavioral science consultation team, a
group of psychiatrists and psychologists tasked with preparing
prisoner profiles and advising interrogators on the use of
environmental manipulation, sleep deprivation, exploitation of
individual fears, and other coercive methods.
Among the practitioners was Guantánamo psychologist Major John Leso,
who helped plan and implement the 50-day interrogation of Mohammed al-
Qahtani. Detailed logs of the torture sessions indicate that the
prisoner was sexually humiliated, isolated and deprived of sleep for
extended periods, subjected to extreme cold, shackled in stress
positions, tormented by military dogs, and leashed and made to perform
like a dog.
Leso, who was in the interrogation room for part of Qahtanis ordeal,
advised-among other things-that the detainee could be disoriented by
spinning him on a swivel chair. Along with the prisons medical
doctors, he regularly evaluated Qahtani for his ability to tolerate
further abuse. During one session, the medical staff injected the
prisoner with three and a half IV bags of saline; Qahtanis questioner
then wouldnt let him urinate until he provided satisfactory answers.
Despite evidence of Lesos actions, the American Psychological
Association (APA) has failed to act on an ethics complaint by a fellow
APA member.
Psychologists are deeply divided on the subject of torture. In 2005 an
association task force (6 of its 10 members had military ties) voted
to condemn torture but still allow psychologists in the interrogation
room, where, its members argued, they might discourage abuse and even
save detainees lives. Incensed, thousands of psychologists petitioned
for a full member vote in 2008, and in a roughly 60-40 tally, the
association decided that psychologists have no place in the
interrogation room. It was the right choice, says Robert Jay Lifton, a
psychiatrist who has written about the role of Nazi doctors during the
Holocaust. Putting health professionals into an abusive setting, he
argues, can confer an aura of legitimacy and can even create an
illusion of therapy and healing.
In May 2006 the American Psychiatric Association, which represents
some 38,000 psychiatrists, reiterated its past position that its
members should not directly assist in interrogations. But Steven
Sharfstein, then the associations president, also noted that
psychiatrists wouldnt get in trouble if they heeded military orders
over the associations advice-which, he added, should not be
considered an ethical rule.
Its not that the medical community lacks the tools to police itself.
State licensing boards are legally obligated to investigate
violations, and they have the power to suspend licenses-yet no state
medical board has ever disciplined a doctor for assisting in military
torture.
One California complaint illustrates the boards reluctance to
confront the military. Filed by attorney Scott Sullivan on behalf of
four former detainees, the 2005 complaint targeted Captain John S.
Edmondson, then Guantánamos lead physician. The men claimed that
their medical records were shared with interrogators, who then
withheld treatment for heart problems, worms, constipation, and
injuries inflicted by the camps internal reaction forces-five-man
teams dispatched to beat recalcitrant prisoners. When these attackers
showed up, the detainees claimed, medical personnel would instruct
them on details: Hit him around the eye; dont poke him in the eye.
But the complaint never got a hearing: The medical board demurred to
the Pentagons jurisdiction. Citing insufficient subpoena power and
resources, the board turned the matter over to military investigators,
who found no evidence of wrongdoing. The board didnt care how they
got out of it, says Sullivan. They just didnt want to be in the
middle of a hot-button political issue.
Absent action from the profession, some states have turned to
political pressure. Californias Senate passed a symbolic joint
resolution last year urging the states licensing boards to warn
doctors that they could be prosecuted for participating in torture.
(The American Psychiatric Association petitioned unsuccessfully to
have psychiatrists exempted.) A bill under consideration in New York
would bar any health care worker from participating in torture or
improper treatment, as defined by international standards. But
reform advocates say legislation is no substitute for sanctions by
doctors themselves. The practice of medicine, says George Annas, a
professor of law and public health at Boston University, is something
the profession defines and the profession has to guard.
Back at Abu Ghraib, Andrew Duffy was in no position to disobey a
direct order, so he did as he was told and gave water to his diabetic
prisoner. By the next morning, detainee No. 173379 was even weaker and
more confused. Duffy and his partner again called for a hospital
transfer-their third try-and again the supervisor denied the request.
This time, she told them to administer saline through a 14-gauge
needle.
Thats a huge needle-more than two millimeters in diameter. A civilian
doctor would only use it for extreme trauma situations, with an
unconscious patient or with a local anesthetic to numb the pain. At
Abu Ghraib, the large needles were used as punishment, or to
discourage detainees from asking for care.
A day later, the Armys criminal investigation unit summoned Duffy and
his partner for questioning. No. 173379 was dead. Interpreting his
symptoms as insubordination, MPs had pepper-sprayed the man and stuck
him in a tiny cell in the scorching heat. Duffy says he filled out a
five-page sworn statement, but his captain gave a conflicting account,
and the case was dropped. Later, when it became clear that the dead
man had been an associate of Abu Musab al-Zarqawi, the bloodthirsty
commander of al-Qaida in Iraq, soldiers came up to congratulate the
medics.
Duffy did what he felt he could. Beyond his statement (which the
investigators now claim they have no record of), he complained to his
superiors about the shoddy medical supplies and the stripping of Red
Cross emblems. More recently, he filed complaints about his platoon
sergeant and captain with the Army Inspector Generals office, but
nothing has come of it. In any case, much of the paper trail that
might have implicated them is probably lost. When the military
abandoned Abu Ghraib in September 2006, Duffy and his comrades were
given one last order: Burn all of the compounds medical records.
Excerpted from Mother Jones (July-Aug. 2009), a bimonthly that
combines serious reporting chops with progressive ideals in covering
news, politics, and culture. www.motherjones.com
date: Fri, 23 Oct 2009 06:49:31 -0700 (PDT)
author: Lance
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