Bioethics Discussion Blog: More on Prisoner Interrogation and the Physician’s Role

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Thursday, June 15, 2006

More on Prisoner Interrogation and the Physician’s Role

The Physicians for Human Rights (PHR) has in the past weeks released their views of a recent directive by the Defense Department regarding the role of physicians in interrogation of prisoners and their views of the recent American Medical Association’s stand on the issue. The Physicians for Human Rights organization is said to “mobilize the health professions to advance the health and dignity of all people by protecting human rights. As a founding member of the International Campaign to Ban Landmines, PHR shared the 1997 Nobel Peace Prize.” The following press releases were provided to me by the Physicians for Human Rights. If there are opposing views, from my visitors, to those presented here, my Bioethics Discussion Blog is a place to discuss them ..Maurice.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++


Physicians for Human Rights Denounces New Pentagon Instructions on Medical Support for Interrogation


Physicians for Human Rights (PHR), a health professional organization that has served as a leading voice against torture and abuse of detainees in US custody, today denounced new Defense Department guidelines on the role of health personnel in interrogations, calling them “an assault on medical ethics, the professional integrity of military health personnel, the Geneva Conventions, and on US military tradition and discipline.”
[Moderator’s note: Here is the link to the complete U.S. Dept. of Defense ”Medical Program Support for Detainee Operations” directive: so that you can read it for yourself]

"The DoD directive released today by Assistant Secretary of Health Affairs, William Winkenwerder, Jr., puts doctors and other health professionals in the untenable position of assisting in the infliction of harm,” said Leonard Rubenstein, Executive Director of Physicians for Human Rights. “This policy takes the United States further away from the most basic medical ethical and legal standards”
These new guidelines directly involve certain military health personnel, particularly mental health professionals, in the interrogation of detainees, making them active parts of the Behavioral Science Consulting Teams (known as “BSCTs”). “Military medical leadership ought to protect the ethical commitments and honor of our dedicated military health personnel,” said Brigadier General Stephen N. Xenakis, MD (USA—RET), an Advisor to Physicians for Human Rights. “Instead, they are subverting the essence of the Hippocratic Oath and compromising the integrity of the health professions as a whole.”
"The Pentagon policy also explicitly allows clinical information from medical records to be used in interrogation, in violation of core ethical principles protecting the confidentiality of information provided by patients to their health care providers,” said Rubenstein.
Rubenstein noted that the guidelines conflict directly with new policies issued last month by the American Psychiatric Association (APA) and World Medical Association (WMA), which prohibit psychiatrists and physicians, respectively, from directly supporting individual interrogations in any way. The WMA amended part of the Declaration of Tokyo, setting forth medical ethics regarding prisoners and detainees, to provide that “physicians should be particularly careful to ensure the confidentiality of all personal medical information” and that “[t]he physician shall not use nor allow to be used, as far as he or she can, medical knowledge or skills, or health information specific to individuals, to facilitate or otherwise aid any interrogation, legal or illegal, of those individuals.” The American Medical Association is a member organization of the WMA.
"The WMA and APA position recognizes that even lawful interrogation is an inherently adversarial and coercive process,” Rubenstein said, “and that there can be no ethical role for a health professional in the inevitable, ensuing infliction of stress and harm to a subject’s health and dignity. The only way to protect the health professional’s essential function as healer is to protect them from the interrogation process altogether, as the WMA and APA have done.”
The threat to health professional ethics extends even further, Rubenstein explained. The Pentagon guidelines do not follow universally recognized standards of medical ethics to guide the conduct of the BSCTs or any other health personnel, nor do they require the BSCTs to comply with international humanitarian and human rights law endorsed or ratified by the United States, such as the Geneva Conventions or the Convention Against Torture. Instead, BSCT health professionals are authorized to engage in any interrogation-related activity that complies with “applicable” US law.
"The problem with that standard,” Rubenstein warns, “is that the Bush Administration has interpreted US law on psychological torture in a way that violates the Convention Against Torture, as was recently reported by the UN Committee Against Torture. The Administration has further denied the applicability of the Geneva Conventions to many detainees and, according to news reports, has sought to delete the most basic tenets of the Conventions from the sections of the revised Army Field Manual that govern interrogations. What’s more, the Administration has sought to undermine the enforcement of the ‘McCain Amendment,’ passed by Congress last year to reaffirm the absolute ban on cruel, inhuman and degrading treatment by all US personnel. The net result is that health personnel participation in psychological forms of torture are not prohibited by these guidelines because they do not violate the Administration’s interpretations of US law.”
The Pentagon directive also instructs health professionals to violate ethical standards regarding hunger strikes, Rubenstein added, by instructing them to force-feed detainees who protest against their conditions of confinement by denying nutrition. Earlier this year, PHR and 250 leading doctors from around the world condemned the brutal force feeding methods used by military personnel in a campaign to break the will of hunger strikers at Guantanamo Bay.
The American Medical Association has also clarified that medical ethics generally prohibit force feeding hunger strikers. In a March 10, 2006 statement, the AMA said that the Association “has shared with U.S. military officials its position on hunger strikes or feeding individuals against their will. Specifically, the AMA endorses the World Medical Association's Declaration of Tokyo, which states:
‘Where a prisoner refuses nourishment and is considered by the physician as capable of forming an unimpaired and rational judgment concerning the consequences of such a voluntary refusal of nourishment, he or she shall not be fed artificially. The decision as to the capacity of the prisoner to form such a judgment should be confirmed by at least one other independent physician.'"
"The new Pentagon directive flies in the face of these established ethical guidelines, Rubenstein said, “and open the door to painful and abusive force-feeding methods intended to discourage detainees from calling attention to inhumane conditions of confinement through this form of protest. It is beyond ironic for the Pentagon to justify its unethical force-feeding policy by claiming concern about the health and well-being of detainees.”
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PHR Welcomes American Medical Association's Adoption of Rules Against Physician Involvement in Interrogation; Pentagon Must Commit to Adhere to AMA's Guidelines


Today in Chicago, the American Medical Association's (AMA's) House of Delegates adopted ethical guidelines that make it unethical for physicians to participate in the interrogation of detainees, such as those held at Guantanamo Bay and other US facilities. The new ethical guidelines appear to conflict directly with the rules released last week by the Pentagon for guiding the involvement of military physicians and other health personnel in interrogations. The guidelines, drafted under the guidance of Assistant Secretary of Defense for Health Affairs, William Winkenwerder, find no ethical obstacle to physicians playing an active role in the interrogation process.
"The new AMA policy goes a long way toward protecting the ethical commitments and integrity of all military medical personnel," said Leonard Rubenstein, Executive Director of Physicians for Human Rights. "While the AMA rule leaves a bit more room for interpretation than do the other medical association policies - something the AMA can and should quickly remedy - we believe this policy can only be read as an unambiguous rejection of the Pentagon's use of military physicians to support individual interrogations, as BSCT members or in any other capacity."
The AMA's action is the latest in a recent series of forceful statements from the medical community that repudiate the Pentagon's efforts to use medical knowledge and skill in the interrogation process, which, in even lawful interrogation, is inherently coercive and adversarial. In rejecting a role for physicians in individual interrogations, the AMA joined the American Psychiatric Association (APA) and the World Medical Association (WMA), both of which adopted explicit policies last month absolutely prohibiting physicians from participating in the interrogation process.
"The AMA acted today to defend the basic principles of medical ethics and to protect the men and women bravely serving our country as military health personnel," stated Brigadier General Stephen Xenakis, MD (USA-Ret), an advisor for Physicians for Human Rights. "Since 2001, the civilian leadership at the Pentagon has been engaged in a full frontal assault on the basic standards of medical and military ethics, from the Hippocratic Oath to the Geneva Conventions. All the major medical associations are now standing together to demand that this administration respect the core values of both the health professional and the soldier."
The new ethical policy adopted by the AMA prohibits physicians from directly participating in interrogations, from helping to plan and develop interrogation strategies on individual detainees, and from intervening in specific interrogations. This prohibition is needed, according to the new policy statement, to protect "the physician's role as healer" and to preserve trust in the medical profession.
Like the AMA, the new American Psychiatric Association policy prohibits psychiatrists from direct participation in interrogations, including "asking or suggesting questions, or advising authorities on the use of specific techniques of interrogation with particular detainees." The WMA rule, adopted with the support the AMA at last month's meetings, similarly provides that physicians may not "use, or allow to be used, as far as he or she can, medical knowledge or skills, or health information specific to individuals, to facilitate or otherwise aid any interrogation, legal or illegal, of those individuals."
The Pentagon's guidelines, however, require certain health personnel, particularly psychiatrists and psychologists on Behavioral Science Consultation Teams (BSCTs), to participate directly and extensively in the interrogation of individual detainees, and they facilitate the unethical disclosure of confidential medical information.
"The Pentagon must immediately revise its guidelines and rescind all regulations permitting the use of physicians and psychologists in individual interrogations and as part of the BSCTs." Rubenstein added that the AMA, APA and other medical associations can be expected to press for elimination of the BSCT role in view of their new policies banning direct physician involvement in interrogations.
Elaborating on the new limits imposed by the AMA on physicians in interrogations, Rubenstein emphasized that "no participation in individual interrogations is authorized by the new AMA rule. Physicians are only permitted under the rule to help develop interrogation strategies for 'general training purposes,' provided those strategies do not threaten or cause harm, are humane, and do not violate detainees' rights. We are deeply concerned even with this level of involvement," Rubenstein said, "because of the ambiguity of that qualifying language. It's simply not reasonable to require a physician to determine, in the abstract, whether a particular interrogation strategy will or will not be used in a way that inflicts harm, or whether it is clearly 'humane' or legal. Given the nature of interrogation, we believe it best, as the APA and WMA policies do, to insulate physicians entirely from the design of interrogation strategies, and we hope the AMA will fine-tune its policy accordingly."
Rubenstein also suggested that the AMA also should continue to refine its policy on confidential medical information to provide greater protection against disclosure to interrogators. "In stark contrast to the Pentagon guidelines," he said, "the new AMA rule significantly restricts physicians from disclosing information they obtain from detainees when providing medical care. We urge the AMA to go one step further, as the WMA has done, in requiring physicians to do what they can to prevent interrogators themselves from gaining direct access to detainees' medical information."

In the wake of the three suicides of detainees over the weekend that were being held at the US detention facility in Guantanamo Bay, Cuba, PHR strongly called for the Pentagon to grant access to Guantanamo and other facilities to independent medical and human rights experts and to publicly commit to vigorously enforce the McCain Amendment's prohibition against cruel and inhumane treatment of detainees, including the use of psychological torture. The group also reiterated its standing call for the Pentagon to end the force feeding of hunger strikers at the facility, a practice that is against the Declaration of Tokyo, the World Medical Association's prohibition of force feeding of voluntary hunger strikers.

3 Comments:

At Saturday, June 17, 2006 8:29:00 AM, Anonymous R. Carlton Jones, M.D. said...

Translation of Department of Defense INSTRUCTION NUMBER 2310.08E June 6, 2006:

SUBJECT: Medical Program Support for Detainee Operations

Translation:

SUBJECT: Exploitation of Military and DoD Contract Health Care Professionals

Executive Summary Translation:

'Military health care professionals are instructed to shut the f*** up and do
as you are told. Non-medical commanders can (and probably will) order you to
violate your personal principles of medical/nursing/PA/BSC ethics. You may
even be ordered to commit crimes against humanity. You are instructed to
remember that you are a military officer (or NCO, or soldier/sailor/airman/marine)
first, and everything else second. Remember Rule Number One: if someone is
labeled an 'enemy combatant', anything goes; Rule Number Two: refer to rule
number One; Rule Number Three: if you object to the above rules, you risk being
labeled an illegal combatant Enemy of the State yourself. After all, if you are not
with us, you are with the terrorists. Remember: in detention, as in space, no one
can hear you scream.'

Translation of Specific Sections of the Policy Follows:

4.1.2. Health care personnel charged with the medical care of detainees have a
duty to protect detainees’ physical and mental health and provide appropriate treatment for disease.
To the extent practicable, treatment of detainees should be guided by
professional judgments and standards similar to those
applied to personnel of the U.S. Armed Forces.

Translation:

''Health care personnel' (HCP) not charged with the medical care of detainees
will do whatever the Commander tells them to do, even if this means harming or
contributing to harm of the patient, er, enemy combatant. Note that we are
explicitly devaluing physicians by lumping them together with other HCPs,
including Airman Snuffy who once watched an entire episode of 'House' on
television.'


4.1.3. Health care personnel shall not be involved in any professional
provider-patient treatment relationship with detainees the purpose of which is
not solely to evaluate, protect, or improve their physical and mental health.

Translation:


'We are setting up a two track system for physicians and other medical
professionals: Docs specifically assigned to a 'professional provider-patient
treatment relationship' (PPPTR) role will be allowed to act as humane
physicians, in accordance with the Hippocratic Oath and international law;
physicians and other 'LIPs' (Licensed Independent Providers) assigned to break
down the will of 'illegal combatants' will do whatever Command asks of them;
basic biomedical ethical principles will not apply. See section 4.3:

'Health care personnel engaged in non-treatment activities, such as
forensic psychology, behavioral science consultation, forensic pathology, or
similar disciplines, shall not engage in any professional provider-patient
treatment relationship with detainees...'

'So, Doc Jones is assigned to a PPPTR; she is issued a stethoscope. Doc Smith,
on the other hand, is assigned to an NTA role (Non-Treatment Activity); he is
issued a cattle prod.'


4.1.4. Health care personnel, whether or not in a professional
provider-patient treatment relationship, shall not apply their knowledge and
skills in a manner that is not in accordance with applicable law or the
standards set forth in Reference (c).

Translation:

'Note: there is no Reference (C) in the instruction (see: http://www.dti
c.mil/whs/directives/corres/rtf/231008x.rtf
) . There never was. If you
wish to extrapolate the content of Reference (C), an executive summary of same
would be: 'Shut up and do what you're told, Major, or suffer the
consequences.''


4.4. Medical Information. Health care personnel shall safeguard patient
confidences and privacy within the constraints of the law. Under U.S. and
international law and applicable medical practice standards, there is no
absolute confidentiality of medical information for any person.

Translation:

'We are setting up a pseudo-legal cover for our blatant misuse of patient
medical information by incorrect extrapolation of specific cases to the general
misuse of medical information as we see fit. This is known as the 'slippery
slope' fallacy. IF it is true that physicians are required to report child
abuse or drug use to law enforcement or command authorities, then it MUST be
true that Achmed's childhood trauma from a severe dog bite can be communicated
to the OGA guy in the black outfit sans nametag, who can (and will) transmit
this information to Doc Smith, who is assigned to NTA prisoner interrogation
duties today. Quod Erat Demonstrandum.'

'For an explanation of OGA, go here: http://www.post-gazette.
com/pg/03236/214533.stm


4.4 (continued)

'However, whenever patient-specific medical information concerning detainees is
disclosed for purposes other than treatment, health care personnel shall record
the details of such disclosure, including the specific information disclosed,
the person to whom it was disclosed, the purpose of the disclosure, and the
name of the medical unit commander (or other designated senior medical activity
officer) approving the disclosure.'

Translation:

'If the person to whom it is disclosed is an OGA spook, however, the use of
pseudonyms will be required, as in 'I told Agent Orange to set dogs on Achmed
to break his will.''


'Similar to legal standards applicable to U.S. citizens, permissible purposes
include preventing harm to any person, maintaining public health and order in
detention facilities, and any lawful law enforcement, intelligence, or national
security-related activity.'

Translation:

''Any lawful law enforcement, intelligence, or national security related
activity' means do anything the F*** we say, or risk being labeled an enemy
combatant yourself, LtCol (Dr.) Jones. After all, name me something, anything
we do in military service which cannot be construed as a 'National
Security-Related Activity'. Can't think of anything, can you, punk? Neither
can we, so shut your pie hole and follow orders.'

4.4.1 When the medical unit commander (or other designated senior medical
activity officer) suspects the medical information to be disclosed may be
misused, or if there is a disagreement between such medical activity officer
and a senior officer requesting disclosure, the medical activity officer shall
seek a senior command determination on the propriety of the disclosure or
actions to ensure the use of the information will be consistent with applicable
standards.

Translation:

'The medical unit commander is not given authority to implement ethical patient
care standards and to enforce observation of the Hippocratic Oath and basic
humanity. The non-physician, non-medically-trained commanding bureaucrat has
the authority to overrule physicians under her command. Although this is
tantamount to allowing a physician to order a pilot to take off in an airplane
suffering from a known, fatal mechanical problem, this is policy, so deal.'

4.4.2. Consistent with applicable command procedures, International Committee
of the Red Cross physicians shall be given access to review medical records of
detainees during visits to detention facilities.

''Applicable command procedures' includes the right to ignore international
laws, treaties and conventions. After all, if our Commander in Chief can issue
policy letters that explicitly and unconstitutionally overturn laws passed by
the Congress of the United States of America via 'signing statements' (see
http://www.nybooks.com/articles/19092 , how much easier is
it for a military commander to promulgate a 'Command Procedure' that states
that 'Operational Security' would be threatened by giving ICRC representatives access to our detainees'.



4.5. Reportable Incident Requirements. Any health care personnel who
in the course of a treatment relationship or in any other way observes or
suspects a possible violation of applicable standards, including those
prescribed in References (b), (c), and (e), for the protection of detainees
shall report those circumstances to the chain of command.

Translation:

'...who will ignore the whining of lower-ranking medical pukes.'


Health care personnel who believe such a report has not been acted upon
properly should also report the circumstances to the medical program
leadership, including the Command Surgeon or Military Department specialty
consultant.

Translation:

'...who will cover-up the whining of their lower-ranking puke subordinate
whiners, in order to protect their own careers.'


Officials in the medical program leadership may inform the Joint Staff Surgeon
or Surgeon General concerned, who then may seek senior command review of the
circumstances presented.

Translation:

'...if they have a suicidal need to destroy their own careers, subject
themselves to adverse performance reviews and Letters of Reprimand, while not
affecting the actual care of detainees one iota.'

Other reporting mechanisms, such as the Inspector General, criminal
investigation organizations, or Judge Advocates, also may be used.

Translation:

'...because, since 2001, we have seen how effective these mechanisms have been
in covering up war crimes and violations of international laws at Abu Ghraib,
Guantanamo, Bagram Air Base, and various classified 'rendition' sites across
Eastern Europe. The IG system is especially helpful in whitewashing wrongdoing
by the chain of command. All that is required is a legal finding that the
crimes against humanity were committed unilaterally by 18 year olds who had
been asking 'do you want fries with that' until the day before their Reserve
units were activated, rather than as a direct result of inhumane torture
policies promulgated by General officers, such as this one: LtGen
Ricardo S. Sanchez's 14 Sep 2003 Interrogation Rules of Engagement
using
black-clad OGA spooks to instruct teenagers on how to break down 'detainees'
wills. None of these legal mechanisms includes humans who know anything about
the ethical standards of medical care of patients by physicians and other
health care professionals, which is the entire point: the Flag Rank Chain of
Command is considered paramount and sacrosanct, while mealy-mouthed complaints
by company grade and field grade physicians are consigned to the unique
military circular file reserved for all dissenting opinions by inferiors. Res
ipsa loquitur.'

4.5.1. Health care personnel involved in clinical practice activities shall
make a written record of all reports of suspected or alleged violations in a
reportable incident log maintained by the medical unit commander or other
designated senior medical activity officer.

Translation:

'...so that said incident log can be ignored and/or held against the medical
officer as evidence of her disloyalty to the will of the President.'


4.6. Training. The Secretaries of the Military Departments and, as
appropriate, Combatant Commanders shall ensure health care personnel involved
in the treatment of detainees or other detainee matters receive appropriate
training on applicable policies and procedures regarding the care and treatment
of detainees. This training shall include at least the following elements:

Translation:

'1) Basic cattle prod insertion techniques: Above the waist
2) Advanced cattle prod insertion techniques: Below the waist
3) How to use anesthesia drugs to Poison the Pizzas of
Enemy Combatants
to subdue them
4) Basic use of seduction by cute psychiatrists (of either gender): Up to R
5) Advanced use of seduction by cute psychiatrists (of either gender): NC17 and
beyond
6) Koran desecration 101: Environmental Alterations (fire, water, etc.)
7) Koran desecration 201: Bodily Functions
8) Fingernail anatomy refresher course for bamboo sliver insertion purposes
9) Recent advances in waterboarding: Is air mandatory or optional for human
survival?
10) Electricity: Neurophysiologic responses to genital application of
alternating current vs. direct current, and their connection to Broca's
cortical area mediating speech production'

4.7. Consent for Medical Treatment or Intervention. In general, health care
will be provided with the consent of the detainee.

Translation:

'In specific cases, consent is entirely optional.'

4.7.1. In the case of a hunger strike, attempted suicide, or other attempted
serious self-harm, medical treatment or intervention may be directed without
the consent of the detainee...

Translation:

'So stuff that NG tube down Achmed's nose now, Major, because your commanding
officer orders you to do so...Don't believe me, son? Read this and weep:'

Such action...must be approved by the commanding officer of the detention
facility or other designated senior officer responsible for detainee
operations.

Translation:

'...because that Commander outranks the most senior physician on base/post, so
his/her will is Law, regardless of any limpwristed ethical objections you
harbor.'

4.7.2. Involuntary treatment or intervention under subparagraph 4.7.1. in a
detention facility must be preceded by a thorough medical and mental health
evaluation of the detainee and counseling concerning the risks of refusing
consent. Such treatment or intervention shall be carried out in a medically
appropriate manner, under standards similar to those applied to personnel of
the U.S. Armed Forces.

Translation:

'Detention Center X-ray, Andrews AFB, November 11, 2008:
SSgt Johnson, we are about to stuff an NG tube down your nose involuntarily
because you have gone on a hunger strike to protest your detention as an enemy
combatant as a result of your seditious anti-Empress Jenna postings to various
internet blog sites from June 2007 through October 2008. You have been
medically evaluated by a legally-sanctioned housekeeper physician's assistant
assistant's assistant, and mentally evaluated by your Commanding Officer, who
has given you the Command-designated DSM-V diagnosis of 'Nuts'. Therefore, in
accordance with policy, you are given the following legal order: suck it down.'


4.9. Health Care Personnel Management. As a matter of personnel
management policy, except as provided in this paragraph, health care
personnel’s support of detainee operations is limited only to providing health
care services in a professional provider-patient treatment relationship in
approved clinical settings, conducting disease prevention and other approved
public health activities, advising proper command authorities regarding the
health status of detainees, and providing direct support for these activities.
Medical personnel shall not be used to supervise, conduct, or direct
interrogations. Health care personnel assigned as, or providing direct support to,
BSCs, consistent with Enclosure 2, or AFME personnel, are the only
authorized exceptions to this paragraph. The Assistant Secretary of Defense
for Health Affairs (ASD(HA)), or designee, must approve any other exceptions to
this paragraph.

Translation:

'Doctor Jones, ASD (HA) Winkenwerder says you have to go to Cell Block 17 to
help interrogate Achmed, so refer to the executive summary of Department of
Defense INSTRUCTION NUMBER 2310.08E June 6, 2006: 'shut the f*** up and do as
you are told'.'

Face it: Military Medicine is Dead, Jim.


R. Carlton Jones, M.D.
ex-LtCol, USAF, MC
ex-Medical Director of Anesthesia, Travis AFB, CA
ex-Assistant Chief Anesthesiologist, Andrews AFB, MD
Harvard '85, USU '90, WHMC residency 1994
Diplomate, American Board of Anesthesiology, 1995
webmaster_AT_medicalcorpse_DOT_com
http://www.medicalcorpse.com

Nemo Me Impune Lacessit

Above Copyright (C) 2006 R. Carlton Jones, M.D. All republishing rights reserved.
E-mail webmaster_AT_medicalcorpse.com for permission to republish whole or in part.

 
At Saturday, June 17, 2006 8:57:00 AM, Anonymous R. Carlton Jones, M.D. said...

Sorry about the formatting of my post; the preview page hid Notepad's carriage returns.

A far more legible version of the above can be found on my website here:

http://www.medicalcorpse.com/torturepolicy.html

By the way, sorry about the typo in the URL for the true story of the Pitifully Peculiar Case of the Poisoned Pizza, which can be found here:

http://www.medicalcorpse.com/poisonedpizza.html

Peace out.

R. Carlton (Rob) Jones, M.D.
ex-LtCol, USAF, MC
etc.

 
At Tuesday, June 27, 2006 7:13:00 AM, Blogger Prup (aka Jim Benton) said...

Dr. Bernstein:
This is a brilliant discussion of the situation. Like OATH BETRAYED, by Dr. Miles, it should be getting massive publicity. If I have any criticism of this, or for you writing it, it is just that I am unaware of any attempts you are making to get it to a wider audience.
It is not enough to have said it, it needs to get heard, not just by Senators and Representatives, but by the American people.
I am tired of going to bed, for the first time in my 60 years, truly ashamed of the actions of America.

 

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