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.
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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.