The Global Pulse Journal Blog

Evidence about the role of American physicians, clinical psychologists, and other health professionals in abuse and coercive interrogation at military detention sites has been accumulating slowly but incontrovertibly in the wake of the War on Terror.  In August 2009, Physicians for Human Rights released its most recent report describing in detail how the CIA relied on medical expertise to rationalize, plan, and carry out unlawful interrogations at detention sites.  Licensed health professionals observed physically abusive interrogation sessions and advised on how to increase the prisoner’s suffering.  They kept records of waterboarding, and consulted medical literature on hypothermia to determine “precise gradations” of the procedure.  When not aiding “coercive interrogations” directly, health professionals were still involved in facilitating and monitoring them, and also observed clear medical evidence of abuse without intervening — practices that subverted and violated well-established medical ethical obligations, to say nothing of the Geneva Conventions, the U.S. Constitution, and U.S. military law (JAMA).

To date, the U.S. has barely begun to address the gravity of what has taken place.  In the absence of a meaningful national response, medical professional organizations and the legislatures of individual states are stepping up to the challenge.  With the introduction of the Gottfried-Duane Bill in the State Assembly and State Senate, New York is posed to become the first state  in the country to explicitly prohibit health professionals licensed in the state from assisting in torture, interrogations, and prisoner abuse, while providing them with strong legal protection to resist any future coercion to participate in such acts.

The bill is meant to stop physician-assisted torture ever becoming a reality again, as well as to help health professionals address abuse and medical neglect of prisoners in domestic jails and detention centers.  Co-sponsored by 30 members of the State Assembly from both parties, the bill was favorably reported by Assembly committees last year, and is currently being revised in preparation for the floor vote.  It is supported by the NY state chapter of the American College of Physicians; by nursing, psychology, and social work associations;  and by civil liberties and human rights advocacy groups.

More on the Gottfried-Duane Bill, and why you should care, after the jump.

Click here to sign PHR’s petition in support of the Gottffried-Duane bill.

(There is a link for out-of-staters to show solidarity, too.)

StopTortureNY.org

Legislation Details:

The Gottfried-Duane bill will prohibit direct and indirect actions which constitute participation, complicity, incitement, assistance, planning, design, attempt, or conspiracy to commit torture or improper treatment of a prisoner.  Partaking in such actions will result in the loss of the provider’s license.  Furthermore, a duty to report suspected cases of torture and prisoner abuse is established, as well as mitigation for compliance with an investigation of alleged torture.  This legislation applies to professionals licensed by the state of New York, regardless of where the conduct takes place.

Importantly, the bill establishes protections for potential abuse against healthcare providers. Improper treatment does not include adverse effects of standard treatments, providers must reasonably know that they are participating in torture to violate the law, and employees are protected if they report any violations of the law.

The full text of the Assembly and Senate versions is available:  A-6665/S-4495.

Ethics Background:

Regardless of one’s political allegiance or beliefs regarding the justifiability of torture, the ethics of the medical profession allow for but one stance on the issue of involvement or enabling it.  The AMA Code of Medical Ethics Opinion 2.067 clearly defines torture in accordance with international standards, and clearly states that:

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. (AMA)

For a more in-depth analysis of medical ethics, scroll down for a list of cases on the AMA’s Virtual Mentor website.

Politics and Accountability

Although Guantanamo Bay was closed by executive order in the early days of the administration, and illegal interrogation procedures discontinued, the procedural and legal loopholes that enabled torture remain.  The torture investigation commission championed by U.S. Senators Durbin (D-IL) and Whitehouse (D-RI) is currently waiting on a key report by the Department of Justice’s Office of Professional Responsibility, and the Obama Administration sporadically gets called out on stalling on the issue.   (See coverage of Sheldon Whitehouse’s speech on holding high-level officials accountable for torture at the PHR National Conference in Providence last year.)

In order to appreciate what the accountability investigation is all about, I highly recommend the website Torturingdemocracy.org — an astounding documentary project about how a brand-new system for unlawful interrogations came to be created:

Another revealing documentary, Doctors and Detainees, is anticipated in Spring 2010.

Relevance:

Why is it so important for doctors, medical students, and allied health professionals, to come out strongly in support of efforts such as the Gottfried-Duane Bill?  Because our profession’s complicity in acts of torture is not only illegal, but viscerally abhorrent.  Medical knowledge is gathered as the sum of society’s progress, distilled from the dedicated effort of generations of doctors and patients, and taught with reverence.  We receive it as part of an ancient trust, and on the condition that we shall use it for the good of others.  This obligation is codified in the terms of medical ethics, and upheld by medical professional organizations — but its true power is as old as witch-doctors, as old as society’s fundamental belief  in the beneficence of doctors.  It is what lets patients entrust themselves to our knowledge and our beneficence during the most vulnerable moments of their lives.  To use that knowledge purposefully in order to inflict intolerable pain on another human being, or to stand by and knowingly allow it to be used in that way, is a violation that shakes our profession to the roots.  No other compromise we make with our professional conscience — no other quandary of dual loyalty – can even come close.

As a future physician, I urge you to speak your mind on this issue, whether you agree, disagree, or are conflicted.   The worst thing we can do is pretend this chapter never happened.  If you are a resident of New York State, or are interested in similar efforts in your own state, please contact the New York Medical Student Coalition Against Torture, NYMSCAT@gmail.com. You may also find their Facebook group useful.

Further Reading:

For further reading on torture, medical complicity, and the need for public and professional responses:

• Len Rubenstein discusses the complicity and motives of health professionals in torture with AMSA’s Global Pulse Journal in our Fall 2009 issue
• Health and Human Rights Journal’s Open Forum Blog posts on torture
• PHR’s Anti-Torture Campaign and Health Rights Advocate Blog
• The Center for Constitutional Rights website: WhenHealersHarm.org
• Amnesty International’s Spotlight on Torture
• The AMA’s Virtual Mentor ethics journal’s discussions on physician duties in treating war detainees, the role of physicians in interrogations, the history of torture and human rights in medicine, and physicians’ obligations to speak out for prisoners’ health.

To read the reports in more detail:

• PHR’s reports: Break Them Down (2005), Leave No Marks (2007), and Broken Laws, Broken Lives (2008)
• The CIA Inspector General’s 2004 Report is available online from the New York Times.
• The U.S. Department of Defense’s website on detainee investigations.

Note: NYMSCAT leaders will be speaking at the PHR 2010 National Conference on Health and Human Rights Education in Boston next weekend. You may also contact me personally at editorinchief.gp@gmail.com to find out what AMSA is doing on this issue, and how to become involved. — HA