Detainees' Medical Files Shared

By Peter Slevin and Joe Stephens
Washington Post Staff Writers
Thursday, June 10, 2004

Military interrogators at the U.S. detention facility at Guantanamo Bay, Cuba, have been given access to the medical records of individual prisoners, a breach of patient confidentiality that ethicists describe as a violation of international medical standards designed to protect captives from inhumane treatment.

The files, which contain individual medical histories and other personal information about prisoners, have been made available to interrogators despite continued objections from the International Committee of the Red Cross, according to interviews and documents obtained by The Washington Post. After discovering the practice in mid-2003, the Red Cross refused to send medical monitoring teams to the facility for more than six months, sources said.

There is no universally established international law governing medical confidentiality. But ethics experts said international medical standards bar sharing such information with interrogators to ensure it is not used to pressure prisoners to talk by withholding medicine or by using personal information to torment a detainee.

"I don't think any American medical worker, doctor, nurse should go along with this," said Arthur L. Caplan, director of the Center for Bioethics at the University of Pennsylvania. "The role of health care workers in any facility should be solely looking after the health of patients; anybody who is not involved in that should not have access to medical records."

How military interrogators used the information is unknown. But a previously undisclosed Defense Department memo dated Oct. 9 cites Red Cross complaints that the medical files "are being used by interrogators to gain information in developing an interrogation plan." Maj. Gen. Geoffrey Miller, the commander of the facility at the time, denied the allegations, according to the memo.

Military officers have reported a continuous search for defensible ways to pressure Guantanamo's 600 prisoners to reveal details about terrorist operations and organizations. Early last year, the Defense Department formally authorized interrogators to use "stress and duress" techniques designed to disorient detainees and weaken resistance. With proper permission, the guidelines allow some prisoners to be subjected to techniques designed to "invoke feelings of futility."

A Defense Department spokesman declined to comment on the use of medical files that are generated by medical personnel at Guantanamo Bay or other detention facilities around the world. A Pentagon official, who refused to be named, said public discussion about the files could violate a Defense Department policy of not commenting on interrogation techniques.

But specialists in international humanitarian law said that by making the files available to nonmedical personnel, U.S. authorities crossed a line that separates the medical needs of prisoners from the government's interest in interrogating them.

"That is a violation of ethical standards that are quite old and accepted," said Leonard S. Rubenstein, executive director of Physicians for Human Rights, a Boston-based advocacy organization. "I don't think you would find any medical person who would say this is okay."

Steven H. Miles, a professor of bioethics at the University of Minnesota, said that using the information in interrogations of detainees would be a "clear-cut violation" of the Geneva Conventions.

"This is an enormously serious breach," said Miles, past president of the American Association of Bioethics. "You just can't do that."

Miles said use of information in the prisoners' medical records also would violate the ethics code of the World Medical Association, which prohibits doctors from providing information that could aid "cruel, inhuman or degrading treatment" or "diminish the ability of the victim to resist such treatment."

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