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Medical Oaths Betrayed
The records also show instances of clinicians who did not confront abusive acts. In late 2003, Sgt. Neil Wallin, a medic, was called to a cell after Abu Ghraib guards slammed a prisoner into a wall, lacerating his chin. He saw the prisoner with a sandbag over his head and blood running down his clothes from a 2 1/2 -inch cut. According to a sworn statement, he saw "blood on the wall near a metal weld, which I believed to be the place where the detainee received his injury." He sutured the wound with 13 stitches but did not report it because he said he did "not know how he was injured or if it was done by himself or another."
Physicians are responsible for collecting medical evidence from patients who report being assaulted. Bruises disappear, fractures heal and witnesses move on, so a physician's job includes describing and, if possible, photographing injuries. One Abu Ghraib record recounts a prisoner's story of beatings, stress positions, being forced underwater until he vomited and being sodomized with an "industrial penis."
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But such records were the exception. Red Cross medical monitors described a number of prisoners with injuries from beatings or burns that had not been recorded in clinical notes. In 2003, U.S. soldiers arrested Sadiq Zoman and imprisoned him at their base in Tikrit. A month later, soldiers dropped him off at a hospital, according to a New York Times account. His family found him there four months later, unconscious, with three skull fractures, a broken thumb and burns on the soles of his feet. The Army had given the hospital a medical record saying that Zoman had suffered a heart attack and heatstroke.
'The Authority of God'
A medic who beat prisoners during his service in Iraq described his experience to a reporter like this: "You get a burning in your stomach, a rush, a feeling of hot lead running through your veins and you get a sense of power. . . . Imagine wearing point-blank body armor, an M-16 and all the power in the world and the authority of God."
In his 1973 study of Vietnam veterans, psychiatrist Robert Jay Lifton wrote that "atrocity-producing situations" arise at the confluence of extreme stress, a dehumanized enemy and the assurance from authorities that ordinary limits on conduct do not apply. However, a torturing society also needs the passive assent or active complicity of its medical profession. In the 20th century, such circumstances came together on several occasions. How does U.S. medical culpability in the war on terrorism compare to the role physicians played in the horrific abuse in Nazi Germany and the Soviet Union, or to medical complicity in the "dirty wars" of Argentina and Chile?
Nazi and Soviet physicians were architects of torture. Nazi doctors put their profession at the service of the party. They built a pseudoscientific foundation for anti-Semitism, called race hygiene. Physicians and politicians then used that "science" to build and operate the machinery for fascist eugenics, first killing the chronically ill and then, in the Holocaust, committing genocide. Soviet physicians constructed a diagnosis of "sluggish schizophrenia" and put it at the service of the state for incarcerating political dissidents. By contrast, the torture physicians of Argentina and Chile simply went to work in the prisons. They did what was asked of them and did not report what they saw.
The complicity and silence of U.S. clinicians and military medical commanders are more like the behavior of physicians in this second category. There were enough clinicians who were willing to be culpably ignorant, silent or actively complicit to staff the prisons and to allow the abuse to continue without medical challenge. Many civilian and military health professionals knew nothing of the abuse and bear no responsibility. But some senior military medical commanders, and the leadership of civilian medical associations, should have known or should have taken steps to know.
Clinicians are frontline monitors for human rights abuse in prisons. We are in prisons in which the Red Cross never goes and we are there when it is not. We can discern physical and psychic injuries even if they are not disclosed. Torturers need medical accomplices to keep prisoners alive as trauma is inflicted, to predict how severely detainees can be twisted. Such complicity shows a prisoner that he or she is utterly beyond help; complicit clinicians thus inflict the torment of despair.
It will require tenacious professionalism for medicine to remove the stain of its complicity with torture. We might start by recalling the story of the birth of Western medicine in ancient Greece. In grief over his beloved's death, Apollo, the god of healing and reason, dedicated their son, Asclepius, to healing. Asclepius ("Unceasingly gentle") married Epione ("Soothing"), and Hippocrates descended from that lineage. Greek medicine of 2,500 years ago had two foundations: medicine as a natural science and medical practice as a moral enterprise. The Hippocratic Oath speaks of those values in its vow to society, to patients and even to the prisoners at Abu Ghraib: "I will use regimens for the beneit of the ill in accordance with my ability and my judgment, but from what is to their harm or injustice I will keep them."
Steven H. Miles is a professor of medicine at
the University of Minnesota Medical School
and a member of its Center for Bioethics. He
is author of "Oath Betrayed: Torture, Medical Complicity, and the War on Terror" (Random House), from which this article is adapted.
