Do No Harm

A detainee is escorted by U.S. military guards at Camp X-Ray at Guantanamo Bay Naval Base.
A detainee is escorted by U.S. military guards at Camp X-Ray at Guantanamo Bay Naval Base. (Andres Leighton / Ap)
Reviewed by Peter D. Kramer
Sunday, July 23, 2006


Torture, Medical Complicity, and the War on Terror

By Steven H. Miles

Random House. 220 pp. $23.95

Vulnerable in body and mind, we look to our physicians for compassion -- which makes torture that's abetted by the medical profession especially horrific. Jacobo Timerman, a victim of Argentina's "dirty war," wrote of the special pain of seeing a doctor present in the interrogation room, of the sense of abandonment that lay in knowing that a person of science "is with you when you are tortured by the beasts."

In the wake of the unspeakable acts of Nazi doctors during the Holocaust, modern governments adopted a series of international conventions that declared doctors' participation in torture to be unethical. Professional associations followed. A 1999 ruling of the American Medical Association's judicial council is typical; it prohibits U.S. physicians from "providing or withholding any services, substances, or knowledge to facilitate the practice of torture" and obliges doctors to support victims and to "strive to change situations in which torture is practiced."

But the link between healing and torture is hard to sever. In the Renaissance, special "torture doctors" helped inquisitors choose their interrogation methods. In August 2004, Steven H. Miles, a bioethicist and professor of medicine at the University of Minnesota, reported in the British medical journal the Lancet that the United States had, in effect, returned to the era of the torture doctor. In Iraq and Afghanistan and at Guantanamo Bay, Cuba, Miles wrote, "The medical system collaborated with designing and implementing psychologically and physically coercive interrogations." Miles's charges were detailed: Death certificates had been falsified, he wrote, and military health personnel had reported incidences of torture belatedly, if at all.

Oath Betrayed is Miles's expansion of his Lancet article. It is rich in examples. Miles describes the work of the Behavioral Science Consultation Teams (known as BSCTs, or "biscuits") active in Iraq and Guantanamo: groups of psychiatrists and psychologists who used detainees' medical charts and test data to devise "physically and psychologically coercive interrogation plans" designed to break their resistance. In at least one camp in Iraq, all harsh interrogations reportedly were first approved by the medical team.

Expanding on his 2004 charge that medical personnel were rigging death certificates, Miles writes of an Afghan prisoner named Dilawar, an innocent 22-year-old who drove his taxi to "the wrong place at the wrong time." At the U.S. airfield detention center in Bagram, Afghanistan, in December 2002, Miles reports, Dilawar was suffocated with a sandbag and then shackled, suspended by his arms and beaten until his legs were (in the words of the coroner) "pulpified." He was then chained to the ceiling of his cell, where he died. Although a Dec. 13 autopsy called Dilawar's death a homicide, Miles writes, Gen. Daniel McNeil told reporters in February that Dilawar had died of natural causes on the grounds that one of his coronary arteries was partly occluded. The words "coronary artery disease" were typed in a different font on the prisoner's death certificate.

Cases like this lay bare the absurdity of the position in which doctors at facilities such as Bagram and Guantanamo are placed. For interrogations in which leg pulpifying is planned, should the screening physical include a cardiac stress test?

Many of the documents that Miles cites are available online, so readers can judge his allegations for themselves. My impression is that while Miles's overall conclusions regarding unethical behavior by physicians are probably justified, the evidence he cites for medical complicity in specific instances of torture sometimes falls short of definitive proof. But his accumulation of disturbing reports effectively buttresses his larger charge that -- at Abu Ghraib, Guantanamo and elsewhere -- post-9/11 America has become "a torturing society."

The debate over the ethics of torture often contrasts idealism with pragmatism. Opponents of torture tend to follow the Harvard scholar Elaine Scarry, who characterized the practice as "close to being an absolute of immorality," an "undoing of civilization" whose connection to the proclaimed aim of obtaining information is rarely to be taken at face value. Those who argue that torture may sometimes be permissible -- Miles uses the psychiatrist and Washington Post columnist Charles Krauthammer as his prime example -- usually begin with the "ticking bomb" scenario, in which torturing a detainee might produce the intelligence to prevent mass murder. Krauthammer quips, "Once you've established the principle" that torture must sometimes be used to elicit information that saves innocent lives, then "to paraphrase George Bernard Shaw, all that's left to haggle about is the price." The hope, Krauthammer continues, is that the "level of inhumanity of the measures used . . . would be proportional to the need and value of the information."

Miles's book lends strong support to the absolutist foes of torture, on humane and practical grounds alike. His numerous examples of heedless cruelty make the case that authorizing torture creates a subculture that knows nothing of proportionality; if torture is permitted in the rare crisis, it will be put to use routinely. He also argues convincingly that confessions elicited under torture are of dubious reliability. In July 2004, the British ambassador to Uzbekistan protested the Uzbek intelligence service's interrogation practices: "Tortured dupes are forced to sign up to confessions showing what the Uzbek government wants the U.S. and UK to believe. . . . This material is useless -- we are selling our souls for dross."

Though medical complicity is a deeply troubling element in the torture enterprise, it is hardly a decisive one. In May, the American Psychiatric Association strengthened its opposition to doctors' "asking or suggesting questions, or advising authorities on the use of specific techniques of interrogation with particular detainees." The Pentagon countered by announcing that it would continue its program but try to use psychologists only.

Ending our status as "a torturing society" requires change at a higher political level -- for instance, the Bush administration's recent acknowledgment that the Geneva Conventions' ban on "humiliating and degrading treatment" applies to all terrorism suspects in U.S. custody, including alleged al-Qaeda operatives. But who is to say that such movement does not occasionally begin with moral suasion -- as a result of the sort of witness Miles offers here? ยท

Peter D. Kramer is the author, most recently, of "Against Depression." His brief biography of Sigmund Freud will be published in November.

© 2006 The Washington Post Company