Outlook: Doctors Complicit in Torture

Dr. Steven Miles , professor at the University of Minnesota's Center for Bioethics, was online Monday, July 10, at 12:30 p.m. ET to discuss his Sunday Outlook article on medics that allowed the abuse of Guantanamo Bay detainees ( Medical Oaths Betrayed , ( Post, July 9, 2006 )). Miles says that "there were enough clinicians who were willing to be culpably ignorant, silent, or actively complicit to allow the abuses to continue without medical challenge." He is author of Oath Betrayed: Torture, Medical Complicity, and the War on Terror."

The transcript follows.

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Kansas City, Mo.: In the example of Al Qahtani, who was referenced by you as an example of torture supervised by medics, you fail to mention that he was the twentieth hijacker who after coercive questioning gave valuable information (When Lawyers Go To War; Heather McDonald; WSJ: July 7, 2006). The medics were used to monitor the techniques to ensure preservation of life and prevention of permanent impairment. The fact of the matter is, when it comes to discussing the horrible acts of atrocities committed by fanatic Islamic extremists, the real moral and ethical outrage is how one can ignore the pain and suffering of their victims but focus on the effort by our armed forces to obtain information to protect our country. If it were not for medics and physicians, many of these Islamic prisoners would be dead or maimed. Take away their contributions and the prisoners indeed would be much worse off than they are now. That examples can be found where questionable responses by medics and doctors occur is part of the chaos of war and will never completely be eliminated. No fault should be assigned to medical personnel when established guidelines are followed which have been given them by their superiors when the reason for war is of high moral validity. And to say that no moral validity exists in ridding the world of a group of terrorists who commit such horrible misdeeds as the Islamic terrorists is in itself a moral obscenity

Dr. Steven Miles: The Geneva Conventions do not distinguish according to the nature of the crime of the prisoner. We do not allow that distinction to apply with regard to treatment of our own prisoners.

"Oath Betrayed" contains a detailed discussion of the non-efficacy of coercive interrogation.

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Spokane, Wash.: Isn't it especially odious that the U.S. is conducting this interrogations as well as these human rights and medical ethics violations in Cuba, a country we accuse of being a human rights abuser and torturer?

Dr. Steven Miles: The United States is having increasing difficulty appealing to human rights standards that we have set aside. When we recently appealed to these standards on behalf of a Chinese dissident, China told us that we were hypocritical to do so and Russia concurred.

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Washington, D.C.: What do you think about the work of the ICRC in Guantanamo?

Dr. Steven Miles: The International Committee of the Red Cross ICRC is in a difficult situation, they get their access by promising the prison authorities that ICRC reports will not be public. This is different from Amnesty International or Human Rights Watch. The ICRC is not allowed private access to interview prisoners as of this date--until they are, the US cannot credibly speak of compliance with human rights treaties.

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Arlington, Va.: I have long marveled at the remote statistical odds against all these "bad apples" "rouging" in such parallel ways in geographically disparate places (Cuba, Afghanistan and several sites in Iraq). The stories of physicians being routinely in the loop during our country's torture of those opposing our military incursions pretty much puts the final lie to the ridiculous notion that these actions were not sanctioned by the higher-ups. Why has our domestic(ated) media done such a nonexistent job of tracing all this stuff upward?

Dr. Steven Miles: When the Abu Ghraib prison investigation was announced in January 04, the US media and Congress was in an uproar over a wardrobe malfunction at a football game.

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Washington, D.C.: Dr Miles- I was distressed to see the confusion engendered by your article and an erroneous headline. I decry the participation of many health care personnel (in your parlance, "clinicians") in these episodes, but there was no evidence presented that physicians (i.e. MDs) participated in any of this. Most readers - especially lay readers will not be able to make this distinction when the ambiguous terms "clinician" is employed, and The Post even headlines "doctors" on its second page. These are allied health care personnel that were involved; they do not take the Hippocratic oath, they are not licensed physicians, they have not attended medical school for 4 grueling years followed up by 3-7 years of truly demanding postgraduate training. In short, physicians, even in the military, have held the ethical line you and I support, and I am not surprised. I am dismayed, but not shocked, that individuals with a much lower commitment, fewer years of training, and less graduate education were compromised. As an MD, yourself I hope that your will work with the Post to address this misperception and casual editing that that indicts physicians unfairly. Physicians should not be confused with techs, corpsmen and other allied health care personnel.

Dr. Steven Miles: The various UN protocols, including the Principles of Medical Ethics Relevant to the role of Health Personnel, particularly Physicians in the protection of Prisoners and Detainees Against Torture and Other Cruel Inhuman and Degrading Treatment, do not separate out physicians.

The book details the roles of several physicians including the psychiatrist in charge of the Behavioral Science Consultation Team at Abu Ghraib, the MDs who ordered forced feeding at Gitmo etc.

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Fairfax, Va.: Is the culpability of medical personnel something new in America? If so, could it have similar origins as does the complicit behavior of those in the media who enable political leaders to do equally bad things by looking the other way or by actively participating in the perpetuation of misinformation?

Dr. Steven Miles: Although the US has a trouble history of collaborating with torturing regimes such as in El Salvador, Argentina, Chile, Guatemala, South Vietnam, and Batista's Cuba, our own military treatment of POWs has set the standard since WWII.

It is particularly distressing to me to see the good reputation of military medicine tarnished by civilian leaders at the Dept of Justice and Defense and by Commanders when this reputation was entrusted to them for temporary safe keeping and stewardship. General Colin Powell warned of this as the administration embarked on this policy.

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Alexandria, Va.: When I was growing up in the 50s I use to read about some of the tactics that Soviet doctors used to assist in the torture of prisoners, Andrei Shakarov as an example, sleep deprivation. I find it abhorrent that under this administration, we have resorted to such tactics.

Dr. Steven Miles: Yes, Soviet psychiatry invented a diagnostic term called sluggish schizophrenia which was used as a pretext for imprisoning dissidents and abusing them with medications and other abusive treatments.

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Va.: What about the Cuba interrogators in North Vietnam's POW camps? Or the Cuba medical staff on South African POWS?

Dr. Steven Miles: The book reviews the sad fact that about 60% of torture victims report that medical professionals were involved in their abuse. This does not count the people who never see the doctor who falsifies a death certificate or those who do not see the physician who devised a torture device.

Thus, physicians from Cuba, East Germany, Japan, Germany, etc etc have participated in the abuse of prisoners.

This book is not about the treatment on the battlefield--it is about the treatment of disarmed captives. It was our horror at the treatment of US POWs that has lead us to support conventions like the the Geneva conventions. We should not join torturing countries in a race to the bottom.

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Anonymous: Considering that Dr. Mengele's "research" was sponsored by BAYER, are there any corporate sponsors for any shady activities at Gitmo?

Dr. Steven Miles: I am unaware of any corporate sponsors for US activities in its prisons. I am also not aware of research such as bioweapons or ballistic wound treatment being conducted in US war on terror prisons and would be very surprised to see that it had occurred. I do not believe that it has.

On the other hand, private contractors have supplied US personnel with interrogation backgrounds to work at least in Iraq. I am not aware that any of them had medical backgrounds and thus did not address their role in "Oath Betrayed."

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New Hampshire: Dr. Miles, thank you so very much for your important work and your adherence to ethics. I fear we are in danger of losing what is left of our national soul. I am a medical professional and cannot fathom how our brothers and sisters could have participated in these horrors. We all take an oath to do no harm. My feeling is that these atrocities have been perpetrated because of a flawed and deeply immoral leadership. If we had adhered to our laws and the treaties and conventions that we are signatory to, this would never have happened on this scale. Just last week, we learned that the military is recruiting gangs and neo- nazis and that they have already infiltrated the ranks; things may get far worse!

I was pleased at the SCOTUS decision with regard to Hamdan. Do you think the Republican controlled Congress and administration will act to reign in this "run amok" situation, or do you think we will have to wait until more balance is restored to the government via elections?

Dr. Steven Miles: I am not a pundit or a fortune teller however it is important to note that the US Supreme Court in Hamdan upheld the applicability of Common Article III of the Geneva Conventions at Gitmo and thus presumably to Iraq (where the US said the Geneva Convention applied) and to Afghanistan where the US said it did not apply for the same reasons as at Gitmo.

Article III contains the ban on torture, cruel, inhuman or degrading treatment and violation of this is a grave breech of the convention, by definition a war crime.

The US has also enacted something called the US War Crimes Act (look it up!) which says that US personnel who violate Geneva are committing a federal crime. Accountability will come by history, probably by selected subpoenas or indictments from the European human rights community. This will be necessary to restore the international rule of law in prisons.

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Toronto Canada: Thanks for your excellent article.

Sami Al Laithy, an Egyptian academic, one of the 38 detainees who was determined not to have been an "enemy combatant" after all by his Combatant Status Review Tribunal, lost the use of his legs shortly after his arrival in Guantanamo. He says an angry guard threw him out of his hospital bed and jumped up and down on him, fracturing two of his vertebrae. DoD spokesmen say Al Laithy loss of the use of his legs was due to a (unspecified) pre-existing medical condition.

Many detainees were given their medical records when they were released. Do you happen to know whether Al Laithy was given his Guantanamo medical records? Do you happen to know whether he has made his records public and whether they back up his account of his loss of use of his legs?

Mahmoud Habib's medical records were analyzed by an expert, following his release. And he pointed to his frequent bouts of blood in his urine as a warning sign that Habib was being subjected to severe beatings. Are the DoD still giving released detainees their medical files? Or has the Habib analysis caused them to curtail this practice?

Thanks again for the excellent article.

Dr. Steven Miles: At this time, I cannot comment on the Laithy case. Lawyers seem to be having more luck getting medical records for some of the prisoners. It is important to note however that these medical records do not include the interrogation logs which detail the medical involvement in the course of the harsh interrogations. Also, it appears that the pre and post interrogation exams may in some instances be kept separate from the regular medical records. My book has an extensive discussion of missing data in some medical records and of medical records that become lost when investigators go looking for them.

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Washington, D.C.: I haven't had a chance to read your article yet (but I will!) but noticed the online discussion. A while back I was tangentially involved in an effort by Brazilian human rights organizations to revoke licenses of doctors in that country who had participated in torture. Any thought of doing the same here?

I've also thought this would be an interesting angle to take with administration lawyers as well -- those who most egregiously ignored clear precedent in justifying torture.

Dr. Steven Miles: There have been a couple of instances, discussed in the book, where licenses have been suspended for physicians who collaborate with abuse.

California Medical Board was recently asked to sanction a physician who oversaw forced feeding at Guantanamo and used its discretion to decline to review the matter.

I entirely agree that the lawyers who wrote the policies, Yoo, Delahunty, Gonzales, Ashcroft, Beaver et al should be evaluated in the same way that clinicians are. This by the way would not include the equally off base Alan Dershowitz who does not hold a policy making position and is simply exercising his first amendment protected right to speak.

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Washington, D.C.: RE: Kansas City, Mo: Almost any interrogator or intelligence professional will tell you that information obtained as the result of torture (or whatever euphemism you prefer) is inherently reliable. So your claim that the end justifies the means is not only morally bankrupt but factually false.

God bless you, Dr. Miles, for shining the spotlight on these abuses!

Dr. Steven Miles: I spend a great deal of time researching what is known about interrogational torture.

It gets bad information e.g. Saddam and Al Queda collaboration on bioweapons.

It results in sending our troops out on dangerous wild goose chases.

It alienates potential informants.

It enrages the populations against which it is directed.

It convinces opponents of the rightness of their cause and of the evil of their oppressors.

It endangers our own POWs and friends of democracy whose welfare we would support.

It does not produce usable evidence for trial.

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Washington, D.C.: Do you have a feel for how most medical personnel in the army feel about what you've described? I know you said the vast majority act ethically, but do they feel like they're being tarred by the activities of the few who aren't?

Dr. Steven Miles: One of the saddest and most infuriating things about this is that this event has tarnished the reputation and traditions of US military medicine.

I have worked with our Armed Forces, most recently in tsunami wrecked Indonesia, also in the VA. Our soldiers are honorable and professional men and women. This policy framework was inherently corrupting, command accountability was wrecked, the damage to the abused, to the abusers, to our national reputation will be long lasting.

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Silver Spring, Md.: I appreciated your article. In our society, as well as in the military, it is important for people who have some degree of influence, such as physicians, to stand up for what is right instead of just following orders. There are a lot of us who have no such influence who have a hard time trying to figure out what to do to stop the madness. A similar situation may be coming into the forefront regarding the death penalty in the US, where physicians may be able to effectively stop executions by refusing to attend. More power to them! And you!

Dr. Steven Miles: Thank you

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Arlington, Va.: A Zogby survey a few months ago found that 85% of our military personnel in Iraq think they are there "retaliating for Saddam's role in 9/11". I have often imagined that the Pentagon encouraged this misconception in our soldiers to make it easier for them to dehumanize those who would rise up against them after we invaded their country. However, it's hard to believe that the president's Saddam-9/11 lie could be pulled very effectively on the highly educated (i.e., doctors). What other tactics do you think might have been used to help military physicians see Iraqis as sub-human and unworthy of basic human rights?

Dr. Steven Miles: A torturing society is one that is blighted by the politics of dehumanization. Though it is far outside the scope of my book, the attacks in NY, the Pentagon, in Nairobi, Madrid, Egypt, Bali, etc merit a vigorous international police response as has been used against the mob or the Medellin drug cartel. War will not solve this problem and in fact seems to be serving as a recruiting tool and as a training opportunity for terrorists of the future. A senior military office has recently called Abu Ghraib "Jihad University."

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Tuscumbia, Mo.: Someday, perhaps sooner than you think, an Islamic fundamentalist terrorist will succeed in constructing a nuclear weapon located in the heart of one of our major cities. As our security measures continue to improve (recently demonstrated with the successful apprehension of terrorist cells in Florida and Canada) the real possibility exists that the terrorist(s) will be identified who knows where the nuclear device is located and when it is to be detonated. My question to you is do you believe that avoidance of coercive measures of questioning of the terrorist are required even at the risk of sacrificing thousands of innocent lives were the nuclear device to be exploded? Such scenarios, though perhaps less dramatic, occur on the battlefield regularly.

Dr. Steven Miles: This ticking time bomb scenario lies at the heart of the argument for torture. Serious intelligence agents do not put much credence in it.

It is vanishingly rare that an interrogator would know that one person has one piece of information that will pop out with a given level of torture and be instantly usable.

I have looked at the three ticking time bomb cases.

In one it was claimed that the torture of an Al Qaeda operative in the Philippines picked up a plot to blow up a bunch of trans-pacific commercial airliners. In fact the information was obtained from his laptop at arrest--torture added nothing.

In another, torture lead to false information about Iraq-Al Qaeda collaboration on bioweapons with disastrous policy consequences.

The Hamoodi case cited by Schlesinger and discussed in chapter 1 was also false.

A French general claimed successful use of interrogational torture in Algiers--his claim has not been validated. It is true that the use of torture alienated the population, mobilized the resistance. Any minor tactical advance was offset by a strategic failure.

Read the CIA Kubark and MBark reports for more. Citations in my book.

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Tampa, Fla.: A Nov. 4, 2005, NY Times op-ed by Bloche and Marks points out that the "coercive" techniques used at Abu Ghraib and elsewhere after 9/11 are not interrogation techniques, but actually brainwashing techniques. This seems to explain why, according to the FBI, we have gained no actionable intelligence from their use. Leaving aside questions about legality, the techniques don't work in the first place!

So the physicians and other health-care personnel betraying their oaths are really trying to brainwash their victims.

If they want to torture people, they at least ought to know what they're doing. Adding incompetence to wanton cruelty doesn't advance our cause, but plays right into the hands of al Qaeda.

Dr. Steven Miles: The Fay report which looked at this process in Iraq pointed out that the interrogators in this system were by and large novices with little training.

Secretary of Defense Rumsfeld in effect established a rump intelligence organization outside of standard Army doctrine in these interrogation centers and granted extraordinary powers to poorly trained interrogators who operated outside of a clear chain of command.

The amateurism and unprofessionalism of this system has deeply distressed many seasoned intelligence professionals and the FBI who have strenuously protested. Former CIA director and Admiral Stansfield Turner spoke for their distress when he called Dick Cheney our "Vice President of Torture."

The clinicians who became actively and passively complicit with this abusive system just went to work.

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Toronto, Canada: Thanks for the excellent article. I have an additional question.

Bush administration spokesmen have been responding to the claims of abuse by military personnel by citing the "Manchester manual", and claiming it tells al Qaeda trainees to lie about being tortured.

So, I did a web search on the manual, and read the chapters about what to do in case of capture. I didn't find it advising readers to lie about being tortured. I did find it encouraging readers to do their utmost to report when they had been tortured.

In particular, it encouraged readers do their utmost to get a medical examination as soon as possible, prior to any interrogation, if possible, in order to help document that subsequent injuries were administered while in custody.

Isn't this advice the very opposite of what it would advise if it counseled readers to lie about torture? Wouldn't medical examinations prior to interrogation help their captors document that the captive wasn't tortured?

Dr. Steven Miles: I cannot comment on this document. The Army Surgeon General found that our safety system of pre and post interrogation exams was very often skipped.

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Dr. Steven Miles: Thank you all for your questions.

The book is "Oath Betrayed: Torture, Complicity, and the Medical Profession" Random House. It is available through Amazon and at larger bookstores for $16-24.

For those of you who wish to become engaged on this matter, I suggest Human Rights Watch, Physicians for Human Rights, ACLU (Obtaining documents), and the Center for Constitutional Rights, as well as various torture victim treatment centers.

I am signing off at 12:23

Steven Miles, MD

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