Doctors and Torture: NEJM

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http://content.nejm.org/cgi/content/full/351/5/415

 

New England Journal Of Medicine

 

Volume 351:415-416 Number 5 July 29, 2004

 

Doctors and Torture

Robert Jay Lifton, M.D.

 

There is increasing evidence that U.S. doctors,

nurses, and medics have been complicit in torture and

other illegal procedures in Iraq, Afghanistan, and

Guantanamo Bay. Such medical complicity suggests still

another disturbing dimension of this broadening

scandal.

 

We know that medical personnel have failed to report

to higher authorities wounds that were clearly caused

by torture and that they have neglected to take steps

to interrupt this torture. In addition, they have

turned over prisoners' medical records to

interrogators who could use them to exploit the

prisoners' weaknesses or vulnerabilities. We have not

yet learned the extent of medical involvement in

delaying and possibly falsifying the death

certificates of prisoners who have been killed by

torturers.

 

A May 22 article on Abu Ghraib in the New York Times

states that " much of the evidence of abuse at the

prison came from medical documents " and that records

and statements " showed doctors and medics reporting to

the area of the prison where the abuse occurred

several times to stitch wounds, tend to collapsed

prisoners or see patients with bruised or reddened

genitals. " 1 According to the article, two doctors who

gave a painkiller to a prisoner for a dislocated

shoulder and sent him to an outside hospital

recognized that the injury was caused by his arms

being handcuffed and held over his head for " a long

period, " but they did not report any suspicions of

abuse. A staff sergeant–medic who had seen the

prisoner in that position later told investigators

that he had instructed a military policeman to free

the man but that he did not do so. A nurse, when

called to attend to a prisoner who was having a panic

attack, saw naked Iraqis in a human pyramid with

sandbags over their heads but did not report it until

an investigation was held several months later.

 

A June 10 article in the Washington Post tells of a

long-standing policy at the Guantanamo Bay facility

whereby military interrogators were given access to

the medical records of individual prisoners.2 The

policy was maintained despite complaints by the Red

Cross that such records " are being used by

interrogators to gain information in developing an

interrogation plan. " A civilian psychiatrist who was

part of a medical review team was " disturbed " about

not having been told about the practice and said that

it would give interrogators " tremendous power " over

prisoners.

 

Other reports, though sketchier, suggest that the

death certificates of prisoners who might have been

killed by various forms of mistreatment have not only

been delayed but may have camouflaged the fatal abuse

by attributing deaths to conditions such as

cardiovascular disease.3

 

Various medical protocols — notably, the World Medical

Association Declaration of Tokyo in 1975 — prohibit

all three of these forms of medical complicity in

torture. Moreover, the Hippocratic Oath declares, " I

will use treatment to help the sick according to my

ability and judgment, but never with a view to injury

and wrongdoing. "

 

To be a military physician is to be subject to

potential moral conflict between commitment to the

healing of individual people, on the one hand, and

responsibility to the military hierarchy and the

command structure, on the other. I experienced that

conflict myself as an Air Force psychiatrist assigned

to Japan and Korea some decades ago: I was required to

decide whether to send psychologically disturbed men

back to the United States, where they could best

receive treatment, or to return them to their units,

where they could best serve combat needs. There were,

of course, other factors, such as a soldier's pride in

not letting his buddies down, but for physicians this

basic conflict remained.

 

American doctors at Abu Ghraib and elsewhere have

undoubtedly been aware of their medical responsibility

to document injuries and raise questions about their

possible source in abuse. But those doctors and other

medical personnel were part of a command structure

that permitted, encouraged, and sometimes orchestrated

torture to a degree that it became the norm — with

which they were expected to comply — in the immediate

prison environment.

 

The doctors thus brought a medical component to what I

call an " atrocity-producing situation " — one so

structured, psychologically and militarily, that

ordinary people can readily engage in atrocities. Even

without directly participating in the abuse, doctors

may have become socialized to an environment of

torture and by virtue of their medical authority

helped sustain it. In studying various forms of

medical abuse, I have found that the participation of

doctors can confer an aura of legitimacy and can even

create an illusion of therapy and healing.

 

The Nazis provided the most extreme example of

doctors' becoming socialized to atrocity.4 In addition

to cruel medical experiments, many Nazi doctors, as

part of military units, were directly involved in

killing. To reach that point, they underwent a

sequence of socialization: first to the medical

profession, always a self-protective guild; then to

the military, where they adapted to the requirements

of command; and finally to camps such as Auschwitz,

where adaptation included assuming leadership roles in

the existing death factory. The great majority of

these doctors were ordinary people who had killed no

one before joining murderous Nazi institutions. They

were corruptible and certainly responsible for what

they did, but they became murderers mainly in

atrocity-producing settings.

 

When I presented my work on Nazi doctors to U.S.

medical groups, I received many thoughtful responses,

including expressions of concern about much less

extreme situations in which American doctors might be

exposed to institutional pressures to violate their

medical conscience. Frequently mentioned examples were

prison doctors who administered or guided others in

giving lethal injections to carry out the death

penalty and military doctors in Vietnam who helped

soldiers to become strong enough to resume their

assignments in atrocity-producing situations.

 

Physicians are no more or less moral than other

people. But as heirs to shamans and witch doctors, we

may be seen by others — and sometimes by ourselves —

as possessing special magic in connection with life

and death. Various regimes have sought to harness that

magic to their own despotic ends. Physicians have

served as actual torturers in Chile and elsewhere;

have surgically removed ears as punishment for

desertion in Saddam Hussein's Iraq; have incarcerated

political dissenters in mental hospitals, notably in

the Soviet Union; have, as whites in South Africa,

falsified medical reports on blacks who were tortured

or killed; and have, as Americans associated with the

Central Intelligence Agency, conducted harmful,

sometimes fatal, experiments involving drugs and mind

control.

 

With the possible exception of the altering of death

certificates, the recent transgressions of U.S.

military doctors have apparently not been of this

order. But these examples help us to recognize what

doctors are capable of when placed in

atrocity-producing situations. A recent statement by

the Physicians for Human Rights addresses this

vulnerability in declaring that " torture can also

compromise the integrity of health professionals. " 5

 

To understand the full scope of American torture and

abuse at Abu Ghraib and other prisons, we need to look

more closely at the behavior of doctors and other

medical personnel, as well as at the pressures created

by the war in Iraq that produced this behavior. It is

possible that some doctors, nurses, or medics took

steps, of which we are not yet aware, to oppose the

torture. It is certain that many more did not. But all

those involved could nonetheless reveal, in valuable

medical detail, much of what actually took place. By

speaking out, they would take an important step toward

reclaiming their role as healers.

 

 

Source Information

 

From the Department of Psychiatry, Harvard Medical

School, Boston.

 

References

 

1. Zernike K. Only a few spoke up on abuse as many

soldiers stayed silent. New York Times. May 22,

2004:A1.

2. Slevin P, Stephens J. Detainees' medical files

shared: Guantanamo interrogators' access criticized.

Washington Post. June 10, 2004:A1.

3. Squitieri T, Moniz D. U.S. Army re-examines

deaths of Iraqi prisoners. USA Today. June 28, 2004.

4. Lifton RJ. The Nazi doctors: medical killing and

the psychology of genocide. New York: Basic Books,

1986.

5. Statement of Leonard Rubenstein, executive

director, Physicians for Human Rights, June 2, 2004.

(Accessed July 9, 2004, at

http://www.aclu.org/news/NewsPrint.cfm?ID=13965 & c=36.)