Army Doctors Implicated in Abuse in NEJM

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http://www.washingtonpost.com/wp-dyn/articles/A51032-2005Jan5.html

 

 

Army Doctors Implicated in Abuse

Medical Workers Helped Tailor Interrogations of Detainees, Article Says

 

By Joe Stephens

Washington Post Staff Writer

Thursday, January 6, 2005; Page A08

 

U.S. Army doctors violated the Geneva Conventions by helping

intelligence officers carry out abusive interrogations at military

detention centers, perhaps participating in torture, according to an

article in today's edition of the New England Journal of Medicine.

 

Medical personnel helped tailor interrogations to the physical and

mental conditions of individual detainees at Abu Ghraib prison in Iraq

and the U.S. military prison at Guantanamo Bay, Cuba, according to the

article. It says that medical workers gave interrogators access to

patient medical files, and that psychiatrists and other physicians

collaborated with interrogators and guards who, in turn, deprived

detainees of sleep, restricted them to diets of bread and water and

exposed them to extreme heat and cold.

 

 

" Clearly, the medical personnel who helped to develop and execute

aggressive counter-resistance plans thereby breached the laws of war, "

says the four-page article labeled " Perspective. "

 

" The conclusion that doctors participated in torture is premature, but

there is probable cause for suspecting it. "

 

The article was written by M. Gregg Bloche, a law professor at

Georgetown University and adjunct professor at Johns Hopkins

University, and by Jonathan H. Marks, a London barrister who is a

bioethics fellow at Georgetown University Law Center and Johns

Hopkins. It is based on interviews with more than two dozen military

personnel and on a review of documents released to the American Civil

Liberties Union under the Freedom of Information Act.

 

Pentagon officials said yesterday that the article is inaccurate and

misrepresents military officials' positions and acts. Doctors did not

violate the Geneva Conventions, said William Winkenwerder Jr.,

assistant secretary of defense for health affairs. Some functioned as

consultants to intelligence officers but never acted unethically, he said.

 

" We have no evidence of maltreatment by physicians, or of physicians

participating in torture or torturous activity, " he said. " We just do

not have evidence of that. "

 

The article in the medical journal purports to add new facts to the

public record and put others in context. But it is most significant

because it adds to a chorus of concern expressed by respected medical

institutions, said Arthur L. Caplan, director of the Center for

Bioethics at the University of Pennsylvania.

 

" The New England Journal of Medicine plays a unique role in serving as

a moral beacon for the health profession; when they take it on, it's

important, " Caplan said.

 

Leonard S. Rubenstein, executive director of Physicians for Human

Rights, an advocacy organization based in Cambridge, Mass., added:

" This underscores the pressing need for a transparent and full

investigation, which the Pentagon has consistently refused to initiate. "

 

The Geneva Conventions forbid the use of abusive techniques in

questioning prisoners of war. Tactics used in Iraq and Cuba were

" transparently coercive, " the article says. It discloses that the

Army's surgeon general is developing new rules for medical personnel

who work with detainees, and its authors call for a broad, public

effort to develop new guidelines for military doctors.

 

" The therapeutic mission is the profession's primary role and the core

of physicians' professional identity. If this mission and identity are

to be preserved, there are some things doctors must not do, " the

article says. " They should not be party to interrogation practices

contrary to human rights law or the laws of war. "

 

Doctors also have a duty to document abuse and report it to

commanders, the article says, concluding that " by these standards,

military medicine has fallen short. "

 

Defense Department officials challenged that assessment, saying that

military doctors are always expected to act ethically. Doctors who

function as caregivers fulfill a different role than doctors who

consult with intelligence officers, they said. Often, the consulting

doctors help ensure that interrogators do not inadvertently endanger a

detainee's health, they said.

 

" We always expect a physician to behave ethically in any

circumstance, " Winkenwerder said. " There is no question about that. We

just would take offense to the implication that there are situations

or circumstances where we would advise people to look the other way. "

 

He rejected implications that medical personnel control

interrogations, and said detainees' medical records are treated in

manner similar to those of U.S. prison inmates. When incarcerated, he

said, " the individual does not have a complete and absolute right to

privacy of medical information. That is the standard in prisons. "

 

The article is the most recent criticizing the medical treatment of

detainees. In July, an essay in the New England Journal of Medicine

urged U.S. military doctors to come forward with any evidence of

recent abuse. In August, the British medical journal the Lancet

charged that medical workers at Abu Ghraib had falsified death

certificates and did not report injuries from beatings. After an

inspection at Guantanamo Bay last summer, the International Committee

of the Red Cross charged that methods used there were tantamount to

torture.

 

The Washington Post reported in June that military interrogators at

Guantanamo Bay had been given access to the medical records of

individual prisoners despite repeated objections from the Red Cross, a

breach of patient confidentiality that ethicists said violated

international medical standards. The article in the New England

Journal of Medicine says that interrogators in Iraq also had access to

prisoners' medical files.

 

The article says that David N. Tornberg, deputy assistant secretary of

defense for clinical and program policy, confirmed in an interview

that interrogation units at Abu Ghraib and Guantanamo Bay had access

to detainee medical records. In fact, interrogators " couldn't conduct

their job " without such access, Tornberg is quoted as saying.

 

He and other military officials argue in the article that when a

doctor participates in interrogation, he is acting as a combatant, so

the Hippocratic oath does not apply.

 

Tornberg is on leave and was unavailable to comment yesterday.

Winkenwerder said that he believes Tornberg's comments were

misrepresented in the article, and that they did not represent the

Defense Department's views.