U.S. military and intelligence agencies directed physicians in U.S. military detention centers to violate ethical principles and medical standards to avoid infliction of harm, according to a panel of physicians, ethicists, retired military personnel and other public health and legal experts.
press release. These practices included “designing, participating in, and enabling torture and cruel, inhumane and degrading treatment” of detainees, according to the report.
“The American public has a right to know that the covenant with its physicians to follow professional ethical expectations is firm regardless of where they serve,” said Task Force member Gerald E. Thomson, MD, MACP, Professor of Medicine Emeritus at Columbia University. “It’s clear that in the name of national security the military trumped that covenant, and physicians were transformed into agents of the military and performed acts that were contrary to medical ethics and practice. We have a responsibility to make sure this never happens again.”
The report, Ethics Abandoned: Medical Professionalism and Detainee Abuse in the War on Terror, is based on two years of review of records in the public domain by the 19-member task force. (The panel includes 5 Fellows and Masters of the American College of Physicians.)
According to the Task Force, the Department of Defense specifically:
• excused violations of ethical standards by inappropriately characterizing health professionals engaged in interrogation as “safety officers,” masking one of their key functions,
• implemented rules that permitted medical and psychological information obtained by health professionals to be used in interrogations,
• required physicians and nurses to forgo their independent medical judgment and counseling roles, as well as to force-feed competent detainees engaged in hunger strikes even though this is forbidden by the World Medical Association and the American Medical Association,
• improperly designated licensed health professionals to use their professional skills to interrogate detainees as military combatants, a status incompatible with licensing, and
• failed to uphold recommendations by the Army Surgeon General to adopt international standards for medical reporting of abuse against detainees.
The group also said that the CIA’s Office of Medical Services played a critical role in reviewing and approving forms of torture, including waterboarding, as well as in advising the Department of Justice that “enhanced interrogation” methods, such as extended sleep deprivation and waterboarding that are recognized as forms of torture, were medically acceptable. CIA medical personnel were present during administration of waterboarding, says the Task Force.
The Task force called on states and professional associations to discipline members who breached standards of professional conduct.
ACP Internist addressed issues specific to physicians who care for enemy combatants and other detainees in conference coverage of Internal Medicine 2008. The ACP Advocate Blog addressed the history of ACP’s stance on the issue in a 2009 post.
ACP’s Ethics Manual, Sixth Edition, states, “Physicians must not be a party to and must speak out against torture or other abuses of human rights. Participation by physicians in the execution of prisoners except to certify death is unethical. Under no circumstances is it ethical for a physician to be used as an instrument of government to weaken the physical or mental resistance of a human being, nor should a physician participate in or tolerate cruel or unusual punishment or disciplinary activities beyond those permitted by the United Nations’ Standard Minimum Rules for the Treatment of Prisoners. Physicians must not conduct, participate in, monitor, or be present at interrogations (defined as a systematic effort to procure information useful to the purposes of the interrogator by direct questioning of a person under the control of the questioner; it is distinct from questioning to assess the medical condition or mental status of an individual) or participate in developing or evaluating interrogation strategies or techniques. A physician who becomes aware of abusive or coercive practices has a duty to report those practices to the appropriate authorities and advocate for necessary medical care. Exploiting, sharing, or using medical information from any source for interrogation purposes is unethical.”