Condemning the Cooperation of Health Professional Personnel in Physical and Mental Abuse and Torture of Military Prisoners and Detainees

It has been documented since the spring of 2004 that the U.S. military medical system in Guantanamo Bay, Afghanistan and Iraq failed to protect detainees' rights to medical treatment, failed to promptly report injuries or deaths caused by beatings, failed to report acts of psychological and sexual degradation, and sometimes collaborated with abusive interrogators and guards.¹

There is substantiation to allegations that medical personnel in direct violation of international laws of war and medical ethics have worked with the U.S. military in designing torture techniques used against detainees.² Unethical behavior by professionals in obedience to authority has been well documented historically. A recent New England Journal of Medicine article describes many examples of professional misconduct, which have occurred during atrocity production situations.³

Scientific experiments, including the Zimbardo Stanford Prison Experiment, have repeatedly demonstrated that ordinary citizens can be easily persuaded to participate in torture. Zimbardo notes in a recent discussion of his work that, our planned two-week investigation into the psychology of prison life had to be ended prematurely after only six days because of what the situation was doing to college students who participated. In only a few days, our guards became sadistic, and our prisoners became depressed and showed signs of extreme stress.⁴

The Schlesinger Panel Report Final Report of the Independent Panel to Review Department of Capital Defense Detention Operations recommended that all personnel who may be engaged in detention operations, from point of capture to final disposition, should participate in a professional ethics program that would equip them with a strong moral compass for guidance in situations often driven with conflicting moral obligations.⁵ At the same time, the Schlesinger Report does argue that the aggressiveness of interrogation techniques employed must be measured against the value of intelligence sought. As Physicians for Human Rights noted in their commentary on the Schlesinger Panel Report, this balancing of harsh and aggressive interrogation against the value of intelligence is an invitation to abuse, torture and death.^5-6

The American Medical Association has passed a resolution stating that Torture refers to the deliberate, systematic or wanton administration of cruel, inhumane, and degrading treatments or punishments during imprisonment or detainment. Physicians must oppose and must not participate in torture for any reason. Physicians should help provide support for victims of torture and, whenever possible, strive to change the situation in which torture is practiced or the potential for torture is great.⁷

The Geneva Convention relative to the Treatment of Prisoners of War, U.S. Army regulations, and the War Crimes Act require all military personnel not to engage in and to report acts of abuse or torture.^8-10 Also, the Geneva Convention relative to the Treatment of Prisoners of War requires military medical personnel to provide prisoners with monthly health inspections, a system to request medical assistance, and proper medical treatment.^8-10

The International Committee of the Red Cross considers it improper to share medical files of prisoners with interrogators.¹¹ The World Medical Association says physicians should not participate in or facilitate torture or other forms of cruel, inhuman and degrading procedures of prisoners or detainees in any situations.¹² The United States has ratified and implemented the Convention Against Torture and Other Cruel, Inhuman, or Degrading Treatment or Punishment (Convention Against Torture), which was adopted by the United Nations in 1984.¹³

Historically, in regimes characterized by suppression of civil liberties, racism, nationalism and militarism, physicians and other medical personnel have participated in torture, abuse, degradation, murder, mass sterilization, and egregious human experimentation under the guise of serving the interests of the state.¹⁴ Under these regimes, the health professionals were educated in a way that did not deter their participation in, tolerance of, or silence about torture and abuse.

APHA has passed resolutions condemning the abuse of prisoners in the United States and opposing physician cooperation in executions.¹⁵ Also, many international associations have taken positions opposing torture and abuse.

Therefore, APHA:

1. Condemns any participation in, cooperation with, or failure to report by health professionals the mental or physical abuse, sexual degradation, or torture of prisoners or detainees;
2. Declares that health care practitioners have an affirmative obligation to report abuse or torture of prisoners and detainees
3. Supports the rights of health workers to be protected from retribution for refusing to participate or cooperate in abuse or torture in military settings; and
4. Urges schools and programs responsible for the education of health professionals to include training in ethical conduct, the internationally recognized codes of professional behavior, and historical cases of abuse and torture of prisoners by health professionals.

References:

1. The Fay Report, www.c-span.org/pdf/armyabughraib.pdf.
2. Lifton, RJ. Doctors and Torture. NEJM 2004; 351; 415-6.
3. Miles, SH. AbuGhraib: Its Legacy for Military Medicine. Lancet 2004; 264; 725.
4. The Stanford Prison Experiment Web Site. Available at http://www.prisonexp.org/. Accessed on June 30, 2005. 
5. Schlesinger, JW. Final Report of the Independent Panel To Review DoD Detention Operations, p. 94, last accessed on June 30, 2005 at http://www.defense.gov.news/aug2004/d20040824finalreport.pdf.
6. Schlesinger Panel's Report Inadequate: Not Strong Enough on Torture; Comprehensive Investigation Needed. Physicians For Human Rights. accessed on June 30, 2005 at http://www.phrusa.org/research/torture/release08242004.html.
7. American Medical Association Resolution E-2.067 at www.ama-ass.org.
8. Geneva Convention Relative to the Treatment of Prisoners of War at http://www.unhchr.ch/html/menu3/b/91.htm.
9. United States Army Regulation AFJ131-304 at www.army.mil/usapa/epubs/multi_services_1.html.
10. War Crimes Act of 1996[18USC Section 2441] at http://www2.uakron.edu/law/war%20crimes%20Act %20of%201996.doc.
11. Doctors at Risk: A Viewpoint from the International Committee of the Red Cross at www.ICRC.org/Web/Eng/siteeng0.nsf/iwpList302/B7
12. 9B2620BD4BO789C1256B66005AAB5D.
13. World Medical Association Codes of Ethics at www.iit.edu/departments/csep/PublicWWW/codes/coe/World_Medical_Association_International_Code_of_Medical_Ethics .
14. Convention against Torture.
15. Daniele, Y et al, The Universal Declaration of Human Rights: Fifty Years and Beyond. Baywood Publishing Co, Amityville, NY, 1999. pp.360-2..
16. Lifton, RJ. The Nazi Doctors. Basic Books, New York, 1986. 13. Bachrach, S. In the Name of Public Health-Nazi Racial Hygiene. NEJM 2004;351;417-20
17. APHA Policy Statements 7315(1/1/73): Health Care in Jails and Prisons and 200125(1/1/01): Participation of Health Professionals in Capital Punishment.

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