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First, Do Harm

Doctors were involved with torture from the start. Can the medical profession redeem itself?

MENTAL HEALTH practitioners were, if anything, even more deeply involved in the abuses. In November 2002, Gitmo commander Maj. General Geoffrey Miller put together a Behavioral Science Consultation Team, a group of psychiatrists and psychologists tasked with preparing prisoner profiles and advising interrogators on the use of environmental manipulation, sleep deprivation, exploitation of individual fears, and other coercive methods.

Among the practitioners was Guantanamo senior psychologist Major John Leso, who helped plan and implement the 50-day interrogation of Mohammed al-Qahtani. Detailed logs of the torture sessions indicate that the prisoner was sexually humiliated, isolated and deprived of sleep for extended periods, subjected to extreme cold, shackled in stress positions, tormented by military dogs, and leashed and made to perform like a dog.

Leso, who was in the interrogation room for part of Qahtani's ordeal, advised—among other things—that the detainee could be disoriented by spinning him on a swivel chair so that he couldn't fix his eyes on one spot. Along with the prison's medical doctors, he regularly evaluated Qahtani for his ability to tolerate further abuse. During one session, the medical staff injected the prisoner with three and a half IV bags of saline—Qahtani's questioner then wouldn't let him urinate until he provided satisfactory answers. Despite evidence of Leso's actions, the American Psychological Association has failed to act on an ethics complaint by a fellow APA member.

Rank-and-file psychologists are deeply divided on the subject of torture. In 2005, an association task force (six of its ten members had military ties) voted to condemn torture but still allow psychologists in the interrogation room, where, its members argued, they might discourage abuse and even save detainees' lives. Incensed, thousands of psychologists petitioned for a vote on the question by the APA membership. In a roughly 60-40 tally, the association decided that psychologists have no place in the interrogation room. (For more on the APA and torture, see David Goodman's "The Enablers".) It was the right choice, says Robert Jay Lifton, a psychiatrist and former military medic who has written about the role of Nazi doctors during the Holocaust. Putting health professionals into an abusive setting, he argues, "can confer an aura of legitimacy and can even create an illusion of therapy and healing."

Which is more or less what Duffy experienced. "If a medic was around, there was a sense of some control," he told me. "The guards probably thought, 'If I really cross the line, this guy would stop me.'"

In May 2006, the American Psychiatric Association, which represents some 38,000 psychiatrists, reiterated its past position that its members should not directly assist in interrogations. But Steven Sharfstein, then the association's president, also noted that psychiatrists "wouldn't get in trouble" if they heeded military orders over the association's advice—which, he added, should not be considered "an ethical rule."

 

IT'S NOT THAT the medical community lacks the tools to police itself. Doctors can't practice without a state license, and a grave breach of ethics can cost them that license. State licensing boards are legally obligated to investigate violations, yet no state medical board has ever disciplined a doctor for assisting in military torture.

One California complaint illustrates the boards' reluctance to confront the military. Filed by New York-based attorney Scott Sullivan on behalf of four former detainees, the 2005 complaint targeted Captain John S. Edmondson, then Guantanamo's lead physician. The men claimed that their medical records were shared with interrogators, who then withheld treatment for heart problems, worms, constipation, and injuries inflicted by the camp's "internal reaction forces"—five-man teams dispatched to beat recalcitrant prisoners. When these attackers showed up, the detainees claimed, medical personnel would instruct them on details such as, "Hit him around the eye; don't poke him in the eye.

But the complaint never got a hearing: The Pentagon claimed jurisdiction in the case, and the medical board demurred. Citing insufficient subpoena power and resources, it turned the matter over to military investigators, who found no evidence of wrongdoing. "The board didn't care how they got out of it," says Sullivan. "They just didn't want to be in the middle of a hot-button political issue."

Mother Jones obtained three similar complaints filed by former APA member Trudy Bond against psychologists who allegedly participated in abuses. In addition to targeting Leso's license in New York, she pursued his Gitmo colleague, senior psychologist Colonel Larry C. James, in Louisiana. In Alabama she filed a complaint against Diane M. Zierhoffer, a military psychologist who helped direct the interrogation of an Afghan teenager accused of throwing a grenade at a US military vehicle. Zierhoffer recommended a month of isolation, which can cause or exacerbate mental health problems; later, the teen tried to hang himself.

None of these complaints resulted in disciplinary action. Licensing boards, says bioethicist Marks, are "reluctant to call into question anything with broader implication beyond the individual physician, especially if it is impugning government officials or state policy."

Absent action from the profession, some states have turned to political pressure. California's Senate passed a symbolic joint resolution last year urging the state's licensing boards to warn doctors that they could be prosecuted for participating in torture. (The American Psychiatric Association petitioned unsuccessfully to have psychiatrists exempted.) A bill under consideration in New York would bar any health care worker from participating in torture or "improper treatment," as defined by international standards. But reform advocates say legislation is no substitute for sanctions by doctors themselves. "The practice of medicine," says Boston University professor Annas, "is something the profession defines and the profession has to guard."

 

BACK AT ABU GHRAIB, Andrew Duffy was in no position to disobey a direct order, so he did as he was told and gave water to his diabetic prisoner. By the next morning, detainee No. 173379 was even weaker and more confused. Duffy and his partner again called for a hospital transfer—their third try—and again the captain denied the request. This time, she told them to administer saline through a 14-gauge needle.

That's a huge needle—more than two millimeters in diameter. A civilian doctor would only use it for extreme trauma situations, with an unconscious patient or with a local anesthetic to numb the pain. At Abu Ghraib, the large needles were used as punishment, or to discourage detainees from asking for care.

A day later, the Army's criminal investigation unit summoned Duffy and his partner for questioning. No. 173379 was dead. Interpreting his symptoms as insubordination, MPs had pepper-sprayed the man and stuck him in a tiny cell in the scorching heat. Duffy says he filled out a five-page sworn statement, but his captain gave a conflicting account, and the case was dropped. Later, when it became clear that the dead man had been an associate of Abu Musab al-Zarqawi, the bloodthirsty commander of Al Qaeda in Iraq, soldiers came up to congratulate the medics.

Duffy did what he felt he could. Beyond his statement (which the investigators now claim they have no record of), he complained to his superiors about the shoddy medical supplies and the stripping of Red Cross emblems. More recently, he filed complaints about his platoon sergeant and captain with the Army Inspector General's office, but nothing has come of it. In any case, much of the paper trail that might have implicated them is probably lost. When the military abandoned Abu Ghraib in September 2006, Duffy and his comrades were given one last order: Burn all of the compound's medical records.

Correction: It was in 2005 that the American Psychological Association’s task force voted to condemn torture but still allow psychologists in the interrogation room, not in 2007 as originally reported. This story has been updated to reflect the change.

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