First, Do No Harm

In this NY Times op-ed, called Physician, Turn Thyself In, the writer alerts us to another phenomenon that I have wondered about of late concerning torture — the role of the medical profession.

I wrote about this earlier in this post back on May 22nd, in which I excerpted this NY Times article:

Much of the evidence of abuse at the prison came from medical documents. Records and statements show 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.

Two doctors recognized that a detainee’s shoulder was hurt because he had his arms handcuffed over his head for what they said was “a long period.” They gave him an injection of painkiller, and sent him to an outside hospital for what appeared to be a dislocated shoulder, but did not report any suspicions of abuse. One medic, Staff Sgt. Reuben Layton, told investigators that he had found the detainee handcuffed in the same position on three occasions, despite instructing Specialist Graner to free the man.

“I feel I did the right thing when I told Graner to get the detainee uncuffed from the bed,” Sergeant Layton told investigators.

Sergeant Layton also said he saw Specialist Graner hitting a metal baton against the leg wounds of a detainee who had been shot. He did not report that incident.

Sgt. Neil Wallin, another medic, recorded on Nov. 14: “Patient has blood down front of clothes and sandbag over head,” noting three wounds requiring 13 stitches, above his eye, on his nose and on his chin.

Sergeant Wallin later told investigators that when he got to the prison: “I observed blood on the wall near a metal weld, which I believed to be the place where the detainee received his injury. I do not know how he was injured or if it was done by himself or another.”

He also told investigators that he had seen male detainees forced to wear women’s underwear and that he had seen a video in which a prisoner known to smear himself with his own feces repeatedly banged his head against the wall, “very hard.”

Helga Margot Aldape-Moreno, a nurse, told investigators that in September she reported to the cell to tend to a prisoner having a panic attack, and that, opening the door, she saw naked Iraqis in a human pyramid, with sandbags over their heads. Military police officers were yelling at the detainees, she said.

Ms. Aldape-Moreno tended to the prisoner, she said, then left the room and did not report what she saw until the investigation began in January.

Today, the Washington Post reports that interrogators have been given access to detainee’s medical files, presumably so that information contained therein can be used to extract information. Accroding to medical ethicists interviewed for the story, this is strictly and unequivocally unethical:

How military interrogators used the information is unknown. But a previously undisclosed Defense Department memo dated Oct. 9 cites Red Cross complaints that the medical files “are being used by interrogators to gain information in developing an interrogation plan.” Maj. Gen. Geoffrey Miller, the commander of the facility at the time, denied the allegations, according to the memo.

[…]

An account pieced together from confidential documents and sources familiar with the matter shows that a Red Cross team discovered the sharing of the medical records in a visit to the Guantanamo Bay medical facility in mid-2003, during Miller’s tenure there.

The Red Cross team’s task, repeated at prisons throughout the world, was to assess how the complex’s medical facility functioned. The medical team studied equipment and treatment options, speaking with detainees and U.S. military medical staff. Other Red Cross experts monitored other aspects of prison life.

The team’s mission was not to treat detainees, but to ensure that they received adequate care. If a prisoner had persistent headaches, was he able to see a doctor? If he suffered from psychological problems — 21 captives have tried to kill themselves at Guantanamo Bay — was he receiving treatment?

U.S. military doctors told Red Cross medics that interrogators had access to prisoners’ medical records, according to two people knowledgeable about the issue who demanded anonymity because details of the interrogations and Red Cross monitoring are kept secret. As one source said, the doctors “were very honest about that” and “some people expressed concern.”

Daryl Matthews, a civilian psychiatrist who visited Guantanamo Bay in May 2003 at the invitation of the Pentagon as part of a medical review team, described the prisoners’ records generated by military physicians as similar to those kept by civilian physicians. Matthews said they contain names, nationalities, and histories of physical and psychological problems, as well as notes about current complaints and prescriptions.

Matthews said an individual’s records would routinely list psychologists’ comments about conditions such as phobias, as well as family details, including the names and ages of a spouse or children.

Such information, he said, would give interrogators “tremendous power” over prisoners. Matthews said he was disturbed that his team, which issued a generally favorable report on the base’s medical facility, was not told patient records were shared with interrogators.

Asked what use nonmedical personnel could make of the files, he replied: “Nothing good.”

The practice made some military medical workers at Guantanamo Bay uncomfortable. “Not everyone was unified on this,” said one person aware of the situation. “It creates a tension. You have people with many different opinions.”

There is another aspect of this that is also troublesome, aside from the apparent lack of professional ethics on the part of all the participants, is the fact that there appears to be drugs being used to coerce information or confessions and it seems likely that medical professionals are taking part in the administration of them.

Various reports from those who were detained either in Afghanistan and let go or transported to Guantanamo from other places bring this up over and over again. According to the Washington Post’s analysis of the torture memo:

The law says torture can be caused by administering or threatening to administer “mind-altering substances or other procedures calculated to disrupt profoundly the sense of personality.” The Bush lawyers advised, though, that it “does not preclude any and all use of drugs” and “disruption of the senses or personality alone is insufficient” to be illegal. For involuntarily administered drugs or other psychological methods, the “acts must penetrate to the core of an individual’s ability to perceive the world around him,” the lawyers found.

We have apparently been operating on this premise, because there have quite a few accounts of drugs being forcibly used on prisoners:

“Finally, on 1 May, he was dressed in goggles and an orange jump suit, injected with a sedative and flown to Guantanamo Bay.” The Guardian May 16, 2004

“Mr. Shah alleged that the Americans had given him injections and tablets prior to interrogations. ‘They used to tell me I was mad,’ the 23-year-old told the BBC in his native village in Dir district near the Afghan border. ‘I was given injections at least four or five times as well as different tablets. I don’t know what they were meant for.'” BBC May 22, 2004

“Many detainees were given regular injections, after which ‘they would just sit there like in a daze and sometimes you would see them shaking’. He [al-Harith] said he was beaten and put in isolation because he refused injections and was sometimes forcibly given unidentified drugs.” Sun Herald (Sydney) March 14, 2004 Sunday

“A British detainee recently released from Guantanamo Bay has said that Habib had told him he had been subjected to beatings, electric shocks and injected with drugs while in Egypt.” The Age (Melbourne) May 24, 2004

“A team of intelligence service psychiatrists, psychologists, behavioural scientists and psychoanalysts known as “the specialists” have prepared a detailed study of how the interrogators can break him…Truth drugs will be administered intravenously shortly before Saddam’s interrogation begins – probably in the new year. Drugs were used early on in their captivity on Taliban and al-Qaeda prisoners at Guantanamo Bay to try to discover where Osama bin Laden is hiding.” The Advertiser December 20, 2003

The good news is that we are being “compassionate conservatives.” Despite the fact that virtually eveyone (except for General Ripper) admits that there has been almost no good intelligence gleaned from the prisoners in Guantanamo and even our own soldiers have been beaten severely in training exercizes, we can rest assured that the medical personnel are looking after the prisoners well being:

In the last six weeks alone, he said, three inmates have tried to hang themselves in their cells with camp-issued “comfort items” such as towels and sheets, and another tried to slit his wrists with a plastic razor. None has succeeded.

Hoey said camp doctors are treating some detainees for psychological disorders and have administered antidepressants and antipsychotic drugs.