Torture: "Speaking up about the unspeakable."*

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"All of us in the healing professions know we are vulnerable of causing harm in the process of doing good... What is truly horrific is our vulnerability to be asked to do harm without doing any good."Jancis Long, PhD, president of Psychologists for Social Responsibility

Medical human rights groups and medical ethicists are calling for an independent investigation into the role of U.S. military and government healthcare personnel in the brutal interrogation of detainees suspected of terrorism in the years following 9/11. 

The human rights advocates, such as Physicians for Human Rights and Psychologists for Social Responsibility, are asking members of Congress to conduct a nonpartisan investigation into how and why medical personnel were involved in the design, implementation, and monitoring of enhanced interrogaton techniques and if they violated the ethics of their professions.

"The only way you make sure abuses of this magnitude never happen again is through accountability and punishment," says Nathaniel Raymond, who a member of the advocacy group Physicians for Human Rights.
Government documents have revealed during the past several years that U.S. military and government medical personnel, particularly psychologists, were aware of and were in some cases involved in, the abuses of detainees that took place at Guantanamo Bay, Abu Ghraib, and other U.S. prisons in Iraq, Afghanistan, and other countries.

But the release in April of several new key government documents and a report from the International Committee of the Red Cross indicate that medical personnel were deeply involved in designing and implementing the aggressive interrogation program used on high value detainees by the military and the CIA.

More Than Bystanders
These memos "give us a higher resolution picture of the fact that medical personnel were not simply involved as bystanders," says Steven Miles, MD, a professor of medicine at the University of Minnesota Medical School and a member of the university's Center for Bioethics. Instead, the medical personnel were involved in designing, conducting, and monitoring the abuses, he says.

It is clear from the new documents -- four memos from the Department of Justice to the CIA during the Bush Administration and a report from the Senate Armed Services Committee entitled "Inquiry into the Treatment of Detainees in U.S. Custody" -- that physicians and psychologists were part of the program. It is less clear if nurses and medics were involved as well. But Miles, who has authored two books about the role of medical personnel in torture, says his documents, all obtained through the U.S. government and posted on his Web site, show that nurses and medics, as well as physicians and psychologists, were involved in or at least knew about the abuses.

The professional medical societies, including the American Nurses Association, have been reluctant to protest, question, or call for further inquiry into the role of medical personnel in interrogations, say activists. The ANA failed to provide a response regarding torture despite numerous requests by -- The Magazine. 

"Health professional licensing boards and societies have declined to investigate complaints or censure healthcare personnel when documented allegations of human rights abuses have been presented," Miles writes in his recently published book "Oath Betrayed: America's Torture Doctors." 

The American Medical Association, which declined comment, and the American Psychiatric Association have reinforced their ethics statements against the involvement of healthcare personnel in interrogation and torture. But more than just ethics statements are needed to try to prevent such abuses in the future, say the advocacy groups.

Demand for Accountability
"The only way you can make sure abuses of this magnitude never happen again is through accountability and punishment, to help create a consequence for just following orders," says Raymond, who is director of the PHR's Campaign Against Torture.

The American Psychological Association has been openly critized by Psychologists for Social Responsibility, the Coalition for an Ethical Psychology, Physicians for Human Rights, and other legal and ethical scholars for its collaboration with the Bush Administration's interrogation policies after 9/11.

"The newly released Senate Armed Services Committee report provides dramatic confirmation of what last week's release of the Office of Legal Counsel memos made clear: that the Bush administration's program of detainee abuse and torture depended crucially upon the profession of psychology and individual psychologists for its implementation and legal justification," the Coalition for an Ethical Psychology wrote in a May 6 editorial to an online political newsletter called "Counterpunch".

M. Gregg Bloche, a legal and medical ethics scholar who has written many articles about the role of military and government medical personnel in the wars in Iraq and Afghanistan, says the relationship between the APA and the Pentagon following 9/11 should be closely examined. 

"The relationship is a shocking case of the association allowing itself to be infiltrated and influenced by our government, which took an extreme positon to international law," he says.

The APA declined to comment beyond the position statements posted on its Web site, including an editorial by its current president James H. Bray, PhD, who was not president following 9/11. Bray writes: "Let's set the record straight: It is a clear violation of professional ethics for a psychologist to have played a role in the torture of CIA detainees, as described in the recently released Bush administration memos." 

Bloche also wants further inquiry into the interrogation program but not to punish those healthcare personnel who were involved. Instead he wants to learn how and why their involvement was sanctioned at the upper levels of government. 

"We need inquiry into how our government came to support and further the use of these techniques," he says. "Nothing that psychologists or physicians did would have happened without our government's embrace of these techniques."

Conscientious Objectors
Healthcare professionals who did object to the techniques of the interrogation program were marginalized, says Bloche, who has interviewed military physicians. "We ought to view them as heroes and look closely to see if any of these professionals who comported themselves admirably were punished in any way by the [government] promotion system."

Although the involvement ]nurses in the interrogations is unclear in government documents, RNs should be aware of and concerned about the situation, says Wanda Mohr, APRN, PhD, FAAN, professor of psychiatric mental health nursing at the University of Medicine and Dentistry of New Jersey. 

"I would like to see a discussion of this issue in the nursing literature and for nurses to be aware of the complicity and silence [on the part of healthcare professionals]," says Mohr, who is an expert in restraints and seclusion. "Nurses did not break the silence at Guantanamo Bay or Abu Ghraib."

*Mohr, who is also an associate editor for the American Journal of Orthopsychiatry, wrote an editorial about torture in her magazine's June issue. 

Torture's "malevolence has infiltrated the consciousness and political tool kits of one of the world's greatest democracies, making a mockery of its consitution," she writes. "The phenomenon happenened, not in the light of public discourse, but in back rooms where politicians, the military, and the intelligence community make clandestine decisions away from public watchfulness and surveillance."

Mohr would like to see the language in nursing organizations' code of ethics strengthened regarding interrogation and torture, as physician associations have done. She would also like to have ethics emphasized in nursing schools.

Jancis Long, PhD, a psychologist and president of Psychologists for Social Responsibility, says that all healthcare professionals need better education about their ethical responsbilties and what constitutes appropriate ethical behavior. 

"All of us in the healing professions know we are vulnerable of causing harm in the process of doing good," she says. "What is truly horrific is our vulnerability to be asked to do harm without doing any good." 

Janet Boivin, RN, is a senior staff writer for Gannett Healthcare Group.

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This page contains a single entry published on July 27, 2009 10:09 AM.

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