Thursday, July 29, 2004
The current issue of the New England Journal of Medicine contains an article on doctors' complicity in the crimes committed at Abu Ghraib, Gitmo, and elsewhere:
There is increasing evidence that U.S. doctors, nurses, and medics have been complicit in torture and other illegal procedures in Iraq, Afghanistan, and Guantanamo Bay. Such medical complicity suggests still another disturbing dimension of this broadening scandal.
We know that medical personnel have failed to report to higher authorities wounds that were clearly caused by torture and that they have neglected to take steps to interrupt this torture. In addition, they have turned over prisoners' medical records to interrogators who could use them to exploit the prisoners' weaknesses or vulnerabilities. We have not yet learned the extent of medical involvement in delaying and possibly falsifying the death certificates of prisoners who have been killed by torturers.
A May 22 article on Abu Ghraib in the New York Times states that "much of the evidence of abuse at the prison came from medical documents" and that records and statements "showed 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." According to the article, two doctors who gave a painkiller to a prisoner for a dislocated shoulder and sent him to an outside hospital recognized that the injury was caused by his arms being handcuffed and held over his head for "a long period," but they did not report any suspicions of abuse. A staff sergeant–medic who had seen the prisoner in that position later told investigators that he had instructed a military policeman to free the man but that he did not do so. A nurse, when called to attend to a prisoner who was having a panic attack, saw naked Iraqis in a human pyramid with sandbags over their heads but did not report it until an investigation was held several months later.
A June 10 article in the Washington Post tells of a long-standing policy at the Guantanamo Bay facility whereby military interrogators were given access to the medical records of individual prisoners. The policy was maintained despite complaints by the Red Cross that such records "are being used by interrogators to gain information in developing an interrogation plan." A civilian psychiatrist who was part of a medical review team was "disturbed" about not having been told about the practice and said that it would give interrogators "tremendous power" over prisoners.
Other reports, though sketchier, suggest that the death certificates of prisoners who might have been killed by various forms of mistreatment have not only been delayed but may have camouflaged the fatal abuse by attributing deaths to conditions such as cardiovascular disease.
Various medical protocols — notably, the World Medical Association Declaration of Tokyo in 1975 — prohibit all three of these forms of medical complicity in torture. Moreover, the Hippocratic Oath declares, "I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrongdoing."
[ ... ]
The doctors thus brought a medical component to what I call an "atrocity-producing situation" — one so structured, psychologically and militarily, that ordinary people can readily engage in atrocities. Even without directly participating in the abuse, doctors may have become socialized to an environment of torture and by virtue of their medical authority helped sustain it. In studying various forms of medical abuse, I have found that the participation of doctors can confer an aura of legitimacy and can even create an illusion of therapy and healing.
[ ... ]
To understand the full scope of American torture and abuse at Abu Ghraib and other prisons, we need to look more closely at the behavior of doctors and other medical personnel, as well as at the pressures created by the war in Iraq that produced this behavior. It is possible that some doctors, nurses, or medics took steps, of which we are not yet aware, to oppose the torture. It is certain that many more did not. But all those involved could nonetheless reveal, in valuable medical detail, much of what actually took place. By speaking out, they would take an important step toward reclaiming their role as healers.