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03.08.04, 13:32
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."1 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.2 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.3
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."
To be a military physician is to be subject to potential moral conflict
between commitment to the healing of individual people, on the one hand, and
responsibility to the military hierarchy and the command structure, on the
other. I experienced that conflict myself as an Air Force psychiatrist
assigned to Japan and Korea some decades ago: I was required to decide
whether to send psychologically disturbed men back to the United States,
where they could best receive treatment, or to return them to their units,
where they could best serve combat needs. There were, of course, other
factors, such as a soldier's pride in not letting his buddies down, but for
physicians this basic conflict remained.
American doctors at Abu Ghraib and elsewhere have undoubtedly been aware of
their medical responsibility to document injuries and raise questions about
their possible source in abuse. But those doctors and other medical personnel
were part of a command structure that permitted, encouraged, and sometimes
orchestrated torture to a degree that it became the norm — with which they
were expected to comply — in the immediate prison environment.
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.
The Nazis provided the most extreme example of doctors' becoming socialized
to atrocity.4 In addition to cruel medical experiments, many Nazi doctors, as
part of military units, were directly involved in killing. To reach that
point, they underwent a sequence of socialization: first to the medical
profession, always a self-protective guild; then to the military, where they
adapted to the requirements of command; and finally to camps such as
Auschwitz, where adaptation included assuming leadership roles in the
existing death factory. The great majority of these doctors were ordinary
people who had killed no one before joining murderous Nazi institutions. They
were corruptible and certainly responsible for what they did, but they became
murderers mainly in atrocity-producing settings.
When I presented my work on Nazi doctors to U.S. medical groups, I received
many thoughtful responses, including expressions of concern about much less
extreme situations in which American doctors might be exposed to
institutional pressures to violate their medical conscience. Frequently
mentioned examples were prison doctors who administered or guided others in
giving lethal injections to carry out the death penalty and military doctors
in Vietnam who helped soldiers to become strong enough to resume their
assignments in atrocity-producing situations.
Physicians are no more or less moral than other people. But as heirs to
shamans and witch doctors, we may be seen by others — and sometimes by
ourselves — as possessing special magic in connection with life and death.
Various regimes have sought to harness that magic to their own despotic ends.
Physicians have served as actual torturers in Chile and elsewhere; have
surgically removed ears as punishment for desertion in Saddam Hussein's Iraq;
have incarcerated political dissenters in mental hospitals, notably in the
Soviet Union; have, as whites in South Africa, falsified medical reports on
blacks who were tortured or killed; and have, as Americans associated with
the Central Intelligence Agency, conducted harmful, sometimes fatal,
experiments involving drugs and mind control.
With the possible exception of the altering of death certificates, the recent
transgressions of U.S. military doctors have apparently not been of this
order. But these examples help us to recognize what doctors are capable of
when placed in atrocity-producing situations. A recent statement by the
Physicians for Human Rights addresses this vulnerability in declaring
that "torture can also compromise the integrity of health professionals."5
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 mor
