http://www.utne.com/print-article.aspx?id=2147485570

Doctors without ethics

by Justine Sharrock, from Mother Jones

The memory of detainee No. 173379 still haunts Andrew Duffy. The 24-
year-old prisoner showed up in March 2006 at Abu Ghraib, where Duffy
was stationed as a medic. His job was to treat new arrivals in an
overcrowded, sweltering tent. Then 19, Duffy handled everything from
common diseases like tuberculosis to festering gunshot wounds.

But the new prisoner stood out. He was belligerent, yelling gibberish,
and staggering like a drunk. Having witnessed this kind of behavior
before with detainees in diabetic shock, Duffy checked the man’s blood-
sugar level and found it was extraordinarily high. The prisoner
explained that Iraqi soldiers had held him for five days without his
insulin. Duffy called the compound’s hospital to request an immediate
transfer. It was denied. Duffy’s medical supervisor ordered him to
just give the guy water.

He was used to this. The prison’s medical officers routinely rejected
medics’ requests to hospitalize sick and wounded detainees; the
general sentiment, Duffy says, was “screw these guys.” Once, he tried
to revive an elderly prisoner whose heart had stopped by using CPR and
mouth-to-mouth. “Why did you make out with that hajji?” the hospital
staffers taunted. “Why didn’t you just let him die?”

Beyond patching up detainees, Duffy and his comrades with the 134th
Medical Company of the Iowa National Guard were ordered to soften them
up for interrogation. Duffy and an MP once restrained and hog-tied a
resisting detainee-cuffing his wrists to his crossed ankles behind his
back-so that Duffy could check his vital signs. Guards later boasted
that they’d left the man that way for 12 hours.

Throughout Duffy’s year at Abu Ghraib-long after the infamous photos
were published and the Pentagon vowed that detainees were no longer
abused-men were still being strapped into restraint chairs and left in
the sun for hours or locked in cells too small to lie down in. The
medics regularly found prisoners dehydrated, wrists bloody from
overtight handcuffs, ankles swollen from forced standing, joints
dislocated from stress positions. They knew to keep their written
evaluations vague, never mentioning cause of injury as a standard
medical report would. When they shuttled broken detainees to and from
the prison’s interrogation rooms, the orders were explicit: Transport
only. No medical care. No paper trail. Flouting the Geneva
Conventions, Duffy’s platoon sergeant even ordered the medics to strip
their uniforms and ambulances of the Red Cross emblems that denoted
them noncombatants. Should anyone from the Red Cross show up to see
the prison, the soldiers were told, send them away and tell them
nothing.

For more than five decades, starting with the prosecution of Nazi
doctors during the Nuremberg trials, the Pentagon ordered its
physicians to abide by international norms. The World Medical
Association (WMA), which counts the American Medical Association (AMA)
as a member, had issued clear directives: Doctors could not assist in
torture or cruelty of any kind, and were duty bound to report abuses
they witnessed. The United Nations later clarified that the rules
apply to all medical personnel, from surgeon to nurse to psychologist
to lowly medic. Even now, the Army’s Military Medical Ethics textbook
echoes the Geneva Conventions, noting that a doctor-warrior’s priority
is always “physician first.”

But even as the nation debates disbarment for the Bush administration
lawyers who green-lighted torture, the medical profession has dealt
reluctantly, if at all, with its own involvement. “The indifference is
shocking,” says retired Army Brigadier General Stephen N. Xenakis, a
rare outspoken critic among military doctors. “Some civilian doctors
are appalled, but many say, ‘It doesn’t affect my life; I’m not
involved.’ ”

Doctors were complicit in the torture strategy from the start. In
December 2002 Defense Secretary Donald Rumsfeld issued a directive
allowing interrogators to withhold medical care in nonemergency
situations-men with injuries including gunshot wounds were denied
treatment as a way to make them talk. The directive was soon revoked,
but the practice continued.

Four months later, Rumsfeld ordered that doctors had to certify
prisoners “medically and operationally” suitable for torture and be
present for the sessions. At Abu Ghraib, interrogations had to be
preapproved by a physician and a psychiatrist. “They have the final
say as to what is implemented,” Colonel Thomas M. Pappas told military
investigators.

The CIA received similar advice in 2002 and 2005 from the Justice
Department, whose torture memos recommended that physicians and
psychologists be present for the interrogation of “high value al-Qaida
detainees.” These doctors, the lawyers argued, would see to it that
interrogators didn’t torture detainees by intentionally inflicting
“serious or permanent harm.”

But it was in June 2005 that the Pentagon delivered its biggest
ethical bombshell, a memo that allowed doctors to participate in
torture and share medical records with interrogators so long as the
detainee in question wasn’t officially their patient. The directive’s
author, physician and top Pentagon health official William
Winkenwerder Jr., received an award from the AMA that year for
outstanding contributions “to the betterment of the public health.”

Field medics like Duffy, who were still being trained to do no harm
according to the military’s old ethical standards, faced a rude
awakening. “You have all these codes you follow as a health care
worker, but then it’s, ‘Now we’re in Iraq, forget those,’ ” Duffy
says.

Plenty of doctors in uniform felt similarly but, like Duffy, did as
they were told. A 2007 Red Cross report indicates that CIA medical
personnel presided over hundreds of waterboardings. Gitmo military
doctors twice sent alleged 9/11 planner Mohammed al-Qahtani to the
hospital after his heart rate fell to dangerously low levels, only to
send him back to the torture chamber when he improved.

Aware of the breaches, Xenakis says, a few military physicians called
for ethical reviews. But the Pentagon overruled them, and the protests
ceased. “There was a blackout,” he explains. Fearing for their
careers, “military doctors wouldn’t speak, even informally.” Before
long, says M. Gregg Bloche, a Georgetown University law professor who
interviewed military physicians on condition of anonymity, the Defense
Department was screening doctors and deploying only those on board
with the program.

During the 1980s, as a symbolic show of support for doctors working
under oppressive regimes, the AMA adopted WMA guidelines that forbade
their participation in torture. But even when it became clear that
U.S. doctors were violating these rules, the association, which
represents a quarter of a million doctors and medical students, took
no steps toward censuring its wayward members. Instead, in 2004, it
released a statement pointing to its existing guidelines. The AMA’s
refusal to take a stronger stand, says Penn State bioethics professor
Jonathan H. Marks, has been “a source of shame” for the profession.

What stood out for Steven H. Miles, a bioethicist at the University of
Minnesota Medical School, was the association’s resounding silence in
February 2006, after the U.N. Commission on Human Rights condemned
American doctors for having “systematically” participated in detainee
abuse. It should have been “a call to arms,” Miles says. “But the AMA
said nothing.”

It wasn’t until November 2006 that the association issued a statement
clarifying that doctors cannot participate in interrogations of any
kind. Xenakis, who helped shape the new policy, says most of the AMA’s
military delegates resisted the move, arguing that “the mission of
getting information was greater than the medical ethics they
acknowledged we were overriding.” (The four military delegates
contacted for this story declined to comment.)

On at least four occasions, doctors have petitioned the AMA’s leaders
to endorse an independent investigation of their colleagues’ role in
the abuses-only to be voted down. “They said, ‘Look, we trust our
military and we aren’t going to step on their toes,’ ” explains
Matthew Wynia, director of the association’s Institute for Ethics.

None of the AMA’s top officials would be interviewed for this story.
When spokeswoman Kate Cox was pressed on why they were so reluctant to
act, even after the complicity of doctors became apparent, she
insisted that the association has no specific knowledge of doctors
being involved in abuse or torture and that it is not equipped to
conduct the sort of investigation needed to “credibly confirm” such
allegations. Besides, Cox said, the AMA has fulfilled its duty simply
by setting ethical standards.

But the AMA’s critics worry that its half measures have already-
perhaps irreparably-damaged the moral standing of American doctors.
“It has had a corrosive effect,” says Xenakis. Adds Miles, “We’re now
in an extremely poor position to protest abuse in other countries. It
will silence us as a medical community.”

Mental health practitioners were, if anything, even more deeply
involved in the abuses. In November 2002 Gitmo commander Major 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.