First, Do Harm: Medical Professionals Who Torture

[McCamy Taylor]

But even as we continue to speak out against human-rights abuses around the world, we need to keep an open mind about certain measures to fight terrorism, like court-sanctioned psychological interrogation.

Jonathan Alter “Time to Think About Torture” Newsweek Nov. 5, 2001

http://www.newsweek.com/id/76304/page/2

Here we see a supposedly sane and right minded member of the press falling for a lie which the Bush administration told---with the help of some ethically impaired psychologists (see the Vanity Fair piece linked below). Cheney and company claimed that their torture program was moral (as well as legal), because they were able to get medical providers to endorse it. As long as the psychologists approved, it had to be safe, right? As long as physicians and PAs were present to declare water boarding and beatings and starvation "humane", then where was the problem?


The problem is that health care providers are only human. They rise from the level of mere service vendors and become medical professionals because they adhere to a code of conduct. You can read a summary of medical ethics here:

http://www.wma.net/e/policy/c8.htm

Note the following rules.

A PHYSICIAN SHALL not allow his/her judgment to be influenced by personal profit or unfair discrimination.

A PHYSICIAN SHALL strive to use health care resources in the best way to benefit patients and their community.

A PHYSICIAN SHALL deal honestly with patients and colleagues, and report to the appropriate authorities those physicians who practice unethically or incompetently or who engage in fraud or deception.

A PHYSICIAN SHALL act in the patient's best interest when providing medical care.

A PHYSICIAN SHALL respect a patient's right to confidentiality. It is ethical to disclose confidential information when the patient consents to it or when there is a real and imminent threat of harm to the patient or to others and this threat can be only removed by a breach of confidentiality.

A doctor, therapist or medical assistant who does not follow these rules is (frankly) a quack and not qualified to practice medicine.

Try to imagine that a group of health care professionals in the U.S. entered into an agreement with a third party to deprive their patients of necessary care. The doctors stood to gain money and promotions. The third party would benefit if the services were not provided. The physicians reported regularly to the third party, providing confidential details of their patients’ health which were designed to allow the third party to create new strategies to deny care . If asked, the doctors lied about their relationship with the third party. Other members of the medical community were aware of this reprehensible behavior but decided not to warn the public.

If the “third party” was an insurance plan and the patients were you or I, we would be hopping mad. We would hound our legislators to ban financial disincentives to care. We would insist that doctors answer to us not the ones who pay the bills, i.e. the insurance company.

The Geneva Conventions affords POWs the right to medical care for their illnesses and injuries. It also prohibits

(a) violence to life and person, in particular murder of all kinds, mutilation, cruel treatment and torture;
(b) taking of hostages;
(c) outrages upon personal dignity, in particular, humiliating and degrading treatment

http://www.icrc.org/ihl.nsf/7c4d08d9b287a42141256739003e636b/6fef854a3517b75ac125641e004a9e68!OpenDocument

The Bush administration may have tried to change the definition of POW, but there is only one meaning of the word "patient" as in the "doctor-patient relationship. " Health care providers are not given an out for patients whom they do not like---say Muslims or even Al Qaeda members. The ethical rules are never optional. If a provider believes that he or she is unable to meet the standards because of prejudice against an individual, he is obligated to terminate the doctor-patient relationship.

Under Bush-Cheney, health care providers in this country routinely violated the code of medical ethics. They did this by assisting with the illegal torture of prisoners of war. The medical community—with one notable exception which I will discuss later--- has denounced this behavior at every turn. For instance, in April of this year, the American Medical Association sent this letter to President Obama.

Dear Mr. President,
We are deeply troubled by reports in the national media about the involvement of health personnel,
some of whom may have been physicians, with the torture of detainees held by the U.S. Central Intelligence Agency.


Any involvement by physicians in torture is fundamentally incompatible with the physician’s role as a healer. Such involvement would violate core ethical obligations of the medical profession to “first,
do no harm” and to respect human dignity and rights.

These core principles are enshrined in the Code of Medical Ethics of the American Medical Association (AMA) and the codes of other professional medical organizations throughout the world. Our AMA Code forcefully states medicine’s opposition to torture or coercive interrogation and prohibits physician participation in such activities. Our Code calls on physicians to support victims of torture, to report the use of torture, and to strive to change situations in which torture is practiced. At stake are the rights and well-being of individuals, the integrity of medicine, and society’s trust in the profession.


As the nation’s largest association of physicians and the voice of the medical profession, the AMA stands ready to work with you to ensure that these core principles guide our nation’s physicians. Our aim is to assure that all physicians are fully aware of their ethical obligations, that physicians are not
put in ethically untenable positions, and that actions like those alleged do not ever occur under U.S.jurisdiction. We will assist you in any way possible to accomplish that goal.

http://bioethicsdiscussion.blogspot.com/2009/04/physicians-and-torture-amas-letter-to.html

This was not the first time that the medical establishment spoke out against Bush-Cheney torture policies. In 2006, the AMA released this statement.

“Physicians in all circumstances must never be involved in activities that are physically or mentally coercive. If physicians engage in such activities, the whole profession is tainted.”

http://www.democracynow.org/2006/6/14/headlines

The British medical journal The Lancet spoke out in 2004, with a report which indicated that medical personal in Abu Ghraib had assisted in torture. Unethical behavior included denying inmates appropriate medical care for health problems. Death certificates were falsified. A physician and psychiatrist were reportedly on hand to monitor torture, which included

beatings, burns, shocks, bodily suspensions, asphyxia, threats against detainees and their relatives, sexual humiliation, isolation, prolonged hooding and shackling, and exposure to heat, cold, and loud noise.1,14,19,24,33,34 These include deprivation of sleep, food, clothing, and material for personal hygiene, and denigration of Islam and forced violation of its rites.19 Detainees were forced to work in areas that were not de-mined and seriously injured.34 Abuses of women detainees are less well documented but include credible allegations of sexual humiliation and rape.

http://www.globalresearch.ca/articles/MIL408A.html


In 2005, the New England Journal of Medicine added its own commentary. According to their report, confidential medical records were being offered to interrogators to assist them with torture.

Using medical records to devise interrogation protocols crosses an ethical line, said Peter Singer, director of the University of Toronto's Joint Center for Bioethics.
"The goal for the physician is to care for the sick, not to aid an interrogation," he said. "Patients are patients and prisoners are prisoners and mixing those two things on the part of physicians who work in prisons is actually quite dangerous. Physicians are there for the benefit of patients and if they are seen to be there for some other purpose, it really blurs what they're doing."

http://www.commondreams.org/headlines05/0623-06.htm

The Red Cross wrote a report about the problem in 2007 (though it was not released until this year). From the New York Times

Based on statements by 14 prisoners who belonged to Al Qaeda and were moved to Guantánamo Bay, Cuba, in late 2006, Red Cross investigators concluded that medical professionals working for the C.I.A. monitored prisoners undergoing waterboarding, apparently to make sure they did not drown. Medical workers were also present when guards confined prisoners in small boxes, shackled their arms to the ceiling, kept them in frigid cells and slammed them repeatedly into walls, the report said.
Facilitating such practices, which the Red Cross described as torture, was a violation of medical ethics even if the medical workers’ intentions had been to prevent death or permanent injury, the report said. But it found that the medical professionals’ role was primarily to support the interrogators, not to protect the prisoners, and that the professionals had “condoned and participated in ill treatment.”
At times, according to the detainees’ accounts, medical workers “gave instructions to interrogators to continue, to adjust or to stop particular methods.”
Snip
The report does not indicate whether the medical workers at the C.I.A. sites were physicians, other professionals or both. Other sources have said that psychologists helped design and run the C.I.A. interrogation program, that physicians’ assistants and former military paramedics worked regularly in it, and that physicians were involved at times.

http://www.nytimes.com/2009/04/07/world/07detain.html?_r=1&hp

It is pretty clear that medical professionals who participated in torture broke the rules. So why all the talk about disbarring the lawyers but so little talk about stripping people of their medical licenses? Maybe because most of us still respect and trust our doctors--or want to trust them. However, that trust can be lost. Even those people who believe that torture works and is justified should have reservations about allowing medical torturers to get away with their unprofessional conduct. These folks will not be in the Army forever. As so often happens among military retirees, they may start second careers, this time in private practice. How would you feel if you knew or suspected that the person who is supposed to be treating you for pain or depression used to torture? Would you worry that he was the type who might violate medical ethics again?

Imagine that your physician once told an ailing Iraqi:

“I look after your body only because we need you for information.”

http://harpers.org/archive/2009/04/hbc-90004704

If a doctor told you “I only look after your body, because I make money doing it” you would run not walk to a new provider.

Now, imagine that your medical provider is represented by a specialty society which once advocated torture—as the American Psychological Association did in 2005, possibly in exchange for financial incentives for its members from the Bush administration.

http://www.vanityfair.com/politics/features/2007/07/torture200707?currentPage=1

You might begin to worry about all psychologists. That would not be good for your health if you developed mental illness and needed the care of a therapist.

Trust between a health care provider and client is essential. People will not reveal their weaknesses to someone they can not trust, and unless people are honest, they can not get adequate care. If the patient thinks that his doctor has divided loyalties, he may not follow medical advice. A bad outcome may lead to worry that the physician was negligent--perhaps deliberately.
The only way to maintain public confidence in the medical professions---and prevent future health care providers from participating in torture--- is to put some teeth on the rules which begin with “First, do no harm.”

[HowHasItComeToThis]

1. Bush and Repubs corrupt everything they touch

[quidam56]

2. A Physician in East Tennessee calls this quality health care...

http://www.wisecountyissues.com/?p=62 Profit Care comes ahead of Patient Care. This is about my father's encounter with the health care system, ( a three day procedure turned into a ten month long nightmare ) after his legs were amputated he was always begging for a gun to end his suffering. Looking back, I wish I had given him a gun. Thanks Wellmont Holston Valley Medical Center and Dr. John Ehrenfried, Kingsport, TN.

[pleah]

3. K&R

[riverwalker]

4. we must pursue this

(you don't need to be a physician or healthcare worker to join their campaign or sign petition)

http://physiciansforhumanrights.org/torture/

[Torn_Scorned_Ignored]

5. Some info on Psychologists and their opposition to Torture

http://www.counterpunch.org/bond08232006.html

http://www.counterpunch.org/bond04142007.html

http://www.counterpunch.org/bond08072008.html

http://psychoanalystsopposewar.org/blog/2009/05/02/lawsuit-seeks-ethics-investigation-of-guantanamo-bsct-psychologist-col-larry-james/

http://psychoanalystsopposewar.org/blog/psychologists-and-interrogations-key-articles/

[vegleftie]

6. do no harm to whom?

Someone should add "to human or nonhuman animals" to the "First, do no harm" admonition. Because doctors are still taught that there's nothing wrong with doing harm to nonhumans in the name of medical progress (which nine times out of ten is not progress at all), and it's a very small step from feeling comfortable with torturing animals to torturing humans.