A Prescription for Torture
By Marie-Jo Proulx

In the span of a few months, and right under our noses, the involvement of American doctors in torture has gone from unthinkable to technically legal, to tacitly ethical. The Bush Administration effectively decriminalized the practice a long time ago, and it continues to flaunt the Geneva Conventions regarding the treatment of detainees. Meanwhile, the American Medical Association (AMA), which is supposed to defend the integrity of the medical profession, is silently writing a prescription for the military use of torture.

The AMA represents U.S. physicians and medical students of all regions and specialties. Since its inception in 1847 it has spoken as the voice of the medical profession. That is certainly how it presents itself when lobbying Congress and state legislatures for caps on medical liability payments and Medicare reimbursement reform. While today two out of three doctors are not joining the association, it still manages to spend roughly $16 million a year on lobbying activities. But the Chicago-based AMA also has a conscience: the Council on Ethical and Judicial Affairs (CEJA), which oversees what is possibly the world’s most comprehensive Code of Medical Ethics. Its principles and opinions are founded on the Hippocratic Oath, which first asserts that a physician shall “do no harm.”

Approximately 1000 delegates attended the AMA’s annual meeting in June, where a resolution entitled “Opposing Cooperation of Physicians and Health Professionals in Torture” was introduced by the Section on Medical Schools. It stated that, “It has been reported since the spring of 2004 that the U.S. military medical system in Guantánamo Bay, Afghanistan and Iraq … failed to promptly report injuries or deaths caused by beatings, failed to report acts of psychological and sexual degradation, and sometimes collaborated with abusive interrogators and guards … .” It also called on the AMA to condemn physicians’ participation in mental or physical torture; support the right of physicians refusing to take part in torture to be protected from retribution; and encourage all medical schools to include training on ethical conduct and internationally recognized codes of professional behavior.

The resolution was debated in a packed room presided over by the Reference Committee on Amendments to Constitution and Bylaws. Delegates lined up at the microphone to offer testimony. Doctors in military uniform quickly filled the ranks in the center aisle. Many spoke of their own experience caring for soldiers and prisoners of war in past conflicts. Some accused the sponsors of the resolution of being influenced by fabricated media reports. One retired medical officer pointed out to his civilian colleagues in the audience that abuse is not the same as torture. Citing the sexual degradation in the Abu Ghraib pictures, he declared that such treatment, while deplorable, legally did not constitute torture. Listening in their seats, many shook their heads in disbelief.

Others read prepared statements and described the thorough education in professional ethics they had received as physicians of the Armed Forces. But it is worth remembering that the large-scale deployment of Reserves (trained in civilian institutions) now means that when it comes to ethics, uniform educational standards are no longer a reality on the ground.

The next morning, following a recommendation by the Reference Committee, the House of Delegates voted to change the title of the resolution to “Medical Treatment of Prisoners of War and Detainees.” The entire language relating to torture was edited out. The previous day’s testimony had reminded the AMA that it did not want to go up against the same administration it is petitioning on other issues dear to doctors’ pocketbooks. Perhaps as a sign of appreciation, on July 8, the AMA’s then-president, Dr. John C. Nelson, was appointed to the new Health & Human Services Medicaid Advisory Commission.

Once the diluted resolution was adopted, the AMA’s media office released a memorandum received earlier in the week from Dr. William Winkenwerder, Jr., Assistant Secretary of Defense for Health Affairs. Sent to Dr. Nelson, the memo is a re-issue of the military’s policy on medical treatment of detainees. It contains provisions such as “To the extent practicable, treatment of detainees should be guided by professional judgments and standards similar to those that would be applied to personnel of the U.S. Armed Forces.” The deliberately ambiguous language raises serious questions. An obvious one is “would be applied” by whom: U.S. doctors or enemy captors? And what defines “practicable” in a combat setting? But the AMA isn’t asking.

The policy also differentiates between physicians providing treatment to detainees and those “engaged in non-treatment activities.” On June 27, the American Psychiatric Association (APA) issued a statement condemning the creation of two classes of psychiatrists. After quoting its own ethical guidelines, the APA, in what can only be interpreted as an appeal for support, pointedly refers to the AMA’s Principles of Medical Ethics. But CEJA isn’t listening.

On July 1, Burton J. Lee III, presidential physician to George H.W. Bush, and a doctor who served in the Army Medical Corps, wrote an impassioned entreaty in the Washington Post. Referring to the military’s use of medical personnel in interrogations, he declared, “These new guidelines distort traditional ethical rules beyond recognition.” He then went on to implore, “As health professionals, we should support the growing calls for an independent, bipartisan commission to investigate torture in Iraq, Afghanistan, Guantánamo Bay and elsewhere…” Unfortunately, his plea was mostly ignored as it went out on the same day that Supreme Court Justice Sandra Day O’Connor announced her resignation.

As of early October, the AMA still had not issued one public statement condemning the participation of doctors in abusive military interrogations. If it wants to salvage its rapidly dwindling legitimacy and recruit new members with its recently branded “Together We Are Stronger” sales pitch, the AMA needs to go on record against torture and start clamoring for an independent inquiry. Until it does so, it should be exposed for the self-serving business lobby it has become. Foreign countries are not the only participants in the Coalition of the Willing. On medically assisted torture, the AMA is the U.S. military’s most precious domestic ally.

Marie-Jo Proulx is a senior writer for Windy City Times, and a volunteer interpreter for survivors of torture seeking asylum status.