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