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Posted on December 11, 2014 at 3:02 AM

by Craig Klugman, Ph.D.

On Tuesday, December 9, the U.S. Senate Select Committee on intelligence released its long awaited report on CIA interrogation and torture. This 500-page executive summary details the results of six years of investigations that covered over 6 million pages of records. What was discovered is that torture was more brutal and extensive than reported, that information was kept secret, that the programs were mismanaged and lacked oversight, and that most likely no information came out of it.

Anyone wishing to read the report can find it here. The length and detail of the document, not to mention its graphic content, make it difficult to go through. A search function, however, allows a reader to look for particular terms.

The word “doctor” brings up 4 listings. In one listing, a detainee (euphemism for a “victim of torture”) was refused a physician visit for pain. In a second, a doctor was asked about edema caused by “standing sleep deprivation” and responded that all that was necessary was to “adjust shackles or [the] method of applying the technique.” The other two detailed physicians depreciating the problems of water boarding and producing pain.

The term “physician” brings up four instances of “physician assistant.” This includes a PA recommending a detainee with a broken foot avoid bearing weight “for a couple of weeks” after a medical officer had said “5 weeks.” Another PA diagnosed gastrointestinal upset as caused by contaminated food and water.

“Medical” is found on 83 pages (though “medicine” is not found at all). On the positive side, there are references to medical personnel questioning interrogation techniques both based on their lack of effectiveness and safety. There are also discussions of the lack of adequate medical care for detainees. Many references refer to a lack of timely medical care or medical care being withheld until a detainee provided information.

“Health” is found seven times in the document. One description was that detention centers needed to meet “basic health needs” which the report says was defined as allowing forced standing while “shackled in darkness and isolation, with a bucker for human waste, and without notable heat during the winter months.” Another reference is about using rectal rehydration to improve the health of detainees on hunger strikes. The CIA is alleged to have determined such rehydration techniques as “medically sound” along with repeated nasogastric feedings despite reports that that latter is a health threat. Health is also noted as being at risk for those in prolonged detention. In another section of the report, “health” appears as a reason that diapers were used during standing sleep deprivation (rather than for humiliation).

There are suggestions in the report that access to health care was conditional on a detainee providing new information. “’The allegation in the report that a CIA medical officer threatened a detainee, stating that medical care was conditional on cooperation is blatantly false. Health care has always been administered based upon detainee needs. It’s neither policy nor practice to link medical care to any other aspect of the detainee program.’ This testimony is incongruent with CIA records.” The report continues by citing a document that asserts “the interrogation process would take precedence over preventing {detainee’s] wounds from becoming infected.”

As if health being used as an instrument of torture, physician and PA involvement were not enough, the report also exposes that two psychologists designed the “interrogation” program and performed waterboarding on detainees. The two formed a private company to oversee the program. That company was paid $80 million for its services

“Nurse” and “nursing” produced no results.

This report suggests two major areas of bioethical concern. The first is the participation and complicity of health care providers: Physicians agreed to be involved with torture whether that means administering it, making sure that detainees were healthy enough for torture, not reporting how badly people were being treated, or even designing interrogation. The AMA and WMA clearly forbid physician involvement with torture and torture related practice. Physicians for Human Rights advocates federal investigation of physicians who have been involved with torture. In this same blog space, I suggested that medical education creates moral cowards out of physicians-to-be by encouraging group-think and an authoritarian hierarchy that disrespects dissent. However, the report also shows that even when interrogators tried to put an end to the torture, senior officials overruled them.

The second area is from a justice/human rights perspective. According to the U.N. Declaration of Human Rights Article 25, everyone has a right to medical care. And in Article 5, “no one shall be subjected to torture or to cruel, inhuman or degrading treatment of punishment.” The Doctors who Torture Accountability Project hopes to hold doctors responsible to work toward ending torture. If one knows of torture, he or she has a responsibility to report it and if it does not place his or her life in danger, to try and stop it.

No one in bioethics has been more outspoken that Steven Miles. He has published a book, several journal articles and even a blog on this website. But where have the rest of us been? We should all be outraged that not only basic human rights but that ethics of all kinds including deontology, virtue, ethics of care all say that treating human beings in these ways is wrong. A health care provider being involved is wrong. And given that the outcome of these interrogations was no new information than what had been learned through other methods, even utilitarianism would consider these actions wrong.

In my last post on this topic I asked health care professionals where their moral courage was. In this post, I will end by asking where is our moral courage as scholars in bioethics to prevent and stop torture?

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