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Oath Betrayed: Torture, Medical Complicity, and the War on Terror Hardcover – June 27, 2006

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About the Author

Steven H. Miles, M.D., is an expert in medical ethics, human rights, and international health care. A professor of medicine at the University of Minnesota Medical School and a faculty member of its Center for Bioethics, Miles is also a practicing physician. He has served as the chief medical officer for a Cambodian refugee camp and worked on AIDS prevention in Sudan and on tsunami relief in Indonesia with the American Refugee Committee. He has also worked with the research committee of the Center for Victims of Torture. The recipient of the Distinguished Service Award of the American Society of Bioethics and Humanities, Miles is widely published on a wide range of health- and health-care-related topics. He lives in Minneapolis.

From The Washington Post

Vulnerable in body and mind, we look to our physicians for compassion -- which makes torture that's abetted by the medical profession especially horrific. Jacobo Timerman, a victim of Argentina's "dirty war," wrote of the special pain of seeing a doctor present in the interrogation room, of the sense of abandonment that lay in knowing that a person of science "is with you when you are tortured by the beasts."

In the wake of the unspeakable acts of Nazi doctors during the Holocaust, modern governments adopted a series of international conventions that declared doctors' participation in torture to be unethical. Professional associations followed. A 1999 ruling of the American Medical Association's judicial council is typical; it prohibits U.S. physicians from "providing or withholding any services, substances, or knowledge to facilitate the practice of torture" and obliges doctors to support victims and to "strive to change situations in which torture is practiced."

But the link between healing and torture is hard to sever. In the Renaissance, special "torture doctors" helped inquisitors choose their interrogation methods. In August 2004, Steven H. Miles, a bioethicist and professor of medicine at the University of Minnesota, reported in the British medical journal the Lancet that the United States had, in effect, returned to the era of the torture doctor. In Iraq and Afghanistan and at Guantanamo Bay, Cuba, Miles wrote, "The medical system collaborated with designing and implementing psychologically and physically coercive interrogations." Miles's charges were detailed: Death certificates had been falsified, he wrote, and military health personnel had reported incidences of torture belatedly, if at all.

Oath Betrayed is Miles's expansion of his Lancet article. It is rich in examples. Miles describes the work of the Behavioral Science Consultation Teams (known as BSCTs, or "biscuits") active in Iraq and Guantanamo: groups of psychiatrists and psychologists who used detainees' medical charts and test data to devise "physically and psychologically coercive interrogation plans" designed to break their resistance. In at least one camp in Iraq, all harsh interrogations reportedly were first approved by the medical team.

Expanding on his 2004 charge that medical personnel were rigging death certificates, Miles writes of an Afghan prisoner named Dilawar, an innocent 22-year-old who drove his taxi to "the wrong place at the wrong time." At the U.S. airfield detention center in Bagram, Afghanistan, in December 2002, Miles reports, Dilawar was suffocated with a sandbag and then shackled, suspended by his arms and beaten until his legs were (in the words of the coroner) "pulpified." He was then chained to the ceiling of his cell, where he died. Although a Dec. 13 autopsy called Dilawar's death a homicide, Miles writes, Gen. Daniel McNeil told reporters in February that Dilawar had died of natural causes on the grounds that one of his coronary arteries was partly occluded. The words "coronary artery disease" were typed in a different font on the prisoner's death certificate.

Cases like this lay bare the absurdity of the position in which doctors at facilities such as Bagram and Guantanamo are placed. For interrogations in which leg pulpifying is planned, should the screening physical include a cardiac stress test?

Many of the documents that Miles cites are available online, so readers can judge his allegations for themselves. My impression is that while Miles's overall conclusions regarding unethical behavior by physicians are probably justified, the evidence he cites for medical complicity in specific instances of torture sometimes falls short of definitive proof. But his accumulation of disturbing reports effectively buttresses his larger charge that -- at Abu Ghraib, Guantanamo and elsewhere -- post-9/11 America has become "a torturing society."

The debate over the ethics of torture often contrasts idealism with pragmatism. Opponents of torture tend to follow the Harvard scholar Elaine Scarry, who characterized the practice as "close to being an absolute of immorality," an "undoing of civilization" whose connection to the proclaimed aim of obtaining information is rarely to be taken at face value. Those who argue that torture may sometimes be permissible -- Miles uses the psychiatrist and Washington Post columnist Charles Krauthammer as his prime example -- usually begin with the "ticking bomb" scenario, in which torturing a detainee might produce the intelligence to prevent mass murder. Krauthammer quips, "Once you've established the principle" that torture must sometimes be used to elicit information that saves innocent lives, then "to paraphrase George Bernard Shaw, all that's left to haggle about is the price." The hope, Krauthammer continues, is that the "level of inhumanity of the measures used . . . would be proportional to the need and value of the information."

Miles's book lends strong support to the absolutist foes of torture, on humane and practical grounds alike. His numerous examples of heedless cruelty make the case that authorizing torture creates a subculture that knows nothing of proportionality; if torture is permitted in the rare crisis, it will be put to use routinely. He also argues convincingly that confessions elicited under torture are of dubious reliability. In July 2004, the British ambassador to Uzbekistan protested the Uzbek intelligence service's interrogation practices: "Tortured dupes are forced to sign up to confessions showing what the Uzbek government wants the U.S. and UK to believe. . . . This material is useless -- we are selling our souls for dross."

Though medical complicity is a deeply troubling element in the torture enterprise, it is hardly a decisive one. In May, the American Psychiatric Association strengthened its opposition to doctors' "asking or suggesting questions, or advising authorities on the use of specific techniques of interrogation with particular detainees." The Pentagon countered by announcing that it would continue its program but try to use psychologists only.

Ending our status as "a torturing society" requires change at a higher political level -- for instance, the Bush administration's recent acknowledgment that the Geneva Conventions' ban on "humiliating and degrading treatment" applies to all terrorism suspects in U.S. custody, including alleged al-Qaeda operatives. But who is to say that such movement does not occasionally begin with moral suasion -- as a result of the sort of witness Miles offers here?

Reviewed by Peter D. Kramer
Copyright 2006, The Washington Post. All Rights Reserved.


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Product Details

  • Hardcover: 240 pages
  • Publisher: Random House; First Edition edition (June 27, 2006)
  • Language: English
  • ISBN-10: 140006578X
  • ISBN-13: 978-1400065783
  • Product Dimensions: 6.1 x 0.9 x 9.2 inches
  • Shipping Weight: 1 pounds
  • Average Customer Review: 4.7 out of 5 stars  See all reviews (10 customer reviews)
  • Amazon Best Sellers Rank: #1,766,758 in Books (See Top 100 in Books)

More About the Author

Steven Miles, MD is Professor of Medicine and Bioethics at the University of Minnesota. He has extensively written in medical ethics especially on doctors who assist torture. He manages The Doctors who Torture Accountability Project

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55 of 56 people found the following review helpful By Edwin C. Pauzer VINE VOICE on August 16, 2006
Format: Hardcover Verified Purchase
In less than 170 pages you will come away with unassailable facts about our treatment of prisoners or detainees in Afghanistan, Iraq and Guantanamo Bay: 1) American servicemen and women tortured and murdered detainees. 2) Many of our doctors, psychologists, nurses, medics and other health practitioners were complicit in these murders and tortures. 3) These tortures and murders were not the acts of a "few bad apples" as some have claimed. 4) The highest levels of our administration sanctioned these tortures.

American servicemen and women beat, tortured, maimed, humiliated, neglected and murdered detainees. One Afghan taxi driver caught in a sweep was beaten so badly about his legs, the doctor said they were "pulpified." Had he survived, both legs would have had to be amputated. He was found to be innocent two days after his death in detention. Men and women were made to pose or crawl naked, sit naked in extreme air conditioning or heat up to 130 degrees. The first execution of an American citizen in Iraq came twelve days after the pictures of torture at Abu Ghraib had been released.

Doctors, nurses and other health care providers covered up murders by guards. And this is the question that brought the author Oath Betrayed. He asks where were the doctors when all this was going on. Why weren't they reporting it, and why weren't they stopping it?

There were a number of detainee deaths due to heart attacks brought on by positional asphyxia from being forced to wear sacks over their heads. The cause of such heart attacks is easy to detect. These were homicides, yet the doctors simply listed them as heart attack victims.
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38 of 41 people found the following review helpful By emmanuel c. on June 30, 2006
Format: Hardcover
This is not an easy book for Americans to read. And everything about it suggests it was not an easy book for its author to write. Steven Miles is not some political pundit exulting in the multiplying revelations of crimes, sadism, dishonesty, and historic failure of the alliance between the Pentagon and the White House in their trumped-up 'War on Terror'. He is a doctor and a medical ethicist who asked, as too few have done, how could so much torture and routine abuse of prisoners in Iraq, Afghanistan, and Guantanamo take place for so long without medical personell -doctors, nurses, medics- sounding the alarm. And in case you've been reading the review posted by a former soldier from Alexandria, VA, let's be clear about something: by the Pentagon's own admission, on the record, the majority of the prisoners subjected to torture and unlawful treatment were innocent of any crimes, let alone any involvement in terror agaist the US, the reason so often invoked in order to frighten the US public into accepting dangerous and degrading treatment of prisoners of war in its name, a policy which Dr. Miles notes will only make it harder for the US to demand that its own soldiers not be treated in like manner in current and future wars. What's more, even if they were not innocent, their mistreatment violates not only our own laws and international treaty obligations; treaties the US itself fought hard to implement worldwide, it also deprives the US of any moral standing as the guarantor of justice, as US Senator and former prisoner of War John McCain has pointed out.

Medical personell, Dr.
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Format: Hardcover
Reviewed By David M. Kinchen
Huntington News Network Book Critic

Hinton, WV (HNN) - When he saw the graphic photographs of U.S. military personnel - including West Virginia's Lynndie England - mugging it up over abused prisoners at Abu Ghraib Prison in Iraq, Dr. Steven H. Miles asked himself "Where were the prison doctors at Abu Ghraib?" when this abuse was going on.

His book, "Oath Betrayed: Torture, Medical Complicity and the War on Terror" (Random House, $23.95, 240 pages) is the Minneapolis, MN-based physician's attempt to answer that question, as well as to determine what went wrong with so many military medical providers taking part in and/or allowing torture and prisoner abuse to take place.

Miles, a professor of medicine at the University of Minnesota Medical School and a faculty member of its Center for Bioethics, is also a practicing physician. He's also an expert in medical ethics, human rights, and international health care who has served as the chief medical officer for a Cambodian refugee camp and worked on AIDS prevention in Sudan and on tsunami relief in Indonesia with the American Refugee Committee. He has also worked with the research committee of the Center for Victims of Torture.

Conventional wisdom is that Americans don't practice torture the way the Germans, Soviets and Japanese did during World War II and virtually everyone else did before that war and since. We're supposed to be inhabitants of that "Shining City on the Hill" - standing apart from abusers and torturers alike. As Miles demonstrates in a section comparing the abuses in Iraq, Afghanistan and Cuba with the American Civil War, torture and abuse of prisoners is nothing new to Americans.
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