Oath Betrayed: Torture, Medical Complicity, and the War on Terror [Hardcover]

Steven Miles (Author)

Book Description

Publication Date: June 27, 2006

“If law be the bedrock of civil society, it can no more undergird torture than it could support slavery or genocide.”
–from the Introduction

The graphic photographs of U.S. military personnel grinning over abused Arab and Muslim prisoners shocked the world community. That the United States was systematically torturing inmates at prisons run by its military and civilian leaders divided the nation and brought deep shame to many. When Steven H. Miles, an expert in medical ethics and an advocate for human rights, learned of the neglect, mistreatment, and torture of prisoners at Abu Ghraib, Guantánamo Bay, and elsewhere, one of his first thoughts was: “Where were the prison doctors while the abuses were taking place?”

In Oath Betrayed, Miles explains the answer to this question. Not only were doctors, nurses, and medics silent while prisoners were abused; physicians and psychologists provided information that helped determine how much and what kind of mistreatment could be delivered to detainees during interrogation. Additionally, these harsh examinations were monitored by health professionals operating under the purview of the U.S. military.
Miles has based this book on meticulous research and a wealth of resources, including unprecedented eyewitness accounts from actual victims of prison abuse, and more than thirty-five thousand pages of documentation acquired through provisions of the Freedom of Information Act: army criminal investigations, FBI notes on debriefings of prisoners, autopsy reports, and prisoners’ medical records. These documents tell a story markedly different from the official version of the truth, revealing involvement at every level of government, from Secretary of Defense Donald Rumsfeld to the Pentagon’s senior health officials to prison health-care personnel.

Oath Betrayed is not a denunciation of American military policy or of war in general, but of a profound betrayal of traditions that have shaped the medical corps of the United States armed forces and of America’s abdication of its leadership role in international human rights. This book is a vital document that will both open minds and reinvigorate Americans’ understanding of why human rights matter, so that we can reaffirm and fortify the rules for international civil society.

“This, quite simply, is the most devastating and detailed investigation into a question that has remained a no-no in the current debate on American torture in George Bush’s war on terror: the role of military physicians, nurses, and other medical personnel. Dr. Miles writes in a white rage, with great justification–but he lets the facts tell the story.”
–Seymour M. Hersh, author of Chain of Command

“Steven Miles has written exactly the book we require on medical complicity in torture. His admirable combination of scholarship and moral passion does great service to the medical profession and to our country.”
–Robert Jay Lifton, M.D., author of The Nazi Doctors: Medical Killing and the Psychology of Genocide, and co-editor of Crimes of War: Iraq

Editorial Reviews

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 (June 27, 2006)
• Language: English
• ISBN-10: 140006578X
• ISBN-13: 978-1400065783
• Product Dimensions: 9.4 x 6.1 x 1.1 inches
• Shipping Weight: 1 pounds
• Average Customer Review: 4.7 out of 5 stars  See all reviews (10 customer reviews)
• Amazon Best Sellers Rank: #343,152 in Books (See Top 100 in Books)
  • #33 in Books > History > Military > Prisoners of War

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54 of 55 people found the following review helpful:

4.0 out of 5 stars What Have We Become?, August 16, 2006

By 

Edwin C. Pauzer (New York City) - See all my reviews
(VINE VOICE)   

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This review is from: Oath Betrayed: Torture, Medical Complicity, and the War on Terror (Hardcover)

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. Psychiatrists and psychologists developed strategies for breaking the will of detainees, and made their medical records available to their interrogators, if they maintained medical records at all. Doctors examined and manipulated dietary consumption and medication to ensure detainees could sustain interrogation.

These tortures and murders were not the acts of a few bad apples or just a few guys blowing off steam as blowhard, Rush Limbaugh and others of his ilk have suggested. Such interrogations, and inhumane treatment were commonplace. Some detainees known as "ghosts" were sent to countries were they would be beaten and tortured. These acts were sanctioned by battalion commanders and base commanders, from division commanders to theater commanders. The lower ranks take their cues from their commanders. Had they made it clear they would be court-martialed for such behavior at the very least, it would not have happened.

The highest levels of our administration sanctioned these tortures. His Arrogancy, Donald Rumsfeld wrote or even approved of interrogation policy in direct contravention to the Geneva Conventions, Attorneys general John Ashcroft and Alberto Gonzalez, and the President of the United States, George W. Bush were complicit in this. It was the attorney generals who got our Justice Department to declare that Afghanistan was a "failed state" which meant the Geneva Conventions did not apply. They rewrote a definition of torture stating it was torture only if it caused permanent effects, organ failure, or death. It was our president who announced that the Geneva Conventions would be observed. It's what he left out that was critical. He did not say he would comply with its provisions.

I recommend this book highly and another, "Conservatives Without Conscience," not because the latter is about conservatives, but it does provide some explanation of authoritarianism. It explains how some people can lead others, and how some people will willingly follow them to commit acts they might never do on their own.

(And people like Dick Clark had the nerve to send an open email to everyone asking us to boycott CBS because 60 Minutes broke the Abu Ghraib story wide open. Isn't there something wrong with where our shock and ire are being directed?)

After reading this, I am, for the first time in my life, ashamed of having been a soldier, and being American.

This book is a powerful expose that should stir every American to stand up and demand accountability of our leaders and our policies.

If not us, who? If not now, when?

37 of 39 people found the following review helpful:

4.0 out of 5 stars America's Descent into Barbarism, June 30, 2006

By 

emmanuel c. (Washington, D.C.) - See all my reviews

This review is from: Oath Betrayed: Torture, Medical Complicity, and the War on Terror (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. Miles points out -and it says much about the present state of American society that this needs pointing out- medical personell have an ethical, legal, and professional obligation to act within the strict bounds of their duty as doctors. They cannot place their medical skills at the service of military or civilian authorities who would use them to tend to the harm or casualties they inflicted on prisoners, or to cover up such abuse, and even murder, all of which Miles amply documents in the book (I suspect the former recruit from Alexandria, VA did not read far into the book, else he would not dwell on what he euphemistically calls "Questions of Definition". No one who listens to the news or reads both FBI and other independent investigation reports into the beatings and killings of inmates has trouble with the definitions. People have been killed, others maimed, and many, many physically and mentally abused to a point which any civilised person would have to regard as inhumane and legally culpable).

Miles is not out to prove the wrongness of the war; he is concerned about the willing complicity of large numbers of medical professionals in illegal and immoral practices which fly in the face of the very ideal they have sworn an oath to uphold. While he lays immediate blame on the steps of the miliatry and political hierarchy whose responsibility it is to set the moral tone, or at least enforce the rules, of war, he notes that such unprecedented ethical decline the medical corps can only take place in a wider social and political climate of moral decline in America. A climate which does not just forgive but tacitly (even openly) encourages the dehumanization of countless human beings 'over there'.

The reviewer from Alexandria is right about one thing. The book is too short. The problem, as the documentation and daily news reports indicate, is far more extensive than Steven Miles' book describes. But how much more evidence do we need?

Like any book written out of a sense of moral urgency, 'Oath Betrayed' is written in a plain documentary style. Sometimes too plain. This is understandable, given the need to let the confirmed facts about medical abuse stand unadorned by personal opinion. But after a while, when the many different instances of ethical neglicence and criminal complicity by military doctors had piled up, I found myself looking not just for the reasoned, humane cautions of Steven Miles, but the deeper reflections borne of a historical sensibility, since this story will reach forward into America's future.

11 of 11 people found the following review helpful:

5.0 out of 5 stars Why we must speak out., August 9, 2006

By 

Jon B. Eisenberg (Oakland, CA USA) - See all my reviews
(REAL NAME)   

This review is from: Oath Betrayed: Torture, Medical Complicity, and the War on Terror (Hardcover)

Toward the end of Oath Betrayed, after a comprehensive overview of the complicity of doctors, nurses and medics in torture at Abu Ghraib and Guantanamo Bay, Steven Miles observes: "The possibility of dissent makes the silence and complicity of senior and frontline medical personnel in the abuse and neglect of prisoners that much more inexplicable and inexcusable." Therein lies a compelling reason why Americans must speak out against the Bush Administration's embrace of state-sanctioned torture: We must speak out because we CAN speak out. Despite the dangerous direction in which our country is headed, under an Executive Branch that equates dissent with treason, we are still free to speak out for basic human rights. That's what Miles has done in Oath Betrayed. It's a very important book.