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

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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?

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.

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.

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. Both the Union and Confederate prison camps were scenes of horrible treatment of prisoners that resulted in tens of thousands of deaths in the South and North alike.

"Oath Betrayed" is based on research of more than 35,000 pages of classified documents obtained under the Freedom of Information act, as well as eyewitness accounts of abuse and torture. Many medical personnel took part in the abuse and its subsequent cover-up, but Miles and other investigators found quite a few military doctors and nurses who told them of their attempts to stop the torture. As anyone who has every served in the military knows, it takes a brave individual to do this.

Miles notes that "silence about abuse has two general forms: failing to see abuse for what it is and failing to act when abuse is seen" (Page 120). "The silent parties do not acknowledge or document their silence. A witness may report that an abusive soldier and a doctor agreed not to record the fact or cause of a prisoner's injury, but such anecdotes do not reveal whether the arrangements were routine or exceptional."

He quotes an Army psychiatrist, Dr. Henry Nelson, who assessed Abu Ghraib this way: "The worst human qualities and behaviors came to the fore and a pervasive dominance came to prevail...the sadistic and psychopathic behavior was appalling and shocking...the Military Intelligence unit seemed to be operating in a conspiracy of silence."

Miles draws on army criminal investigations, FBI notes on debriefings of prisoners, autopsy reports, and prisoners' medical records to document torture and abuse in "Oath Betrayed." As his book amply demonstrates, these documents tell a story significantly 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.

Military doctors, nurses, psychologists and technicians who participated in torture and prisoner abuse are guilty of a profound betrayal of the best traditions of the medical corps of America's armed forces, Miles says. "Oath Betrayed" was a difficult book to read, but it is an important document - the kind that could only be published by a democracy that still has potency. Nothing of the kind was published in World War II Germany or Japan and certainly not in countries that infamously abused prisoners, such as Chile and Argentina in the 1970s and 1980s.

Miles names both the bad guys and the good guys. Among the latter are Sgt. Joseph Darby who "cited his Christian faith as the reason for slipping a disk with the Abu Ghraib photographs under the door to investigators." (Page 166). Or "what led Dr. Michael Gelles, the chief psychologist of the Navy Criminal Investigative Service, to carry his protest of brutal interrogations at Guantanamo to the highest levels of the Pentagon?" (Page 166).

Miles concludes his book by saying that "it will require tenacious professionalism for medicine to remove the stain of complicity with torture in 130 countries where physicians and torturers work side by side."

Publisher's web site: [...]

This book should be read by every member of the medical community as well as lay people concerned about the erosion of ethical standards by medical personnel facing the challenges of dual loyalty especially when serving in the armed forces. The author , the skill of a surgeon, has described in detail, the crisis of ethical behaviour on physicians and others caring for patients under warlike conditions.

what have we become? Doctors on call to determine how much pain a person can endure for maximum intelligence milking? Or for sadistic purposes?

Read Orwell's 1984 on the sadistic use of torture, for starters. And here we have doctors ASSISTING the administration of pain rather than relieving suffering and sickness.

Here we have doctors FORCING harmful, unwanted and unnecessary procedures on innocent hostages rather than using medical science for increased health.

Forcing feeding tubes into the stomachs of those tightly restrained on back boards, who see no other way out than a hunger strike, so that our evening news may not reveal who many we sacrifice, in the great name of national security, on Guantanamo Bay.

We have now left the civilized world, people. This is no longer doctoring. This is torture. This does not increase my sense of national security. It reveals that we ourselves have destroyed our own security, when the one to whom we turn for physical relief from suffering has become our torturers and assistant to torturers. We have met the enemy and he is us.

After years and years of confinement without charges, without evidentiary procedures, without due process and the other marks of a civilized nation, what do these innocent (until proven guilty) hostages (kidnapped and held for no transparent, clear legal purpose) have to offer in the way of intelligence or knowledge of the reality in the field, now, years later?

Torture them to your hearts delight; they have nothing to offer in the way of information. Your torture tells more about you than about any threat to us as a nation and a people. Your torture destroys us as a people, and the seeds of your own senseless violence against these innocent boys gives fruit in the insane violence we now suffer within our own nation, by your example.

When you make violence against innocents a good thing, it grows, and you have destroyed our nation and the positive unity of our once great and promising people.

Stop the violence. Rebuild peace and non-violence in our world. Practice what you claim to believe. Beg for forgiveness for the harm you have done.

Follow the physician's oath: First, to do NO HARM. No doctor has ANY ethical, legal or moral excuse he was just following orders.

Gaudium et spes gives the specific admonition:
"Every act of war directed to the indiscriminate destruction of whole cities or vast areas with their inhabitants is a crime against God and humanity, which merits firm and unequivocal condemnation."

Thus must we Catholics condemn absolutely our war against Iraq which goes back though the long war of attrition to papa Bush in 1990, which has caused over a million Iraqi deaths, women and children in their bloodied beds, and carpet bombing wiping out the ancient city of Fallujah, etc. all for profiteering privateering petroleum piracy.

Further Gaudium et spes states unequivocally:
"If civil authorities legislate or allow anything that is contrary to the will of God, neither the law made nor the authorization granted can be binding on the conscience of the citizens since God has more right to be obeyed than man."

God commands: Thou shalt not kill.

We cannot kill a million Iraqi citizens, women and children in their beds, for the sake of privateering petroleum piracy. We cannot be involved in this genocide in any way shape or form. We in fact are obligated to work and speak strongly against it. Pope John PAul II was first in condemning the aggressive invasion of Iraq.

See also PACEM IN TERRIS in this Christmas season, and The Challenge of Peace. For our advent reading let us read the Reverend Father John Dear's MARY OF NAZARETH: PROPHET OF PEACE

Remember ever our faith. Read Merton's prophetic Peace in a Post-CHristian Era

I met Steven Miles in a restaurant before this book was published. Miles is a soft-spoken physician from Minneapolis, MN, where he is a Professor of Medicine at the University of Minnesota Medical School and a faculty member of the Center for Bioethics. He looks and sounds quintessentially professorial, with a pleasant smile and an easy manner.

Yet our conversation was almost conspiratorial in tone, even though the 35,000 documents Miles consulted for this book were in the pubic domain, thanks to the ACLU and FOIA. Nothing we discussed was really a secret. But Miles had had to discover the meaning of links between documents for himself, connecting the dots from document to document (the documents were in separate files, the connections between them not easily searchable by software.) He had to correlate the movements of military physicians with diverse places and events.

As he discussed his research, outrage and indignation burned through Miles's restrained demeanor. He described how doctors had aided and abetted torture in Iraq, Guantanamo, and other places, some still hidden from view. "When the Abu Gharib pictures were published," he told me, "it was clear this had been going on for a while. Doctors must have seen the abuse or signs of the abuse. Why was this surfacing as a leaked CD rather than a report by the medical profession? I found somewhat to my amazement that it was not just a matter of not reporting but it was actually a matter of being involved in setting the harshness of the interrogation plans and delaying reports of homicide which would have been an important signal to the public of what was wrong inside the prison."

That our conversation about documents in the public domain in a public place should feel conspiratorial is a tip-off to what it does to us to enter the world of this book. We were not being paranoid--we were experiencing the impact of confronting what is being done in the name of the war on terror and in our name as Americans in a secret world.

Researchers like Miles often show the effects of "secondary trauma," a therapist told me, alerting me to my own symptoms. Immersing oneself in this world results in predictable consequences. We become obsessed with the truth, an elusive quarry under any conditions, and our moral framework skews towards the binary. In the face of traumatic events, whether experienced first or second hand, evil seems easy to distinguish from good.

Whether it is a conversation in a restaurant or the experience of reading this book--that's what can happen.

"I am often asked if my life is in danger, because of this research," Miles told me. "That's an epiphenomenon of being a torturing society. A torturing society is a society that is abraded by the process of dehumanization. In that process, we essentially create our own mirrored netherworlds."

The distortion of our thinking, our behavior, our moral compass, as our society justifies, rationalizes, and minimizes the impact of engaging in state torture is inevitable.

That is the deeper subtext of Miles's book, which documents and illuminates how some doctors have kept prisoners alive as they are tortured and interrogated and have falsified death certificates to substitute natural causes for torture as the cause of death. Oath Betrayed shows how the oath sworn by doctors to do no harm is turned on its head in the name of fighting terror.

This book is a plea for justice, an attempt to reinforce the reasons why America rejected torture in the past as ineffective and inhumane for both practical and moral reasons. Miles believes that a society which allows discourse about such events will be affected for the better as consciences are quickened and resolve strengthened. The existence of this book is an act of hope and affirmation.

Miles also knows that discussing these issues does not expose him to the risks faced by colleagues in other countries, who have been tortured themselves or killed for speaking out. He knows that we still have relative freedom of speech. "The implication that I, a citizen of the United States, should acquiesce to fear strikes me as deeply disrespectful to my colleagues in Turkey, Egypt, Chile, South Africa, Cuba, and the former Soviet Union who assumed much greater risks to fight torture." (p. 160) Still, for freedom of speech to be more than a bleeder valve, it must lead to action. In a society saturated with fictional and non-fictional accounts of violence and torture, we have been desensitized to the reality that Miles urges us to confront. It is not easy to read this book. Miles asks that we swim in the deeper waters of the moral, ethical and psychological consequences of our policies and practices, that we understand what it does to us to become a torturing society. Unlike a director of screen violence, he does not do so to produce a vicarious shiver, but so that we will re-examine the thinking that led us to such practices in the first place.

"Law professor Oona Hathaway found that a nation's endorsement of international laws against torture does not reduce the chance that it will resort to torture. However, she also found that when domestic institutions in such nations `use litigation, media exposure, and political pressure' to expose violations of those commitments, those same nations move in the direction of compliance."

"Oath Betrayed" implores us to use those levers not only because torture is short-sighted and ineffective but also because of what it does to us when we rationalize our behaviors afterward, become habituated and insensitive to what we are doing, and create the conditions to do it again with even less justification in the future.

The book, "Oath Betrayed", is a concise tour of the plan and execution of coercive interrogation methods developed for the "war on terror." Dr. Miles reviewed thousands of documents and guides us through the maze of Orwellian doublespeak, with a focus on the silence of the medical community in allowing abuse to continue. The author informs us by explaining the statutory responsibility of physicians to report such abuses.
The style is so direct and cautious, so dispassionate, that the impact is like an unexpected tsunami-the images came into my thoughts in this unassuming way and the horror implicit slowly engulfed me. Finally, the importance of the professions in shaping our culture and society becomes clear as Dr. Miles places the problem in the broader context of modern life. An excellent book, an important book, but not an easy topic.

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Steve Miles, a physician and medical ethicist, has a long history of addressing challenging ethical issues in medicine. He is also the sort of person who goes to scenes of trajedies (e.g. the Tsunami) and volunteers his medical skills. He has been speaking out about the issue of the role of physicians in torture for some time, and I was pleased to see him put his pen to paper on this issue.

The book is direct and penetrating and written in a style of directness. I will not reiterate what all the reviewers have written in major newspapers and here on Amazon. This book is very important reading for those in all professions -- not just medicine -- because it challenges all to examine their role and its ethical implications when in a position which gives power over the fate of others.

Our country has a checkered history as regards torture. We challenge such behavior in countries and groups we oppose, but tend not to cast the same eye on leaders who are allies (e.g. the Shaw of Iran and his dread Savak intelligence service). At present we seem to be unwilling to examine our own behavior, with some of our leaders seeking rationalizations and internal legal protection. Agreements such as the Geneva Accords and International Law seem long forgotten. We are in fact becoming the people our parents warned us about...

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I haven't finished reading "Oath Betrayed" yet. This book was a beautiful gift from Edwin C. Pauzer (Thank you again Ed !). The 4 stars are awarded for what I read so far.

But, at the end of each page, I can't stop asking myself: what will be the opinion of the wife, the family and the friends of Daniel Pearl if they ever read what I am reading now ?

And by the way: was this book translated and sold in South Korea ?