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.
Excerpt. © Reprinted by permission. All rights reserved.
chapter 1
Torture
In November 2003, an Iraqi guard smuggled a Chinese pistol into Abu Ghraib and gave it to a prisoner, Ameen Sa’eed Al-Sheikh. An informant promptly told MPs, who locked down the cellblock and began a cell-to-cell search. When they got to his cell, Al-Sheikh went for the pistol hidden in his bedding. Gunfire was exchanged. Sergeant William Cathcart was hit, but not injured, by a ricochet. The soldiers wrestled Al-Sheikh to the floor and sent him to the hospital with a dislocated shoulder and shotgun wounds to his legs. When Al-Sheikh returned to the cellblock after several days in the hospital, Specialist MP Charles Graner beat his wounded leg with a baton while demanding that the prisoner renounce Islam. He then suspended Al-Sheikh by his injured shoulder even though the prisoner’s wounded legs could not bear weight to protect the shoulder from further injury. Staff Sergeant–Medic Layton Reuben and another medic saw the beating while providing health care in the cellblock. On three occasions, Medic Layton found Al-Sheikh handcuffed with his arms over his head, putting stress on his injured shoulder and leg. Each time, he says that he told Graner to remove the handcuffs. Layton considered that to be the extent of his responsibility: he stated, “I feel I did the right thing when I told Graner to get the detainee uncuffed from the bed.” Under oath, Medic Layton said that he examined Al-Sheikh in his cell with two officers, a Captain Williams and a physician named Ackerson who held the rank of lieutenant colonel, to confirm that Al-Sheikh had a dislocated shoulder from having his arms handcuffed over his head in his cell. Investigators do not record looking at, or for, the medical record of this examination. There is no evidence that any of these persons reported or tried to stop the abuse, either. Months later, an Abu Ghraib investigation recommended that Medic Layton be disciplined for failing to stop or report the ongoing abuse. The released file says nothing about any scrutiny of Dr. Ackerson.
On a cold night, another medic, Sergeant Theresa Adams, saw Al-Sheikh naked and without a mattress or a blanket. The prisoner was bleeding from a drain that should have been connected to a bag to prevent an infection. Sergeant Adams took Al-Sheikh to see the physician on call, who held the rank of colonel. The physician agreed that the hospital had erred in leaving the catheter open but refused to remove the catheter or to transfer Al-Sheikh to the adjoining hospital. When Sergeant Adams asked him whether he had ever heard of the Geneva Convention, the physician answered, “Fine, Sergeant, you do what you have to do; I am going back to bed.” Later, the physician told investigators that he remembered Al-Sheikh’s dislocated shoulder but not the catheter incident, although he agreed that such a catheter should have been removed. That physician also claimed that during four months at Abu Ghraib at the peak of the abusive incidents, he never observed or heard of any abuse, although he did recall the Red Cross complaining about the treatment of the prisoners.
“Torture” comes from the Latin word for “twist,” an origin that conveys both a common technique of bending a victim’s body or the contortion of a person in agony. The torsion and stretching applied by the medieval “strappado,” a ladderlike device that stretched extremities and joints into abnormal and extreme directions, or the shackled “stress positions” widely used in the prisons of the war on terror epitomize the ancient sense of the word. Torture acquired its present meaning of pain inflicted by government officials in France about eight hundred years ago, when the church or governments applied “the torture” to extract confessions or testimony. The English adopted the French noun in about 1550. In 1591, William Shakespeare is credited with first using “torture” as a verb, in Henry VI: “Alas, master, I am not able to stand alone: You go about to torture me in vain. [Enter a Beadle with whips].” However, the many appearances of the verb in the years immediately after the play suggest that the Bard simply recorded an existing colloquial use, rather than originating one.
Definitions of torture bear close reading. The UN Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment defines torture as any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from him or a third person information or a confession, punishing him for an act he or a third person has committed or is suspected of having committed, or intimidating or coercing him or a third person, or for any reason based on discrimination of any kind, when such pain or suffering is inflicted by, or at the instigation of, or with the consent or acquiescence of a public official or other person acting in an official capacity.
Similarly, the World Medical Association’s “Guidelines for Medical Doctors Concerning Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment in Relation to Detention and Imprisonment” defines torture as the deliberate, systematic or wanton infliction of physical or mental suffering by one or more persons acting alone or on the orders of any authority, to force another person to yield information, to make a confession, or for any other reason.
Both of the preceding documents and the Geneva Conventions definetorture as a government practice rather than as suffering that is inflicted by a criminal sadist. By defining torture in relation to the reasons that nations use it (for example, to secure information), they emphasize that torture is not justified by any purpose or rationale. Torture is a crime against humanity, but its occurrence is not confined to war: many of the 130 governments that practice torture do so while they are at peace.
Although it is customary to think of torture as a set of techniques, torture is better understood as a social institution. Torturing societies create laws, policies, and regulations to authorize the practices. They establish, empower, and protect specialized practitioners and places. With fear, incentives, and propaganda, they secure the assent or acquiescence of the press, the judiciary, the professions, and the citizenry. This view of torture as an institution means that moral blame may not be simply laid on the individual soldiers or police who employ horrific techniques. Those officials are agents, acting on behalf of national leaders, public policies, and a social and political consensus. Condemning, convicting, or sacrificing low-ranking soldiers as rogues or bad apples neither eradicates nor expiates the crime. Moral responsibility in a torturing society is broadly shared. Reforms and prevention must look up the chain of command and out into the society at large.
The Case for Torture
Governments rationalize torture in various ways. Stalin, Saddam Hussein, and the generals of Argentina’s Dirty War used terror to suppress dissent and maintain political control. Hitler used anti-Semitism and the eugenic ideology of “race hygiene” to mobilize a political base and justify genocidal policies. Nigeria amputates the hands of thieves to punish (and putatively deter) crime. Submerging women in water to see whether they floated (guilty of witchcraft) or sank (innocent) is perhaps the most notorious use of torture to answer a question independent of a victim’s testimony. The present war on terror rationalizes torture and harsh treatment to facilitate interrogation. In his novel Waiting for the Barbarians, the South African writer J. M. Coetzee has a magistrate define faith in interrogational torture this way: “Pain is truth.”
There are two general types of coercive interrogation. Pain nterrogation posits that a person will tell the truth in order to escape pain. Here, a physician may be asked for advice to prevent a prisoner from dying or to ensure that the prisoner remains conscious during questioning. Or a physician might advise on how to decrease the risk of evidential scars or physical disability (the long-term psychiatric consequences of torture, such as post-traumatic stress syndromes, are rarely taken into account). Toward a similar goal of concealing torture, a physician might ensure that medical records or death certificates do not note evidence of trauma. Psychiatric stress interrogation endeavors to cause a prisoner to regress and become psychologically dependent on the interrogator. Such captives supposedly become submissive to the interrogator and thereby less resistant to questioning, or less inclined to be deceptive. Here, behavioral scientists, psychiatrists, or psychologists devise plans to psychologically “break” a prisoner without impairing his or her ability to speak the truth. For example, the dose of a barbiturate “truth serum” must be sufficient to relax a prisoner but not so large as to cause an exhausted prisoner to fall asleep or a malnourished prisoner to stop breathing. Alternatively, sensory deprivation must not make a prisoner so psychotic or disoriented that she cannot respond to questions. The techniques encompassed by these two incompletely distinguishable approaches vary according to the torturer’s technology and imagination. All are psychologically stressful. Some deprive a prisoner of basic needs. Some cause pain and injury. Most have been used in prisons in the war on terror.
In the “Ethical Issues” section of his investigation of the Abu Ghraib abuses, the former secretary of defense James Schlesinger wrote, “For the U.S., most cases for permitting harsh treatment of detainees on moral grounds begin with some variant of the R...
