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Doctors
and Torture
By
Robert Jay Lifton,
M.D.
The New England
Journal of Medicine
TFF
Associate
August 16, 2004
We know that medical personnel have
failed to report to higher authorities wounds that were
clearly caused by torture and that they have neglected to
take steps to interrupt this torture. In addition, they
have turned over prisoners' medical records to
interrogators who could use them to exploit the
prisoners' weaknesses or vulnerabilities. We have not yet
learned the extent of medical involvement in delaying and
possibly falsifying the death certificates of prisoners
who have been killed by torturers.
A May 22 article on Abu Ghraib in
the New York Times states that "much of the evidence of
abuse at the prison came from medical documents" and that
records and statements "showed doctors and medics
reporting to the area of the prison where the abuse
occurred several times to stitch wounds, tend to
collapsed prisoners or see patients with bruised or
reddened genitals." http://www.truthout.org/docs_04/080604J.shtml#16
According to the article, two
doctors who gave a painkiller to a prisoner for a
dislocated shoulder and sent him to an outside hospital
recognized that the injury was caused by his arms being
handcuffed and held over his head for "a long period,"
but they did not report any suspicions of abuse. A staff
sergeant medic who had seen the prisoner in that position
later told investigators that he had instructed a
military policeman to free the man but that he did not do
so. A nurse, when called to attend to a prisoner who was
having a panic attack, saw naked Iraqis in a human
pyramid with sandbags over their heads but did not report
it until an investigation was held several months
later.
A June 10 article in the Washington
Post tells of a long-standing policy at the Guantanamo
Bay facility whereby military interrogators were given
access to the medical records of individual prisoners.
http://www.truthout.org/docs_04/080604J.shtml#17
The policy was maintained despite
complaints by the Red Cross that such records "are being
used by interrogators to gain information in developing
an interrogation plan." A civilian psychiatrist who was
part of a medical review team was "disturbed" about not
having been told about the practice and said that it
would give interrogators "tremendous power" over
prisoners.
Other reports, though sketchier,
suggest that the death certificates of prisoners who
might have been killed by various forms of mistreatment
have not only been delayed but may have camouflaged the
fatal abuse by attributing deaths to conditions such as
cardiovascular disease. http://www.truthout.org/docs_04/080604J.shtml#18
Various medical protocols -
notably, the World Medical Association Declaration of
Tokyo in 1975 - prohibit all three of these forms of
medical complicity in torture. Moreover, the Hippocratic
Oath declares, "I will use treatment to help the sick
according to my ability and judgment, but never with a
view to injury and wrongdoing."
To be a military physician is to be
subject to potential moral conflict between commitment to
the healing of individual people, on the one hand, and
responsibility to the military hierarchy and the command
structure, on the other. I experienced that conflict
myself as an Air Force psychiatrist assigned to Japan and
Korea some decades ago: I was required to decide whether
to send psychologically disturbed men back to the United
States, where they could best receive treatment, or to
return them to their units, where they could best serve
combat needs. There were, of course, other factors, such
as a soldier's pride in not letting his buddies down, but
for physicians this basic conflict remained.
American doctors at
Abu Ghraib and elsewhere have undoubtedly been aware of
their medical responsibility to document injuries and
raise questions about their possible source in abuse. But
those doctors and other medical personnel were part of a
command structure that permitted, encouraged, and
sometimes orchestrated torture to a degree that it became
the norm - with which they were expected to comply - in
the immediate prison environment.
The doctors thus
brought a medical component to what I call an
"atrocity-producing situation" - one so structured,
psychologically and militarily, that ordinary people can
readily engage in atrocities. Even without directly
participating in the abuse, doctors may have become
socialized to an environment of torture and by virtue of
their medical authority helped sustain it. In studying
various forms of medical abuse, I have found that the
participation of doctors can confer an aura of legitimacy
and can even create an illusion of therapy and
healing.
The Nazis provided
the most extreme example of doctors' becoming socialized
to atrocity. http://www.truthout.org/docs_04/080604J.shtml#19
In addition to
cruel medical experiments, many Nazi doctors, as part of
military units, were directly involved in killing. To
reach that point, they underwent a sequence of
socialization: first to the medical profession, always a
self-protective guild; then to the military, where they
adapted to the requirements of command; and finally to
camps such as Auschwitz, where adaptation included
assuming leadership roles in the existing death factory.
The great majority of these doctors were ordinary people
who had killed no one before joining murderous Nazi
institutions. They were corruptible and certainly
responsible for what they did, but they became murderers
mainly in atrocity-producing settings.
When I presented my
work on Nazi doctors to U.S. medical groups, I received
many thoughtful responses, including expressions of
concern about much less extreme situations in which
American doctors might be exposed to institutional
pressures to violate their medical conscience. Frequently
mentioned examples were prison doctors who administered
or guided others in giving lethal injections to carry out
the death penalty and military doctors in Vietnam who
helped soldiers to become strong enough to resume their
assignments in atrocity-producing situations.
Physicians are no
more or less moral than other people. But as heirs to
shamans and witch doctors, we may be seen by others - and
sometimes by ourselves - as possessing special magic in
connection with life and death. Various regimes have
sought to harness that magic to their own despotic ends.
Physicians have served as actual torturers in Chile and
elsewhere; have surgically removed ears as punishment for
desertion in Saddam Hussein's Iraq; have incarcerated
political dissenters in mental hospitals, notably in the
Soviet Union; have, as whites in South Africa, falsified
medical reports on blacks who were tortured or killed;
and have, as Americans associated with the Central
Intelligence Agency, conducted harmful, sometimes fatal,
experiments involving drugs and mind control.
With the possible
exception of the altering of death certificates, the
recent transgressions of U.S. military doctors have
apparently not been of this order. But these examples
help us to recognize what doctors are capable of when
placed in atrocity-producing situations. A recent
statement by the Physicians for Human Rights addresses
this vulnerability in declaring that "torture can also
compromise the integrity of health professionals."
http://www.truthout.org/docs_04/080604J.shtml#20
To understand the
full scope of American torture and abuse at Abu Ghraib
and other prisons, we need to look more closely at the
behavior of doctors and other medical personnel, as well
as at the pressures created by the war in Iraq that
produced this behavior. It is possible that some doctors,
nurses, or medics took steps, of which we are not yet
aware, to oppose the torture. It is certain that many
more did not. But all those involved could nonetheless
reveal, in valuable medical detail, much of what actually
took place. By speaking out, they would take an important
step toward reclaiming their role as healers.
Source
Information
From the Department
of Psychiatry, Harvard Medical School, Boston.
References
1. http://www.truthout.org/docs_04/080604J.shtml#11
Zernike K. http://query.nytimes.com/search/abstract?res=F00A17F8345B0C718EDDAC0894DC404482
Only a few spoke up
on abuse as many soldiers stayed silent. New York Times.
May 22, 2004:A1.
2. http://www.truthout.org/docs_04/080604J.shtml#12
Slevin P, Stephens J. http://www.washingtonpost.com/wp-dyn/articles/A29649-2004Jun9.html
Detainees' medical
files shared: Guantanamo interrogators' access
criticized. Washington Post. June 10, 2004:A1.
3. http://www.truthout.org/docs_04/080604J.shtml#13
Squitieri T, Moniz D. http://www.keepmedia.com/ShowItemDetails.do?itemID=496505&extID=10032&oliID=213
U.S. Army
re-examines deaths of Iraqi prisoners. USA Today. June
28, 2004.
4. http://www.truthout.org/docs_04/080604J.shtml#14
Lifton RJ. http://www.amazon.com/exec/obidos/tg/detail/-/0465049052/002-3943980-7039207?v=glance
The Nazi doctors:
medical killing and the psychology of genocide. New York:
Basic Books, 1986.
5. http://www.truthout.org/docs_04/080604J.shtml#15
http://www.aclu.org/International/International.cfm?ID=13965&c=36
Statement of
Leonard Rubenstein, executive director, Physicians for
Human Rights, June 2, 2004.
©
TFF & the author 2004
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