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Doctor's Orders -- Spill Your Guts

January 09, 2005|M. Gregg Bloche and Jonathan H. Marks | M. Gregg Bloche is professor of law at Georgetown University and adjunct professor at Johns Hopkins University's Bloomberg School of Public Health. Jonathan H. Marks is a London barrister and Greenwall fellow in bioethics at Georgetown University Law Center and the Bloomberg School of Public Health. This article draws from a piece that appears in the current New England Journal of Medicine.

Credit the folks who ran Abu Ghraib for their wit. "The database is lonely," says a smiley face in a slide show for new interrogators prepared a year ago. "You can help! Visit the database every time you spend time with any of our esteemed guests. Tell the database about what fun conversation you and your guests had." The last slide is a cartoon of an interrogation session. "I realize it sounds rather cliche, but we have ways of making you talk," its caption reads.

At Abu Ghraib, Guantanamo Bay, Cuba, and "undisclosed locations," some U.S. military interrogators used troubling methods to try to get their captives to talk. Many of their efforts have been widely reported; some may have risen to the level of torture under international law. What is less known -- but equally disturbing -- is that military doctors become arbiters, even planners, of aggressive interrogation practice, including prolonged isolation, sleep deprivation and exposure to temperature extremes.

An August 2002 Justice Department memo, sought by White House Counsel Alberto R. Gonzales to protect interrogators against prosecution for employing such methods as sleep deprivation, defined torture in medical terms. Coercive measures, the memo stated, don't constitute torture unless they bring about "death, organ failure ... serious impairment of bodily functions" or prolonged and severe mental illness. Use of mind-altering drugs is OK, so long as it doesn't "disrupt profoundly the senses or the personality." Even when these lines are crossed, the memo held, interrogators aren't torturers if they act "in good faith" by "surveying professional literature" or "consulting with experts."

The International Committee of the Red Cross, which monitors wartime detention practices, alleges that medical personnel at Guantanamo shared clinical information with interrogators, in "flagrant violation of medical ethics," to extract more information from detainees. The Pentagon says the charge is false. But our inquiry into the role that health professionals played in military intelligence-gathering in Iraq and Guantanamo has found a pattern of reliance on medical input. Not only did caregivers pass clinical data to interrogators, physicians and other health professionals helped craft and carry out coercive interrogation plans.

Such conduct violated U.S. obligations under the Geneva Convention, which bar threatening, insulting and other abusive treatment of prisoners. There is also probable cause to suspect that some physicians were complicit in the use of interrogation methods that constitute torture under international law.

Piercing the veil of silence surrounding Abu Ghraib and Guantanamo poses unusual difficulties. Military personnel knowledgeable about interrogation practices or medical care at these sites were reluctant to speak with us. Some cited orders not to discuss their service; others pointed to a general understanding, not expressed as an order, that public discussion of their experiences was ill advised. One, Maj. David Auch, commander of the clinical unit that staffed Abu Ghraib when the notorious photos of Iraqi prisoners were taken, said a military intelligence officer told his medics not to talk about deaths that occurred in detention.

Yet multiple interviews with military medical personnel, often on a not-for-attribution basis, made it possible to "connect the dots." Documents made public through Freedom of Information Act litigation brought by the American Civil Liberties Union also contributed.

Critical to understanding the medical role is the change in interrogation doctrine introduced by Maj. Gen. Geoffrey Miller and his team, first at Guantanamo, then at Abu Ghraib. A classified memo, prepared by Miller in late 2003, made the case for "fusion" of all prison functions to support the "interrogation mission."

Miller argued that "Behavioral psychologists and psychiatrists" were needed to "develop ... integrated interrogation strategies and assess ... interrogation intelligence production." To this end, he called for creation of "Behavioral Science Consultation Teams," known as "Biscuits," made up of psychologists and psychiatrists.

Desperate for some edge against a worsening insurgency in Iraq in November 2003, U.S. commanders implemented Miller's design at Abu Ghraib. In one example that came to our attention, Maj. Scott Uithol, a psychiatrist, arrived in Iraq expecting to serve with a combat stress-control unit. He was deployed instead to Abu Ghraib's newly formed Biscuit.

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