Last month, the CIA released more than 50 declassified documents about the illegal torture program it operated after the September 11, 2001 terror attacks. Many of them elaborate on the sheer brutality of the CIA’s practices, including new details about the 2002 death of Gul Rahman, who was beaten and left to die – chained half-naked to the floor – in sub-freezing temperatures at a CIA black site prison in Afghanistan.
But much of the analysis of the documents overlooked a key revelation: the extent to which physicians, physician assistants, nurse practitioners, and psychologists aided and abetted torture. A subset of these documents confirm how the CIA used the participation of medical professionals to give credence to the lie that torture was “safe, legal, and effective.”
Gul Rahman suffered torture under the watchful eye of CIA medical professionals at the Salt Pit prison in Afghanistan from his arrival in August to his death from hypothermia in November 2002. An internal investigation – released as part of this latest cache – shows that medics actually debated what standard of care they were meant to provide Rahman and other prisoners. They eventually called the CIA’s medical office headquarters and were told simply: “The Hippocratic Oath states that if someone is sick, you treat them.”
These instructions were intentionally vague and logically incoherent, given the purpose of the secret prison: to extract information through torture. And the instructions were duly ignored. The available evidence shows that Rahman was brutalized hours before he froze to death. What’s more, health professionals repeatedly signed off on his torture and appalling conditions of confinement and failed to note any health problems, despite regular abuses.
These breaches by health professionals were directly responsible for Rahman’s death. Not surprisingly, the death investigation includes a doctor’s conclusion that Rahman is to be blamed for dying of hypothermia. By throwing away his last meal, he was unable to “provide his body with a source of fuel to keep him warm.” The autopsy summary reads as a final act of medical complicity.
It is a crime, as well as a violation of medical ethics, to facilitate torture and ill-treatment. Any health professional (indeed, any reasonable person) knows that placing human beings in a coffin, subjecting them to freezing temperatures, sexually humiliating them, or drowning them will cause severe physical and mental pain. But CIA health professionals abandoned their ethics and became participants in such acts.
Instead of stopping the program, the CIA’s medical office drafted a list of “guidelines” following Rahman’s death and the continued mistreatment of other detainees. This latest trove of documents includes a 2004 version – almost totally un-redacted for the first time – which essentially provided a clinical blueprint for torture.
The “medical and psychological guidelines” instruct CIA medical personnel to treat detainees, but only to the point where it doesn’t interfere with torture. “Adequate medical care” should be provided, the document says, but “should not undermine the anxiety and dislocation that the various interrogation techniques are designed to foster.” And despite the title, there are virtually no psychological guidelines for assessing the mental harm these torture techniques would inflict.
In an extraordinary display of double-speak, the CIA’s medical office states all health personnel “remain under the professional obligation to do no harm.” It then directly contradicts this central ethical principle of medicine by providing guidance on how to supervise waterboarding, sleep deprivation, confinement, and other forms of torture.
The architects of the CIA’s unlawful program, psychologists James Mitchell and Bruce Jessen, were paid $81 million dollars to design and oversee these practices (and are currently being sued in federal court). Based on their spurious guidance, the CIA told Bush administration lawyers that the torture techniques weren’t expected to produce severe physical or mental pain – an outright lie.
As these new documents reveal, the CIA and complicit medical professionals created a set of contradictory, ethically unsound guidelines not to prevent harm, as they claimed, but to facilitate the commission and cover-up of torture and to mitigate legal risk.
The torture policies of the Bush administration – which so far President Obama has left uninvestigated – are now well known. Accountability is urgently needed. In the process, we cannot ignore the role of health professionals, who violated their ethical and professional duties, and, in doing so, lent a veneer of medical legitimacy to this criminal enterprise. Their crimes, if proven, cannot and should not go unpunished.