Medicine Used for Harm in US Torture's Mark Benjamin recently covered PHR's analysis of US government torture and interrogation policy documents, declassified since President Obama took office. In his review of documents, PHR Medical Advisor Scott Allen, MD, found alarming evidence of bad applications of scientific knowledge and gross ethical misconduct by medical personnel in interrogations of terror suspects in US custody.

Interrogators pumped detainees full of so much water that the CIA turned to a special saline solution to minimize the risk of death, the documents show. The agency used a gurney "specially designed" to tilt backwards at a perfect angle to maximize the water entering the prisoner's nose and mouth, intensifying the sense of choking—and to be lifted upright quickly in the event that a prisoner stopped breathing.The documents also lay out, in chilling detail, exactly what should occur in each two-hour waterboarding "session." Interrogators were instructed to start pouring water right after a detainee exhaled, to ensure he inhaled water, not air, in his next breath. They could use their hands to "dam the runoff" and prevent water from spilling out of a detainee's mouth. They were allowed six separate 40-second "applications" of liquid in each two-hour session—and could dump water over a detainee's nose and mouth for a total of 12 minutes a day. Finally, to keep detainees alive even if they inhaled their own vomit during a session—a not-uncommon side effect of waterboarding—the prisoners were kept on a liquid diet. The agency recommended Ensure Plus.

In a New York Times Op-Ed on February 28, former PHR President Len Rubenstein and Stephen Xenakis, who has advised PHR, noted several examples in the documents of opinions by the CIA's Office of Medical Services providing professional opinions that harsh tactics did not inflict severe pain or suffering and could therefore be authorized without implicating interrogators in torture.

According to Justice Department memos released last year, the medical service opined that sleep deprivation up to 180 hours didn’t qualify as torture. It determined that confinement in a dark, small space for 18 hours a day was acceptable. It said detainees could be exposed to cold air or hosed down with cold water for up to two-thirds of the time it takes for hypothermia to set in. And it advised that placing a detainee in handcuffs attached by a chain to a ceiling, then forcing him to stand with his feet shackled to a bolt in the floor, “does not result in significant pain for the subject.”The service did allow that waterboarding could be dangerous, and that the experience of feeling unable to breathe is extremely frightening. But it noted that the C.I.A. had limited its use to 12 applications over two sessions within 24 hours, and to five days in any 30-day period. As a result, the lawyers noted the office’s “professional judgment that the use of the waterboard on a healthy individual subject to these limitations would be ‘medically acceptable.’”

The op-ed also noted one occasion on which "a medical corpsman ordered intravenous fluids to be administered to a dehydrated detainee even as loud music was played to deprive him of sleep." Rubenstein and Xenakis reiterated PHR's longstanding call for a full investigation of health professionals' involvement in US interrogations and for accountability for such glaring violations of a doctor's core ethical obligation to "first do no harm."PHR's analysis shows an even deeper corruption of the medical role in examples where not only did doctors authorize harsh treatment, they used their medical expertise to modify interrogation tactics so as to prolong them and increase stress and harm suffered by detainees. In Mark Benjamin's article, Dr. Allen said:

This is revolting and it is deeply disturbing. The so-called science here is a total departure from any ethics or any legitimate purpose. They are saying, "This is how risky and harmful the procedure is, but we are still going to do it." It just sounds like lunacy. This fine-tuning of torture is unethical, incompetent and a disgrace to medicine.

In 2006, the American Medical Association, American Psychiatric Association and World Medical Association all adopted ethical guidelines that make it unethical for their members to participate in interrogations of detainees. Regrettably the American Psychological Association has yet to adopt this standard, and the Department of Defense and CIA still call on health professionals to play an active role in interrogations, without holding these "consulting," "monitoring" or "advising" health professionals to traditional ethical standards.In light of this conflict and ethical and legal violations it has led to, PHR has been working with The Center for Constitutional Rights, The New York Coalition Against Torture (NYCAT) and The Bellevue/NYU Program for Survivors of Torture to support?New York State legislation, sponsored by New York State Assemblyman Richard Gottfried, that would make health professional participation in torture and improper treatment of detainees a violation of the violators' professional licenses. This law would offer clear and absolute protection against the misuse of medical and psychological knowledge and expertise in interrogations, and it would protect individual health professionals against the pressure to engage in harmful interrogation practices.?Please show your support for the Gottfried Bill standards. It is our hope that similar standards can be adopted nationwide.The US government and the health professions cannot fulfill their obligations to the rule of law and medical ethics if we settle only for reform without accountability. Assemblyman Gottfried has compiled a remarkable, eight page list of references to medical professionals contributing to "enhanced interrogation techniques." This document can serve as a roadmap for the investigation of health professionals who authorized torture and used their medical expertise to calibrate and increase harm.

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