Medical Whistleblower Canary Notes Newsletter 38 Torture Dec. 2008 Vol. 3 Issue 12

Medical Whistleblower December 2008 Medical Whistleblower’s Volume 3 Issue 12 Canary Notes Inside this issue: Physical Torture 1 What is Torture? Psychological Torture 2 Sleep Deprivation 3 What is Torture? This might seem to be a simple question but the sliding slope of mis- Threats treatment and abuse makes defining torture a complex legal issue. Torture is defined by Rape and Sexual 4 Abuse the United Nations Convention against Torture and Other Cruel, Inhuman or Degrading Treat- The World Medical 5-6 Association ment or Punishment (UNCAT) June 1987. Article 1 (1) in the following way: Countries who signed 7 & ratified ―For the purposes of this Convention, the term "torture" means any act by which severe pain Psychological Research 7 or suffering, whether physical or mental, is in- How do governments 8 tentionally inflicted on a person for such purposes as obtaining from him or a third person Amnesty Interna- 8 tional information or a confession, punishing him for an act he or a third person has committed or is Cruel and Degrading suspected of having committed, or intimidating Disappearances 9 or coercing him or a third person, or for any reason based on discrimination of any kind, Human Subjects 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.‖ Physicians for Human 10 Rights The definition of Torture by the Torture Abolition and Survivors Support Coalition Inter- national (TASSC) is as follows: Physical Torture Physical Torture is any action or technique, or combination that would result in severe physical pain when inflicted upon a human being. Severe physical pain means a level “The clarity of what of pain that a person would not voluntarily accept for himself or herself. Physical torture you ought to do gives includes but is not limited to the following: you courage.” – Wangari Maathai Electric shock Beatings Near asphyxiation Stress positions Rape or sexual abuse Dog attacks Burning

Medical Whistleblower’s Canary Notes Volume 3 Issue 12 Psychological Torture Non-physical methods can be used to cause psychological suffering. The effects of psychological torture are not immediately apparent unless they alter the behavior of the tortured person, so it is often overlooked or denied. Physical torture is the inflicting of severe pain or suffering on a person. In contrast, psychological torture is directed at the psyche with calculated violations of psychological needs, along with deep damage to psychological structures and the breakage of beliefs underpinning normal sanity. Torturers often inflict both types of torture in combination to compound the associated effects. Torture can include extreme stressors, rape, sexual abuse, mock execution, shunning, violation of deep-seated social or sexual norms and taboos, and extended solitary confinement. Many torturers around the world use methods designed to have a maxi- mum psychological impact, while leaving only minimal physical traces. For survivors, torture often leads to lasting mental and physical health problems. It is important to remember that it is possible to induce severe psychological pain, suffering, and trauma with no externally visible effects. Often torturers prefer methods that, while unpleasant, leave victims alive and unmarked. A victim with no visible damage may lack credibility when telling tales of torture. Mental torture, however can leave scars just as deep and long-lasting as physical torture. Torture can include electrical shock, asphyxiation, heat, cold, noise, and sleep deprivation (which leaves little evidence), beatings, and can even involve horrific mutilation or death. The severe mental pain and suffering of those who have been subjected to sexually humiliating acts can constitute cruel or inhuman treatment and also be considered a psychological form of torture. The definition of Mental Torture by the Torture Abolition and Survivors Support Coalition International (TASSC) is any action or technique, or any combination thereof, which might result in severe mental trauma or harm when inflicted upon a human being. This includes but is not limited to the following: Death threat or threats of immediate and severe physical pain Mock executions Rape or sexual abuse Extended disruption of food and sleep Extended solitary confinement Extended sensory deprivation Extended sensory disruption or overload Use of hallucinogenic or other mentally disruptive drugs Threats against family members Secret detention or "disappearances" of a loved one Forced observance, by hearing or watching, of the mental and/or physical torture or murder of another. Forcible participation in the mental or physical torture of others. Severe mental trauma or harm means a level of fear or trauma that a person would not voluntarily accept for himself or herself, or which results in prolonged mental suffering afterwards. Note: There are countless ways to inflict mental trauma or harm such as the use of psychotropic, mind- altering, or other drugs for the purpose of decreasing resistance or gaining information or the exploitation of phobias, psychopathology, or physical vulnerability . Some methods may appear innocuous, but are in fact devastating.

Medical Whistleblower’s Canary Notes Volume 3 Issue 12 Disruption of Sleep and Meals: Sleep Deprivation and withholding food and water con- stitutes, at a minimum, cruel and degrading treatment. Depending on the age and health of the prisoner, the duration of the disruption, and the other techniques being used in this combination, in most cases this will also constitute mental and/or physical torture. US Fed- eral courts have repeatedly found sleep deprivation to violate both the Eighth and Fourteenth Amendments. The Supreme Court has held that a confession obtained by depriving a prisoner of sleep for thirty-six hours violated the individual’s right to due process. See Ashcraft v. Tennessee, 322 U.S. 143, 154 (1944); see also Ashcraft v. Tennessee, 327 U.S. 274 (1946); see generally United States ex rel. Wade v. Jackson, 256 F.2d 7 (2d Cir. 1958) (depriving arrestee of sleep for twenty-two hours contributed to violations of due process rights). Threats: Universal Declaration of Human The international courts have agreed that threats, including threats to a third Rights person, are prohibited conduct constituting cruel or inhuman treatment. Article 1- [ Campbell v. United Kingdom — 4 Eur. Ct. H.R. 293 (ser. A) ¶ 26(Feb. 25 “All human beings are born free 1982), available at http://www.worldlii.org/eu/cases/ECHR/1982/1.html] and in and equal in dignity and rights. some cases part of a pattern of mental abuse and torture. [Urrutia v. Guate- They are endowed with reason mala, Inter-Am. Ct. H.R., (Ser. C) No. 103, ¶¶ 93-94] The European Court of and conscience and should act Human Rights found that threats can trigger ―long-term symptoms of anxiety towards one another in a spirit of and insecurity, diagnosed as post-traumatic stress disorder and requiring treatment by medication,‖ and can even be by themselves to constitute tor- brotherhood” ture.‖ [Akkoç v. Turkey. App. nos. 22947/93 and 22948/93, 116-17 (Oct. 10, 2000)]. Under US law, threats of imminent death or severe physical pain or suffering to the individual or others, are explicitly banned as forms of mental torture that can lead to long-term harm under the Torture Act and are war crimes under the War Crimes Act (2003). When there are credible verbal threats of the use of deadly force it can be considered to be cruel and unusual treatment that ―shocks the conscience‖ in violation of the Fifth and Fourteenth Amendments. For instance, US Federal appeals courts have found that pointing a loaded weapon at a civilian without a legiti- mate law enforcement purpose violated the Fourteenth Amendment. [Hawkins v. Holloway, 316 F.3d 777, 787 (8th Cir. 2003)] (holding that ―threatening deadly force a as means of oppressing those employed in his department‖ elevated ―his conduct to the arbitrary and conscience shocking behavior prohibited by substantive due process‖); [Robinson v. Solano County, 278 F.3d 1007, 1014 (9th Cir. 2002)].

Medical Whistleblower’s Canary Volume 3 Issue 12 Rape, Sexual Abuse and Humiliation: Article 5- Rape, of course, will always constitute physical and mental torture. Religious, cultural, and sexual humiliation including, but not limited to, forced nakedness and other sexual “No one shall be subjected abuse, such as unwanted touching, forced nudity, and forced masturbation is always, to torture or to cruel, at the very least, cruel and degrading. Sexual abuse and humiliation fall within the definition of mental torture. In the legal case Raquel Martin Mejía v. Perú, Case inhuman or degrading 10.970, Report No. 5/96, Inter-Am. C.H.R. 157, OEA/ser.L/V/II.91, doc. 7 rev. (1996). treatment or punishment” The court announced that rape constituted torture if it was: ―1) an intentional act through which physical and mental pain and suffering is inflicted on a person; 2) committed with a purpose; and 3) committed by a public official or by a private person acting at the instigation of the former.‖ Rape not only is an unspeakable infringement of human rights, but often leaves deep and lasting psychological scars. The international human rights, criminal justice, and humanitarian law communities, including the International Criminal Court (ICC), the ad hoc international criminal tribunals, regional human rights courts, and the UN human rights bodies, are uniform in their designation of rape as a violation of human rights and a crime. Perhaps most significantly, the International Criminal Court statute considers rape, including sexual violence, a war crime and, if used systematically against a civilian population, a crime against humanity. The ICC statute also establishes that rape is a ―grave breach‖ of the Geneva Conventions and may constitute a crime against humanity. Rape by a state agent will almost always be torture as well. The Fourth Geneva Convention considers rape as an act of torture and a war crime. Both the European Court of Human Rights and the Inter-American Court of Human Rights have characterized rape as inhumane treatment, and the Inter-American Court later “I know what few U.S. determined that rape is a form of torture and thus a violation of Article 5.2 of the citizens know: what it is American Convention on Human Rights. The European Court of Human Rights also to be an innocent civilian, and to be accused, found that rape can constitute a violation of Article 3 of the European Convention, interrogated, and tor- which prohibits torture. The court found that ―rape of a detainee by an official of the tured, to have my own government eschew my State must be considered to be an especially grave and abhorrent form of ill-treatment claims for justice and given the ease with which the offender can exploit the vulnerability and weakened re- actively destroy my sistance of his victim.‖ Aydin v. Turkey, 1997-VI Eur. H.R. Rep. 1866, ¶¶ 80-88 ¶ character because my case causes political 83.(1997). Incidents of penetration with a foreign object clearly constitute rape under problems for them. I domestic law such as the War Crimes Act. Military Commissions Act of 2006, Pub. L. know what it is to wait in No. 109-366, 120 Stat. 2600 (amending 18 U.S.C.§ 2441) (2006). Sexually degrading the dark for torture, and what it is to wait in the acts have historically been used in combination with other methods to break down a dark for the truth. I am detainee. Forced nakedness and sexual humiliation violate human dignity and can still waiting.‖ lead to long-term psychological harm. Sexual humiliation and stripping a detainee of Sister Diana Ortiz his clothes adds to his sense of vulnerability and are ―intended to cause . . . feelings of humiliation and inferiority.‖

Volume 3 Issue 12 Medical Whistleblower’s Canary Notes Page 5 The World Medical Association Declaration of Tokyo The World Medical Association Declaration of Tokyo. Guidelines for Physicians Concerning Tor- ture and other Cruel, Inhuman or Degrading Treatment or Punishment in Relation to Detention and Imprisonment Adopted by the 29th World Medical Assembly, Tokyo, Japan, October 1975, and editorially revised at the 170th Council Session, Divonne-les-Bains, France, May 2005 and the 173rd Council Session, Divonne-les-Bains, France, May 2006 PREAMBLE It is the privilege of the physician to practise medicine in the service of humanity, to preserve and restore bodily and mental health without distinction as to persons, to comfort and to ease the suffering of his or her patients. The utmost respect for human life is to be maintained even under threat, and no use made of any medical knowledge contrary to the laws of humanity. For the purpose of this Declaration, torture is defined 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. DECLARATION 1. The physician shall not countenance, condone or participate in the practice of torture or other forms of cruel, inhuman or degrading procedures, whatever the offense of which the victim of such procedures is suspected, accused or guilty, and whatever the victim's beliefs or motives, and in all situations, including armed conflict and civil strife. 2. The physician shall not provide any premises, instruments, substances or knowledge to fa- cilitate the practice of torture or other forms of cruel, inhuman or degrading treatment or to dimin- ish the ability of the victim to resist such treatment. 3. When providing medical assistance to detainees or prisoners who are, or who could later be, under interrogation, physicians should be particularly careful to ensure the confidentiality of all personal medical information. A breach of the Geneva Conventions shall in any case be reported by the physician to relevant authorities. The physician shall not use nor allow to be used, as far as he or she can, medical knowledge or skills, or health information specific to individuals, to fa- cilitate or otherwise aid any interrogation, legal or illegal, of those individuals. 4. The physician shall not be present during any procedure during which torture or any other forms of cruel, inhuman or degrading treatment is used or threatened. 5. A physician must have complete clinical independence in deciding upon the care of a person for whom he or she is medically responsible. The physician's fundamental role is to alleviate the distress of his or her fellow human beings, and no motive, whether personal, collective or political, shall prevail against this higher purpose. 6. Where a prisoner refuses nourishment and is considered by the physician as capable of forming an unimpaired and rational judgment concerning the consequences of such a voluntary refusal of nourishment, he or she shall not be fed artificially. The decision as to the capacity of the prisoner to form such a judgment should be confirmed by at least one other independent physician. The consequences of the refusal of nourishment shall be explained by the physician to the prisoner. 7. The World Medical Association will support, and should encourage the international commu- nity, the National Medical Associations and fellow physicians to support, the physician and his or her family in the face of threats or reprisals resulting from a refusal to condone the use of torture or other forms of cruel, inhuman or degrading treatment.

Medical Whistleblower’s Canary Notes Volume 3 Issue 12 The World Medical Association Declaration, Hamburg, Germany, 11/ 1997 World Medical Association Declaration Concerning Support for Medical Doctors Refusing to Participate in, or to Condone, the Use of Torture or Other Forms of Cruel, Inhuman or Degrading Treatment PREAMBLE 1. On the basis of a number of international ethical declarations and guidelines subscribed to by the medical profession, medical doctors throughout the world are prohibited from countenancing, condoning or participating in the practice of torture or other forms of cruel, inhuman or degrading procedures for any reason. 2. Primary among these declarations are the World Medical Association's International Code of Medical Ethics, Declaration of Geneva, Declaration of Tokyo, and Resolution on Physician Participation in Capital Punishment; the Standing Committee of European Doctors' Statement of Madrid; the Nordic Resolution Concerning Physician Involvement in Capital Punishment; and, the World Psychiatric Association's Declaration of Hawaii. However, none of these declarations or statements addresses explicitly the issue of what protection should be extended to medical doctors if they are pressured, called upon, or ordered to take part in torture or other forms of cruel, inhuman or degrading treatment or punishment. Nor do these declarations or statements express explicit support for, or the obligation to protect, doctors who encounter or become aware of such procedures. RESOLUTION 4. The World Medical Association (WMA) hereby reiterates and reaffirms the responsibility of the organised medical profession: i. to encourage doctors to honour their commitment as physicians to serve humanity and to resist any pressure to act contrary to the ethical principles governing their dedication to this task; ii. to support physicians experiencing difficulties as a result of their resistance to any such pressure or as a result of their attempts to speak out or to act against such inhuman procedures; and, iii. to extend its support and to encourage other international organisations, as well as the national member associations (NMAs) of the World Medical Association, to support physicians encountering difficulties as a result of their attempts to act in accordance with the highest ethical principles of the profession. iv. Furthermore, in view of the continued employment of such inhumane procedures in many countries throughout the world, and the documented incidents of pressure upon medical doctors to act in contravention to the ethical principles subscribed to by the profession, the WMA finds it necessary: v. to protest internationally against any involvement of, or any pressure to involve, medical doctors in acts of torture or other forms of cruel, inhuman or degrading treatment or punishment; vi. to support and protect, and to call upon its NMAs to support and protect, physicians who are resisting involvement in such inhuman procedures or who are working to treat and rehabilitate victims thereof, as well as to secure the right to uphold the highest ethical principles including medical confidentiality; vii. to publicise information about and to support doctors reporting evidence of torture and to make known proven cases of attempts to involve physicians in such procedures; and, viii. to encourage national medical associations to ask corresponding academic authorities to teach and investigate in all schools of medicine and hospitals the consequences of torture and its treatment, the rehabilitation of the survivors, the documentation of torture, and the professional protection described in this Declaration.

Volume 3 Issue 12 Medical Whistleblower’s Canary Page 7 Countries To the Convention Against Torture Article 3- “Everyone has the right to life, liberty and security of person” Map of the world with parties to the Conven- Psychological Research on Torture tion against Torture shaded dark green, In two very important psychological research studies, the Stanford prison states that have signed experiment, and the Milgram experiment, it was found that the people respond to authority figures and will participate in torture. In the acceptance but not ratified the treaty of torture there are is a sliding scale of stages of personal acceptance of in light green, and non- torture and these include: parties in grey. Reluctant or peripheral participation: Official encouragement: Many people will follow the direction of an authority figure (such as a superior officer) in an official setting (especially if presented as mandatory), even if they have personal uncertainty. The main motivations for this appear to be fear of loss of status or respect, and the desire to be seen as a "good citizen" or "good subordinate". Peer encouragement: This is when people begin to accept torture as necessary, acceptable or deserved, or to comply from a wish to not reject peer group beliefs. Dehumanization: This means people seeing victims as objects of curiosity and experimentation, where pain becomes just another test to see how it af- fects the victim. Disinhibition: This is when socio-cultural and situational pressures may cause torturers to undergo a lessen- ing of moral Inhibitions and as a result act in ways not normally countenanced by law, custom and conscience. Milgram, Stanley (1963). "Behavioral Study of Obedience". Journal of Abnormal and Social Psychology 67: 371–378. doi:10.1037/h0040525. PMID 14049516. http://content.apa.org/journals/abn/67/4/371. Full-text PDF.

Medical Whistleblower’s Canary Volume 3 Issue 12 How do Governments Respond to Torture? Torture becomes established as part of internally acceptable norms under certain circumstances, it’s us often becomes institutionalized and self-perpetuating over time. Many perpetrators of torture are coerced by their superiors. It can be: 1.Carried on in silence (official denial) 2. Semi-silence (known but not spoken about) 3. Openly acknowledged in public (in order to instill fear and obedience). Amnesty International Amnesty International researches human rights abuses worldwide and releases re- ports– in order to increase transparency and bring world attention to the problem. It Amnesty International also organizes a huge grassroots movement to call attention to actions of govern- USA website http:// ments and individuals involved in abuses. Amnesty International argues that torture www.amnestyusa.org and ill-treatment are repugnant, abhorrent, and immoral. Amnesty International asserts +1 212 807 8400 that evidence extracted by torture can be unreliable and that the use of torture cor- rupts institutions which tolerate it. People will say or do anything to escape the situa- 5 Penn Plaza - 16th floor, tion, including untrue ―confessions" and implication of others without genuine knowl- New York, NY 10001 edge, who may well then be tortured in turn. Torture has often been sponsored by USA governments. In addition, individuals or groups may inflict torture on others for the same reasons as those acting in an official capacity. The Amnesty International Secretariat is responsible for the majority of the organization's research and leads the campaigning work, based in London, UK. Tele- phone: +44-20-74135500 Fax number: +44-20-79561157 Address:1 Easton Street, London, WC1X 0DW, UK Cruel and Degrading Treatment Cruel and degrading treatment is any action or technique, or combination thereof, that would degrade or humiliate a human being, or result in personal misery. This category may include mental and physical abuse that would not quite amount to torture. Note: Today this category should include forcing a devout Muslim man to wear a woman's underpants on his head, or depriving a prisoner of bathing and toilet privileges. Many of these actions, if repeated or prolonged, or combined with other actions could constitute mental or physical torture.

Newsletter Title Volume 3 Issue 12 Page 9 Disappearances "Ghost Prisoners": Holding any person prisoner in secret detention without access to families, advo- cates, lawyers or the International Red Cross con- stitutes mental torture both for the prisoners, their families and loved ones. Under such conditions, other forms of mental and physical torture become almost inevitable. Secrecy always results in the abuse of power. International Committee of the Red Cross ICRC 1100 Connecticut Ave., N.W., Suite 500, Washington, D.C. 20036, 202-587-4600, Fax: 202-587-4696 http://www.icrc.org/ Torture is at the heart of the deadly politics of national security. http:// www.icrc.org/ Report on High Value Detainees in CIA custody http://www.nybooks.com/icrc-report.pdf Human Subjects Protection Human subjects should be protected and any medical research involving the use of Human Subjects should have a reviewed and approved investigation plan guided by experts in clinical medicine, public health, bioethics, and international human rights law who reviewed and approved the investigation plan. The medical research plan should also be guided by the relevant process provisions of Title 45 of the US Code of Federal Regulations and complied with the Declaration of Helsinki, as revised in 2000. For fur- ther information consult the World Med. Association, Declaration of Hel- sinki: Ethical Principles for Medical Research Involving Human Subjects, World Medical Association Doc. 17.C (1964, am. 1975, 1983, 1989, 1996, and 2000), available at http://www.wma.net/e/policy/b3.htm. The International Committee of the Red Cross (ICRC) is an impartial, neutral and independent organization whose exclusively humanitarian mission is to protect the lives and dignity of victims of war and internal violence and to provide them with assistance. It directs and coordinates the international relief activities conducted by the Movement in situations of conflict. It also endeavours to prevent suffering by promoting and strengthening humanitarian law and universal humanitarian principles.

Medical Whistleblower The information contained through the Medical Whistle- blower Canary Notes Newsletter is provided for general information only. The information provided by the Medial Dr. Janet Parker DVM Whistleblower Canary Notes does not constitute legal or P.O. Box C professional advice nor is it conveyed or intended to be con- Lawrence, KS 66044 veyed in the course of any adviser-client discourse, but is Phone: 360-809-3058 intended to be general information with respect to common Fax: None issues. It is not offered as and does not constitute legal or E-mail: MedicalWhistleblower@gmail.com medical advice or opinion. It should not serve as a substitute for advice from an attorney, qualified medical professional, social worker, therapist or counselor familiar with the facts We are on the Web! of your specific situation. We encourage you in due diligence MedicalWhistleblower.googlepages.com to seek additional information and resources before making any decision. We make no warranty, express or implied, concerning the accuracy or reliability of the content of this newsletter due to the constantly changing nature of the legal Supporting the Emotional Health of All Whistleblowers and medical aspects of these issues . and their Friends, Supporters and Families. Physicians for Human Rights Physicians for Human Rights (PHR) mobilizes health professionals to advance the health and dignity of all people through actions that promote respect for, protection of, and fulfillment of human rights. PHR has a Medical Evidence of Torture track record of more than 20 years documenting tor- by US Personnel and Its ture around the world, including in Turkey, Chile, Impact: A Report by Chechnya, Kosovo, Israel, India, and Chiapas, Mex- Physicians for Human Rights ico. PHR has extensive expertise in evaluating survi- June 2008 vors of torture as well as experience with prisoner health issues. PHR was one of the lead initiators and authors of the Istanbul Protocol on the investigation and Physicians for Human Rights documentation of torture, adopted as an official document by the United Nations in 2 Arrow Street, Suite 301 1999. PHR has repeatedly called for an end to the use of the ―enhanced‖ tactics by all US personnel, an end to all health professional participation in interrogations, a Cambridge, MA 02138 full Congressional investigation of the use of psychological and physical torture by Tel. (617) 301.4200 the US Government, and accountability for perpetrators. PHR has successfully or- Washington Office ganized and mobilized thousands of health professionals and helped to secure the 1156 15th Street, Suite leadership of the major health professional associations to develop ethical guide- 1001 lines related to interrogation that protect against medicine and science being em- Washington, DC 20005 ployed to aid the abuse of prisoners. PHR’s work contributed to the adoption of ethical standards by the American Medical Association, the World Medical Association, Tel. (202) 728.5335 and the American Psychiatric Association prohibiting direct participation of physi- www.physiciansforhumanrights cians in interrogations. PHR has helped move the American Psychological Associa- tion (APA) to prohibit the involvement of its members in the Central Intelligence Agency’s ―enhanced‖ interrogation techniques and has supported a movement within the APA to end the direct participation of psychologists in interrogations.

Medical Whistleblower Canary Notes Newsletter 38 Torture Dec. 2008 Vol. 3 Issue 12

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