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Doctors and interrogators at guantanamo bay

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Doctors and interrogators at guantanamo bay

  1. 1. PERSPE C T I V E doctors and interrogators at guantanamo bayDoctors and Interrogators at Guantanamo BayM. Gregg Bloche, M.D., J.D., and Jonathan H. Marks, M.A., B.C.L. M ounting evidence from many sources, including Penta- gon documents, indicates that exceptions. Other Pentagon offi- cials have reinforced this mes- sage. In a memo made public last tract actionable intelligence from resistant captives. A previously unreported U.S. military interrogators at Guanta- month, announcing “Principles . . . Southern Command (SouthCom) namo Bay have used aggressive for the Protection and Treatment policy statement, in effect since counter-resistance measures in of Detainees,” William Winken- August 6, 2002, instructs health systematic fashion to pressure werder, the Assistant Secretary of care providers that communica- detainees to cooperate. These Defense for Health Affairs, said tions from “enemy persons un- measures have reportedly includ- that limits on detainees’ medical der U.S. control” at Guantanamo ed sleep deprivation, prolonged privacy are “analogous to legal “are not confidential and are not isolation, painful body positions, standards applicable to U.S. citi- subject to the assertion of privi- feigned suffocation, and beat- zens.” leges” by detainees. The state- ings. Other stress-inducing tac- ment, from SouthCom’s chief of tics have allegedly included sexu- staff, also instructs medical per- al provocation and displays of sonnel to “convey any informa- contempt for Islamic symbols.1 tion concerning . . . the accom- The International Committee of plishment of a military or the Red Cross (ICRC) and others national security mission . . . charge that such tactics constitute obtained from detainees in the cruel and inhuman treatment, course of treatment to non-med- even torture. ical military or other United To what extent did interroga- States personnel who have an tors draw on detainees’ health apparent need to know the in- information in designing and formation. Such information,” it pursuing such approaches? The adds, “shall be communicated Pentagon has persistently denied to other United States personnel this practice. After the ICRC with an apparent need to know, charged last year that interroga- whether the exchange of infor- tors tapped clinical data to craft mation with the non-medical interrogation strategies, Defense But this claim, our inquiry person is initiated by the pro- Department officials issued a has determined, is sharply at vider or by the non-medical per- statement denying “the allega- odds with orders given to mili- son.” The only limit this policy tion that detainee medical files tary medical personnel — and imposes on caregivers’ role in were used to harm detainees.”2 with actual practice at Guanta- intelligence gathering is that This spring, an inquiry led by namo. Health information has they cannot act as interrogators. Vice Admiral Albert T. Church, been routinely available to be- The statement, embedded — the inspector general of the U.S. havioral science consultants and along with policies on parking Navy, concluded: “While access others who are responsible for and alcohol — in the personnel to medical information was crafting and carrying out inter- section of the SouthCom Web carefully controlled at GTMO rogation strategies. Through site,4 not only requires caregiv- [Guantanamo Bay], we found in early 2003 (and possibly later), ers to provide clinical informa- Afghanistan and Iraq that inter- interrogators themselves had ac- tion to military and Central In- rogators sometimes had easy ac- cess to medical records. And telligence Agency interrogation cess to such information.”3 The since late 2002, psychiatrists teams on request; it calls on implication is that interrogators and psychologists have been them to volunteer information had no such access at Guantana- part of a strategy that employs that they believe might be of mo and that medical confidenti- extreme stress, combined with value. It thereby makes them ality was shielded, albeit with behavior-shaping rewards, to ex- part of Guantanamo’s surveil-6 n engl j med 353;1 www.nejm.org july 7, 2005 The New England Journal of Medicine Downloaded from nejm.org on April 25, 2011. For personal use only. No other uses without permission. Copyright © 2005 Massachusetts Medical Society. All rights reserved.
  2. 2. PERSPECTIVE doctors and interrogators at guantanamo bay lance network, dissolving the the United States, this principle late 2002, growing frustration Pentagon’s purported separation has attained the status of cus- with the slow pace of intelligence between intelligence gathering tomary international law. Inter- production at Guantanamo led and patient care. national human rights law (most to calls from commanders for Rather than being consistent important, the 1966 Interna- innovative tactics. Major General with the presumption of confi- tional Covenant on Civil and Po- Geoffrey Miller, who took com- dentiality that applies to Ameri- litical Rights) provides addition- mand of Guantanamo in late cans even in prisons, the Guan- al protection for privacy in 2002, approved the creation of a tanamo policy rejects this general — in wartime and “Behavioral Science Consultation presumption. Within military peacetime. Although this pro- Team” (BSCT, pronounced “Bis- prisons, personal health infor- tection isn’t absolute, exceptions cuit”) in order to develop new mation cannot be given to cor- must be justified by pressing strategies and assess intelligence rectional or law-enforcement of- public need, and they must rep- production. A principal BSCT ficials unless they deem it resent the least restrictive way to function was to engineer the necessary for health, safety, or meet this need. Wholesale aban- camp experiences of “priority” security reasons. Confidentiality donment of medical confidenti- detainees to make interrogation is also the starting point in fed- ality hardly qualifies, especially more productive. eral and state prisons for civil- when the “need” invoked is the A psychiatrist and a psycholo- ians, albeit with similar excep- crafting of counter-resistance gist staffed the Guantanamo tions for health, safety, and measures that are prohibited by BSCT. Those initially assigned security. (Federal law permits dis- international law. to this team both came from closure of inmates’ health infor- In what ways did military in- health care backgrounds; nei- mation “to authorized federal of- telligence personnel draw on ther had much training in be- ficials for the conduct of lawful medical information for interro- havioral analysis of the sort that intelligence, counter-intelligence, gation and counter-resistance pur- civilian psychologists perform for and other national security ac- poses? Instructions to Guantana- law-enforcement agencies. Ac- tivities.”) There is debate over mo veterans not to discuss their cording to Hood’s briefing, BSCT the scope of these exceptions, service publicly have been an ob- consultants prepared psycholog- but there is consensus about the stacle to answering this question. ical profiles for use by interroga- basic presumption of medical But available documents, an ac- tors; they also sat in on some privacy. count of a fall 2004 briefing by interrogations, observed others Wholesale rejection of clinical the camp’s commander (Brigadier from behind one-way mirrors, confidentiality at Guantanamo General Jay Hood), and interviews and offered feedback to interroga- also runs contrary to settled with behavioral science profes- tors. The first BSCT psychologist, ethical precepts. Medical privacy sionals enable us to assemble Major John Leso, a specialist in is not an ethical absolute — parts of this picture. assessing aviators’ fitness to fly, caregivers in civilian and military During the camp’s early attended part of the interroga- settings have an obligation to re- months, interrogators could gain tion of Mohammed al-Qahtani, port information to third parties access to personal health infor- thought by many to be the “20th when doing so can avert threats mation (and did so to set limits hijacker.” (An extract from a log to the health or safety of identifi- on practices that might put de- of this interrogation published able persons — but confidential- tainees’ health at risk) but did in Time magazine last month re- ity is the starting premise. not use psychological assessments fers to Leso as “Maj. L.”) The laws of war defer to of individual subjects. Conven- There are strong indications medical ethics. Additional Pro- tional army intelligence doctrine that the Guantanamo BSCT has tocol I to the Geneva Conven- has been unsympathetic to such had access to personal health tions provides that medical per- input: it has relied instead on a information. An internal, May 24, sonnel “shall not be compelled mix of standard interrogation 2005, memo from the Army Medi- to perform acts or to carry out methods meant to appeal vari- cal Command, offering guidance work contrary to the rules of ously to subjects’ insecurities, to caregivers responsible for de- medical ethics.” Although the pride, and fears, within constraints tainees, refers to the “interpre- protocol has not been ratified by set by the laws of war.5 But by tation of relevant excerpts from n engl j med 353;1 www.nejm.org july 7, 2005 7 The New England Journal of Medicine Downloaded from nejm.org on April 25, 2011. For personal use only. No other uses without permission. Copyright © 2005 Massachusetts Medical Society. All rights reserved.
  3. 3. PERSPE C T I V E doctors and interrogators at guantanamo bay medical records” for the purpose quelae of extreme stress — anx- if so, why not oversee isolation of “assistance with the interro- iety, depressed mood, and disor- and sleep deprivation or monitor gation process.” The memo, pro- dered thinking — impair the beatings to make sure nothing vided to us by a military source, understanding of questions and terrible happens? acknowledges this nontherapeu- produce incoherent answers. Rap- Wholesale disregard for clini- tic role, urging health profes- port building, tailored to peo- cal confidentiality is a large leap sionals who serve in this capacity ple’s cognitive styles and cultur- across the threshold, since it to avoid involvement in detainee al beliefs, takes time but yields makes every caregiver into an care, absent an emergency. This better information, its defenders accessory to intelligence gather- acknowledgment is consistent contend. ing. Not only does this under- with other accounts of informa- There is no scientific answer mine patient trust; it puts pris- tion flow from caregivers to be- to the question of which inter- oners at greater risk for serious havioral science consultants to rogation strategy is more effec- abuse. The global political fall- interrogators. tive. For obvious ethical and legal out from such abuse may pose Competing behavioral science reasons, there is unlikely to be more of a threat to U.S. security models have influenced the ad- one. At Guantanamo, the fear- than any secrets still closely held vice given to interrogators by and-anxiety approach was often by shackled internees at Guanta- BSCT members. One approach favored. The cruel and degrad- namo Bay. emphasizes fear and anxiety as ing measures taken by some, in Dr. Bloche is professor of law at Georgetown counter-resistance tools; another violation of international human University and a visiting fellow at the favors rapport with detainees. rights law and the laws of war, Brookings Institution, both in Washington, The former approach, supported have become a matter of nation- D.C., and adjunct professor at Bloomberg School of Public Health, Johns Hopkins by some associated with the John al shame. University, Baltimore. Mr. Marks is a barris- F. Kennedy Special Warfare Cen- Clinical expertise has a lim- ter at Matrix Chambers, London, and ter who have helped to formulate ited place in the planning and Greenwall Fellow in Bioethics at Georgetown University Law Center and the Bloomberg BSCT doctrine, builds on the oversight of lawful interroga- School of Public Health. premise that acute, uncontrolla- tion. Psychologists play such a ble stress erodes established be- role in criminal investigations, An interview with Mr. Marks can be heard at www.nejm.org havior (e.g., resistance to ques- and medical monitoring of de- tioning), creating opportunities tainees is called for by interna- 1. Break them down: systematic use of psy- to reshape behavior. Complex re- tional legal instruments. But chological torture by U.S. forces. Cambridge, ward systems (e.g., the creation proximity of health professionals Mass.: Physicians for Human Rights, 2005. 2. Lewis NA. Red Cross finds detainees of multiple camp “levels” with to interrogation settings, even abuse at Guantanamo. New York Times. different privileges) promote co- when they act as caregivers, car- November 30, 2004:A1. operation. Stressors tailored to ries risk. It may invite interroga- 3. Church report: unclassified executive summary. (Accessed June 16, 2005, at http:// the psychological and cultural tors to be more aggressive, be- www.defenselink.mil/news/Mar2005/ vulnerabilities of individual de- cause they imagine that these d20050310exe.pdf.) tainees (e.g., phobias, personal- professionals will set needed lim- 4. Huck RA. U.S. Southern Command confi- dentiality policy for interactions between ity features, and religious be- its. The logic of caregiver involve- health care providers and enemy persons un- liefs) are key to this approach ment as a safeguard also risks der U.S. control, detained in conjunction and can be devised on the basis pulling health professionals in with Operation Enduring Freedom. August 6, 2002 (memorandum). (Accessed June 16, of detainee profiles. ever more deeply. Once caregiv- 2005, at http://www.southcom.mil/restrict/ Proponents of rapport-based ers share information with in- J1/new%20web%20page/New%20Web% interrogation counter that an- terrogators, why should they re- 20Pages/AG/Policy/Current%20SC% 20Policies/SC%20Current_pols.htm.) swers given under high stress frain from giving advice about 5. Department of the Army. Field manual are unreliable. Not only are peo- how to best use the data? Won’t 34-52: intelligence interrogation. 1992. ple in acute distress inclined to such advice better protect de- (Accessed June 21, 2005, at https://atiam. train.army.mil/soldierPortal/atia/adlsc/ say whatever they think might tainees, while furthering the in- view/public/6999-1/FM/34-52/FM34_ bring relief; the psychiatric se- telligence-gathering mission? And 52.PDF.)8 n engl j med 353;1 www.nejm.org july 7, 2005 The New England Journal of Medicine Downloaded from nejm.org on April 25, 2011. For personal use only. No other uses without permission. Copyright © 2005 Massachusetts Medical Society. All rights reserved.

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