Guantanamo Bay. Abu Ghraib. Americans have long been aware that our government participates in torture. What Americans may not be so readily aware of, however, is physician involvement in torture, an issue that came to light in the CIA report released by the Senate Intelligence Committee on December 9, 2014. The report made headlines worldwide, prompting world leaders to denounce the CIA’s actions and triggering organizations such as the ACLU to call for a full investigation of violations of human rights.
The physician involvement in torture illuminated in this report was a shocking revelation. Doctors sworn to help fellow humans gave clearance to continue torturing prisoners. Psychologists developed techniques based on the theory of “learned helplessness” to change prisoner behavior and make them more passive. When Atul Gawande, a prominent US surgeon, health reporter and author, tweeted angrily that “doctors, psychologists, and others sworn to aid human beings made the torture possible,” physician involvement in torture became a widely discussed topic in the news and in social media.
Medical torture is, sadly, nothing new. In the 1960s, the American public became aware of physician torture with reports of the Tucker Telephone, invented by Dr. A.E. Rollins to punish and extract information from prisoners at the Tucker State Prison Farm in Arkansas. There in the prison, inmates would be strapped to a table and electrodes would be attached to his or her big toe and genitals. When the handle of the device was cranked, as one would crank an old telephone, electric shocks would be delivered to the prisoner’s body. Many prisoners were subjected to “long-distance calls,” during which several prolonged shocks were delivered until the prisoner was on the brink of losing consciousness. The victims often suffered irreversible damage, including multiple organ failure and insanity. The University of Minnesota Human Rights Library cites hundreds of other examples, dating back to 2002, of prisoners in Afghanistan (Operation Enduring Freedom), Iraq (Operation Iraqi Freedom), and Guantanamo Bay being mistreated by medical staff. In Iraq, a psychologist requested medical assistance for a prisoner with an open catheter and the surgeon on duty refused the request. In Afghanistan, a prisoner who was hemorrhaging from a gunshot wound was denied medical care until he provided information. In Guantanamo, a prisoner was brutally beaten and sent to the hospital in stable, but frail, condition. He was reportedly sent back to the jail not when his treatment was complete, or when he was medically approved to go, but when the warden demanded he be forced back into prison. Furthermore, there are countless recorded events of prisoners complaining of chest pain who were ignored only to die of a heart attack, and of prisoners with mental health disorders being isolated or beaten.
Physicians’ involvement in torture has taken place not only during interrogations, but also during medical experiments. One of the most infamous examples of unethical medical experimentation is the heinous experiments Nazi doctors performed on unwilling prisoners. For instance, victims were subjected to freezing temperatures without adequate clothing to test treatments for hypothermia and were administered experimental antidotes after exposure to diseases such as typhus or compounds such as mustard gas. These experiments were carried out not for the well being of the general population, but to determine remedies for conditions the German military often encountered in the field. One well-known Nazi physician was Josef Mengele, who conducted various experiments on children. He was fascinated with twins in particular, believing that his twin experiments would reveal that genetics is a more powerful force than environmental pressures, a conclusion that he intended to use to propagate the Third Reich’s racial purity theories. His experiments included amputating the limbs of one twin and not the other, or injecting one twin with a deadly disease. Many victims did not survive these experiments and, if they did, Mengele had them killed and dissected their bodies. These sickening and unethical experiments are readily recognized as torture due to the unimaginable actions — the mutilations, the infections, the suffering of the subjects — not to mention that they involved non-consenting subjects .
The Nazi physicians were eventually put to justice in the Nuremburg Trials, where their experiments were determined to be war crimes, but they are not the only physicians who have used human subjects who were unable to give proper consent to being experimented on. In the 19th century, for example, Dr. J. Marion Sims, a pioneer in the field of gynecology, practiced gynecological procedures on his own slaves, most of whom were allowed no recovery time before returning to a life of labor and none of whom were able to refuse participating in Sims’ experiments. The doctor operated on some of his female slaves more than ten times until he was satisfied his technique was refined enough for the white women he considered his actual patients. In the early twentieth century it was still uncertain whether high sugar consumption was related to tooth decay. Physician-scientists used patients in mental hospitals, who were never given the opportunity to consent or had no capacity to consent, as subjects, incorporating large amounts of sugar into some patients’ diets. The patients were never informed that their diets were being selectively altered and those with high-sugar diets did indeed experience tooth decay. To make matters worse, no treatment was administered to alleviate the damage or the pain for the sake of seeking the extent of damage sugar could do to these subjects’ teeth. Probably most well known, between 1932 and 1972 American physician-scientists enrolled over six hundred African-American men in a study later to be named the Tuskegee Syphilis Experiment that aimed to discover the natural course of syphilis. These men were given free medical care, meals, and burial services for enrollment, though none of them knew exactly why they were chosen for the study because they were not told by the physicians that they had syphilis. Unfortunately, their free medical “care” did not include treatment for their syphilis and the disease ran its course in the men while physician-scientists studied its effects.
Past medical experimentation was often unethical, but can we consider it real torture? The United Nations’ official definition of torture is as follows:
“Torture means any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from him or a third person information or a confession, punishing him for an act he or a third person has committed or is suspected of having committed, or intimidating or coercing him or a third person, or for any reason based on discrimination of any kind, 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. It does not include pain or suffering arising only from, inherent in or incidental to lawful sanctions.”
At first glance, medical experimentation does not quite seem to fit this definition of torture. The subjects in the above experiments were not experimented on as punishment, nor did the researchers experiment for the purpose of coercion. Nor were they experimented on for the sake of obtaining information from them. The subjects were, however, chosen to participate in these medical experiments based on discrimination. They were chosen because no one objected to their use as subjects of dangerous experiments. According to the definition, as these subjects were experimented on based on discrimination, medical experimentation can be considered torture.
The unwilling participants of medical experiments have always been members of marginalized and powerless groups — Jewish prisoners during the Holocaust, the mentally ill, African-American women in the Antebellum South, and African-American men during the Jim Crow Era. The scientific community and the public at large acknowledge the atrocities that have been committed against marginalized populations in the name of science, so why don’t we call these experiments, which violated patients’ rights, medical torture? Why don’t we denounce the researchers, and disregard their work for violating human rights? Because we also admit that these experiments yielded critical knowledge we still use today. Sims pioneered new gynecological techniques, the dental scientists proved that sugar consumption causes tooth decay, and the Tuskegee Experiments yielded important information on the progression of syphilis. Are we willing to overlook violations of human rights if they benefit humanity as a whole? Well, yes. Take Dr. Jonas Salk, for instance, the researcher who is most famous for developing the polio vaccine and the influenza vaccine. In order to test the influenza vaccine, Salk and his mentor Dr. Thomas Francis administered it to mental patients who did not and in some cases were unable to give consent. The researchers additionally dosed the patients with the influenza virus to prove the vaccine’s efficacy. As a result of Salk’s work, both the polio and flu vaccines have saved millions of lives. Salk is still highly regarded worldwide; in 1985, President Reagan declared May 6th to be Jonas Salk Day, and the Salk Institute for Biological Studies in San Diego is named for him.
We are willing to accept that medical torture is part of our past, but almost no one is willing to accept that this gruesome tradition continues. The American Medical Association has publicly denounced torture as “a violation of core ethical values.” The New York Times Editorial Board has publicly called for health professionals involved in the CIA torture report to have their licenses revoked. The president of the American Psychological Association has similarly castigated the psychologists involved in designing and carrying out psychological torture of prisoners. Completed after the Nuremburg Trials, the Geneva Convention explicitly states that doctors must not be involved in torture in the Physicians’ Oath. This was adopted by the General Assembly of the World Medical Association in 1948:
“At the time of being admitted as a member of the medical profession: I solemnly pledge myself to consecrate my life to the service of humanity; I will give to my teachers the respect and gratitude which is their due; I will practice my profession with conscience and dignity; the health of my patient will be my first consideration; I will maintain by all the means in my power, the honor and the noble traditions of the medical profession; my colleagues will be my brothers; I will not permit considerations of religion, nationality, race, party politics or social standing to intervene between my duty and my patient; I will maintain the utmost respect for human life from the time of conception, even under threat, I will not use my medical knowledge contrary to the laws of humanity; I make these promises solemnly, freely and upon my honor.”
There have been other actions taken place after learning from our past mistakes. IRB boards and medical ethics committees exist in order to ensure that the medical torture described above are never again committed. Laws against discrimination based on race, gender, age, and disability exist to ensure minority groups are no longer marginalized to the point that human beings can be used as experimental subjects without their permission. We’ve decided that anything we might gain from performing studies that intentionally inflict harm upon subjects, that violate our core ethical values, is not worth the price, and to perform these kinds of medical experiments or to participate in medical torture is a grievous moral failure.
Some may also rationalize that some of our best scientists have committed atrocities because their findings have benefited greater humanity. But CIA torture does not advance humanity. CIA torture does not advance the well being of our world. CIA torture is for punishment, behavior control and coercion of information out of prisoners.
It is worth the price, the government insists, national security is on the line. Except that there is evidence that torture does not work. The Senate Select Committee on Intelligence’s summary of the 2014 CIA torture report included the key findings that torture was “not an effective means of acquiring intelligence.” Former FBI interrogator Joe Navarro told NPR, “I’ve done thousands of interviews, and I can tell you, none of [the TV torture stuff] works.” Statements from interrogators in Iraq note that certain practices, such as strip-searching a prisoner, “made sense from a security standpoint. Prisoners are less likely to be a threat, less likely to escape if not clothed, etc.; however, stripping and/or keeping a detainee without clothing did not make sense from a professional interrogation perspective. It would be contrary to establishing trust and confidence in getting the detainee to cooperate.” The CIA reported to Congress that its interrogation program led to the capture of Osama Bin Laden, but the Senate Intelligence Committee’s 2014 report reveals that “a review of CIA records found that the initial intelligence obtained, as well as the information the CIA identified as the most critical — or the most valuable — on Abu Ahmad al-Kuwaiti, was not related to the use of the CIA’s enhanced interrogation techniques.”
Some may say that physicians participate in torture for a reason. If torture is going to occur anyway, their presence is meant to ensure that torture does not go too far. To that, the reports answer that whatever their efforts have been, they have been inadequate. The University of Minnesota Human Rights Library cites numerous examples where a doctor, presumably present for the well being of the tortured, should have intervened to stop torture but didn’t. In one report, a physician gave the go-ahead for a prisoner to be made to stand on his broken feet for 52 hours, despite already being beaten to an unstable medical condition. Perhaps these doctors simply made a bad medical judgment, or perhaps the CIA agents coerced physicians to give their approval. Regardless the circumstance, even if one were to rationalize the necessity of physicians being present during torture situations for the sake of preventing it from proceeding to death, the results are oftentimes not being achieved.
How could physicians and psychologists, whose entire professions are dedicated to helping humanity, participate in torture in the first place? Evidence suggests that a number of military doctors and nurses are coerced by their superiors. A post-9/11 Taskforce on Preserving Medical Professionalism in National Security Detention Centers report states that the US Department of Defense adopted rules for military health personnel that differ greatly from traditional medical ethical standards. For example, military physicians and nurses have been forced by their superiors to feed and force IVs to prisoners against their will during hunger strikes. Doctors were also required to surrender prisoners’ medical and psychological information so that it could be used during interrogations. Further, instances have been reported of military superiors preventing prisoners from receiving medical care for injuries sustained during interrogations, despite their deteriorating conditions. Military doctors have even been threatened by national security officials if they are not cooperative in torture.
But is coercion really an acceptable excuse? The Physicians for Human Rights organization doesn’t think so. It has publicly stated that military doctors should simply refuse to participate in torture, and that any doctor who does not is “complicit at every step.” Is there really any excusable reason for physicians to be involved in torture?
Medical torture is an unfortunate occurrence of our past and of our present, from explicit interrogational torture to unethical medical experimentation. As a community, the STEM field has created ethics boards and rules to ensure unethical treatment of live subjects remains a thing of the past. On a global level, many nations have implemented laws against discrimination of minorities and treaties such as the Geneva Convention have been created in an effort to ensure that the crimes against humanity that have occurred in our past never occur again. But no overlying policy or law will effectively nurture physicians’ ethical development and values in standing for humanity; this decision, to take to heart the Hippocratic oath and how this pertains to humanity, must come from within each of us. As future physicians, we hold a position of relative power in society and, as such, have a unique responsibility to humanity to uphold the values that have laid the foundation of our position. It is time to recognize that our duties include not only caring for the patients who come to our doors seeking aid, but also to uphold our core beliefs and this responsibility to humanity in the face of adversity.