According to CIA director Michael Hayden, the role of medical officers during interrogations has always been “to ensure the safety and the well-being of the detainee” (113).
The Senate Select Committee on Intelligence refuted this testimony as “incongruent with CIA records.”
What a gross understatement that would prove to be.
Reports of physicians and other health care personnel who complied, advised and participated in the torture of CIA detainees are buried throughout the recently released Senate Select Committee on Intelligence Report.
Some cases, like the medically unnecessary rectal feeding and rehydration of up to five detainees, are hard to ignore, while others, like the underreporting of detainee medical complaints, are more subtle (113, 488). But mostly, it’s sickening.
Medical officers advised that the interrogators use saline in future waterboarding sessions to avoid water poisoning (86).
Medical officers adjusted shackles and provided medication “as necessary to prevent edema” in order to allow continued standing sleep deprivations (415).
Medical officers did not always intervene when detainees were experiencing hallucinations from severe sleep deprivation (132).
Medical officers provided consultations for when fractures were healed sufficiently to resume placing detainees in stress positions (113).
Medical officers subjected detainees to rectal rehydration even when they noted they could have easily given them fluids intravenously or through a nasogastric tube. Rectal rehydration was used specifically as a “means of behavior control” because it’s humiliating and painful (100). Preferably, the “largest rectal tube possible” would be used (100).
Behind every dark twist in the CIA’s horrifying interrogation techniques, there is a trained medical officer lurking — complying, advising and facilitating.
Author and surgeon Atul Gawande was one of the first prominent physicians to shed light on the shameful involvement of health care providers in the CIA’s interrogation program. In a series of tweets, Gawande points out that “the medical profession was deeply embedded in this inhumanity.” The report itself described medical personnel as playing a “central role” in the use of interrogation against detainees (490).
At times, the brash cruelty of CIA interrogators overshadows the permissive actions of the medical officers, but don’t let that fool you. Physicians were at the front and center of this tragedy.
Medical officers rectally infused a pureed lunch tray consisting of hummus, pasta with sauce, nuts and raisins into a detainee (100). They did this even when they had no proven scientific evidence that nutrients are absorbed that way. As trained medical providers, they knew that the food would just be expelled after considerable pain and discomfort.
With every action, the line between CIA medical officer and interrogator becomes blurrier until it vanishes completely. The videotape of the interrogation of detainee Abu Zubaydah showed that “the person assumed [to be] a medical officer was dressed completely in black from head to toe, and was indistinguishable from other [interrogation] team members” (490).
How could we as a profession that pledged to “do no harm” let this happen? The Hippocratic Oath is meant to serve as a guiding moral compass for physicians, but the actions of the CIA medical officers are an unwelcome reminder of just how fragile our promise to indiscriminately serve humanity is. It’s terrifying.
The CIA Office of Medical Services (OMS) was supposed to intervene when “advanced interrogation” turned into torture. Instead, “medical officers repeatedly allowed CIA interrogations to take precedence over medical care” (31).
In his concluding tweet, Gawande writes that “doctors were long the medical conscience of the military. The worst occurred because gov’t medical leaders abdicated that role.”
This recent report is not the only time that US medical personnel have been involved in torture. The non-profit organization Physicians for Human Rights has extensively documented the “systematic use of psychological and physical torture by US military and medical personnel against detainees held at Guantánamo Bay, Abu Ghraib, Bagram airbase, and elsewhere.”
These deplorable actions may not be new, but the shock of this report remains fresh. It’s a brutal reminder of how, as the new generation of physicians, we must do better for the people we have pledged to heal. In her introduction to the report, Dianne Feinstein, chairman of the Senate Select Committee on Intelligence, speaks about her reaction to finding out about the CIA’s “cruel, inhuman and degrading” interrogation techniques (3). It is a sentiment that will hopefully resonate strongly with our medical community: “we cannot again allow history to be forgotten and grievous past mistakes to be repeated.”