Doctors and Torture
- Doctors and Torture
Robert Jay Lifton, M.D.
New England Journal of Medicine
Volume 351:415-416 July 29, 2004 Number 5
There is increasing evidence that U.S. doctors, nurses, and medics
have been complicit in torture and other illegal procedures in Iraq,
Afghanistan, and Guantanamo Bay. Such medical complicity suggests
still another disturbing dimension of this broadening scandal.
Photograph by Khampha Bouaphanh, Getty Images.
We know that medical personnel have failed to report to higher
authorities wounds that were clearly caused by torture and that they
have neglected to take steps to interrupt this torture. In addition,
they have turned over prisoners' medical records to interrogators who
could use them to exploit the prisoners' weaknesses or
vulnerabilities. We have not yet learned the extent of medical
involvement in delaying and possibly falsifying the death
certificates of prisoners who have been killed by torturers.
A May 22 article on Abu Ghraib in the New York Times states
that "much of the evidence of abuse at the prison came from medical
documents" and that records and statements "showed doctors and medics
reporting to the area of the prison where the abuse occurred several
times to stitch wounds, tend to collapsed prisoners or see patients
with bruised or reddened genitals."1 According to the article, two
doctors who gave a painkiller to a prisoner for a dislocated shoulder
and sent him to an outside hospital recognized that the injury was
caused by his arms being handcuffed and held over his head for "a
long period," but they did not report any suspicions of abuse. A
staff sergeantmedic who had seen the prisoner in that position later
told investigators that he had instructed a military policeman to
free the man but that he did not do so. A nurse, when called to
attend to a prisoner who was having a panic attack, saw naked Iraqis
in a human pyramid with sandbags over their heads but did not report
it until an investigation was held several months later.
A June 10 article in the Washington Post tells of a long-standing
policy at the Guantanamo Bay facility whereby military interrogators
were given access to the medical records of individual prisoners.2
The policy was maintained despite complaints by the Red Cross that
such records "are being used by interrogators to gain information in
developing an interrogation plan." A civilian psychiatrist who was
part of a medical review team was "disturbed" about not having been
told about the practice and said that it would give
interrogators "tremendous power" over prisoners.
Other reports, though sketchier, suggest that the death certificates
of prisoners who might have been killed by various forms of
mistreatment have not only been delayed but may have camouflaged the
fatal abuse by attributing deaths to conditions such as
Various medical protocols notably, the World Medical Association
Declaration of Tokyo in 1975 prohibit all three of these forms of
medical complicity in torture. Moreover, the Hippocratic Oath
declares, "I will use treatment to help the sick according to my
ability and judgment, but never with a view to injury and
To be a military physician is to be subject to potential moral
conflict between commitment to the healing of individual people, on
the one hand, and responsibility to the military hierarchy and the
command structure, on the other. I experienced that conflict myself
as an Air Force psychiatrist assigned to Japan and Korea some decades
ago: I was required to decide whether to send psychologically
disturbed men back to the United States, where they could best
receive treatment, or to return them to their units, where they could
best serve combat needs. There were, of course, other factors, such
as a soldier's pride in not letting his buddies down, but for
physicians this basic conflict remained.
American doctors at Abu Ghraib and elsewhere have undoubtedly been
aware of their medical responsibility to document injuries and raise
questions about their possible source in abuse. But those doctors and
other medical personnel were part of a command structure that
permitted, encouraged, and sometimes orchestrated torture to a degree
that it became the norm with which they were expected to comply
in the immediate prison environment.
The doctors thus brought a medical component to what I call
an "atrocity-producing situation" one so structured,
psychologically and militarily, that ordinary people can readily
engage in atrocities. Even without directly participating in the
abuse, doctors may have become socialized to an environment of
torture and by virtue of their medical authority helped sustain it.
In studying various forms of medical abuse, I have found that the
participation of doctors can confer an aura of legitimacy and can
even create an illusion of therapy and healing.
The Nazis provided the most extreme example of doctors' becoming
socialized to atrocity.4 In addition to cruel medical experiments,
many Nazi doctors, as part of military units, were directly involved
in killing. To reach that point, they underwent a sequence of
socialization: first to the medical profession, always a self-
protective guild; then to the military, where they adapted to the
requirements of command; and finally to camps such as Auschwitz,
where adaptation included assuming leadership roles in the existing
death factory. The great majority of these doctors were ordinary
people who had killed no one before joining murderous Nazi
institutions. They were corruptible and certainly responsible for
what they did, but they became murderers mainly in atrocity-producing
When I presented my work on Nazi doctors to U.S. medical groups, I
received many thoughtful responses, including expressions of concern
about much less extreme situations in which American doctors might be
exposed to institutional pressures to violate their medical
conscience. Frequently mentioned examples were prison doctors who
administered or guided others in giving lethal injections to carry
out the death penalty and military doctors in Vietnam who helped
soldiers to become strong enough to resume their assignments in
Physicians are no more or less moral than other people. But as heirs
to shamans and witch doctors, we may be seen by others and
sometimes by ourselves as possessing special magic in connection
with life and death. Various regimes have sought to harness that
magic to their own despotic ends. Physicians have served as actual
torturers in Chile and elsewhere; have surgically removed ears as
punishment for desertion in Saddam Hussein's Iraq; have incarcerated
political dissenters in mental hospitals, notably in the Soviet
Union; have, as whites in South Africa, falsified medical reports on
blacks who were tortured or killed; and have, as Americans associated
with the Central Intelligence Agency, conducted harmful, sometimes
fatal, experiments involving drugs and mind control.
With the possible exception of the altering of death certificates,
the recent transgressions of U.S. military doctors have apparently
not been of this order. But these examples help us to recognize what
doctors are capable of when placed in atrocity-producing situations.
A recent statement by the Physicians for Human Rights addresses this
vulnerability in declaring that "torture can also compromise the
integrity of health professionals."5
To understand the full scope of American torture and abuse at Abu
Ghraib and other prisons, we need to look more closely at the
behavior of doctors and other medical personnel, as well as at the
pressures created by the war in Iraq that produced this behavior. It
is possible that some doctors, nurses, or medics took steps, of which
we are not yet aware, to oppose the torture. It is certain that many
more did not. But all those involved could nonetheless reveal, in
valuable medical detail, much of what actually took place. By
speaking out, they would take an important step toward reclaiming
their role as healers.
From the Department of Psychiatry, Harvard Medical School, Boston.
Zernike K. Only a few spoke up on abuse as many soldiers stayed
silent. New York Times. May 22, 2004:A1.
Slevin P, Stephens J. Detainees' medical files shared: Guantanamo
interrogators' access criticized. Washington Post. June 10, 2004:A1.
Squitieri T, Moniz D. U.S. Army re-examines deaths of Iraqi
prisoners. USA Today. June 28, 2004.
Lifton RJ. The Nazi doctors: medical killing and the psychology of
genocide. New York: Basic Books, 1986.
Statement of Leonard Rubenstein, executive director, Physicians for
Human Rights, June 2, 2004. (Accessed July 9, 2004, at
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