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Doctors and Torture

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    Doctors and Torture Robert Jay Lifton, M.D. New England Journal of Medicine Volume 351:415-416 July 29, 2004 Number 5
    Message 1 of 1 , Aug 4, 2004
      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.

      Abu Ghraib.
      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 sergeant–medic 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
      cardiovascular disease.3

      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
      atrocity-producing situations.

      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.

      Source Information
      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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