‘Do No Harm’: When Doctors Torture

Medical officers used their knowledge to aid and abet the CIA's interrogation tactics.

Evlakhov Valerly/Shutterstock/The Atlantic

The Senate released its report on the CIA’s interrogation program on Tuesday, revealing horrendous details of the torture tactics used on prisoners, including waterboarding, sleep deprivation, and “rectal feeding.” Complicit in this treatment were several “medical officers” (it’s not explicitly stated whether they hold M.D.s), who enabled, oversaw, and designed many of the techniques.

Two psychologists, Dr. James Mitchell and Dr. Bruce Jessen, were paid $81 million to design the program, and medical officers and physicians’ assistants are cited throughout the report as consultants who advised on things like forcing detainees to stand on broken limbs and “rehydrating” via a rectal tube rather than a standard IV infusion. While in many medical schools around the United States, students swear the Hippocratic Oath, saying out loud the words “may I long experience the joy of healing those who seek my help,” CIA medical officers used their intimate knowledge of the human body as a weapon, to harm people the U.S. government deemed enemies.

Dr. Steven Miles is a professor at the University of Minnesota Medical School, a board member of the Center for Victims of Torture, and author of Oath Betrayed: America's Torture Doctors. He has been studying doctors’ involvement in torture programs since photos of the human rights violations at the Abu Ghraib prison in Iraq came to light in 2003. He maintains the website Doctorswhotorture.com, which tracks physician standards of conduct and punishments for doctors who aid torture around the world. We spoke by phone about the CIA report, the role doctors play in interrogation, and how they could be held accountable.

Julie Beck: What role did doctors play in this CIA-mandated torture, and how integral was it?

Steven Miles: What’s new here is the CIA side. The role of doctors in torture during the War on Terror has been pretty well excavated on the Defense Department side, but the CIA [has some exemptions] from Freedom of Information Act requests, so that’s remained hidden. Essentially the doctors and psychologists were built in to the entire torture system. They weren’t simply bystanders who were called in to respond when the system went off the rails. Some doctors apparently protested this. But they kept their protests inside [the CIA], they never went outside, which they should have done when they saw these types of abuses.

In general, doctors in torture have a couple roles. Number one, they design methods of torture that do not leave scars. For example, the so-called “rectal feeding” which is actually a medieval technique in which the intestines are inflated with a viscous material to cause intestinal pain. The docs are also involved in making sure that the prisoners who weren’t supposed to die didn’t die. The third thing doctors do is they falsify medical records and death certificates to conceal the injuries of torture. [Ed.: Miles has written on this in the context of Abu Ghraib.]

Beck: When we’re talking about how integral it was, is the medical knowledge that doctors bring to these operations something interrogation programs could not do without? If every doctor in the world refused to participate, would they be out of luck?

Miles: There are two answers to this question. One is, doctors get the prisoners that the Red Cross never sees. So in a sense doctors are frontline human-rights monitors who get into places where regular human rights groups can’t go. Number two, there are a set of professional codes, that are endorsed by the American Medical Association and the World Medical Association, that describe doctor’s duties not only to avoid participating in torture, directly or indirectly, but also a duty to document it and to report it, going outside the chain of command if necessary.

As human rights groups have put additional pressure on regimes around the world with regard to torture, regimes that are responsive to human rights pressure want to use torture that doesn’t leave scars. So they prefer methods like asphyxiation, isolation, cramming people in small boxes, white rooms with loud noises, because it just destroys people psychologically. Whereas regimes like Assad’s regime [in Syria] don’t really care if there are scars. So there is no role for medicine in that respect in an Assad-type regime or in North Korea’s regime.

Beck: So really the doctors become more important in places like the U.S. where if things like this got out, people would pressure the government?

Miles: Yes, doctors play a critical role in torture in regimes that don’t want to leave scars, and that includes the United States.

Beck: Why would people use medical knowledge and expertise learned to heal people for the opposite purpose?

Miles: It’s pretty interesting, I’m writing a book on just that question. The docs who get involved in this, number one, are careerists. They get involved for rank and career, and the regimes never coerce them, or extremely rarely coerce them. Instead what happens is the regimes treat them as some kind of elite. The docs are generally not sadists. This is not the stuff of Saw, for example. They go along with the dominant political theme of the prison: “These are our enemies and we gotta squeeze them for the information.” The thing that’s so interesting is that there is research showing that force of interrogation does not work, that it’s counterproductive. These docs seem to be entirely unaware, not only of the ethics codes, but also of the ineffectiveness of these interrogation strategies, that they never mount a protest.

Beck: What is the relationship between doctors and the military in these War on Terror prisons? I’m sure it’s a very different environment in which to be a doctor as opposed to a hospital.

Miles: The CIA doctors were under an office within the CIA called the Office of Medical Services. That’s not military, that’s CIA.

You had situations where doctors were seeing people with fractures, saying they shouldn’t be made to stand, and the people were standing and the docs weren’t  reporting that the medical regime wasn’t being followed. That’s a form of passive complicity. The docs who supervise and say, “Well, what you should do is use medical saline rather than distilled water when you waterboard people so that you don’t make the blood salts dilute,” that’s active participation.

For example, if I flood your lungs and throat with just plain tap water, what happens is the sodium in your blood and the potassium in your blood goes down because of the distilled water. So it’s less likely to be lethal if I flood you with medical saline (the kind of stuff you see hanging on IV bags) because then those electrolytes don’t get changed. From the prisoner’s standpoint, he’s still experiencing a drowning.

Beck: We’ve talked about the medical side, but what does it mean that there were psychologists who helped design this program? What role does psychology and that knowledge base play?

Miles: Essentially what happened is that the DOD constructed a deal with the American Psychological Association to craft a new code of ethics for War on Terror interrogations.

[Ed.: The APA has authorized an independent review of allegations that it colluded with the George W. Bush administration on torture, and has stated: “In the meantime, the Board again reiterates the Association’s longstanding policy prohibiting any psychologist involvement in torture and cruel, inhuman or degrading treatment or punishment. There are no exceptions to that policy.”]

The military took two psychologists [Mitchell and Jessen] who took the theory of learned helplessness, and they decided to apply that to interrogation. Learned helplessness as a model for interrogation has been discredited. Learned helplessness works like this. If you shock a dog every time it turns to the right, then it’ll start always turning to the left. If you shock a dog no matter which way it turns, eventually the dog just lies down and takes it. The theory of this interrogation system was, if we punish these prisoners no matter what, they will become helpless and compliant to whatever we want. That is, they’d give up information.

Beck: Do you think these doctors who were involved are going to be held accountable? Whether it’s through the law or through medical licensing boards?

Miles: On the website I maintain, I trace the accountability of doctors around the world since the Nazis, not including the Nazis. Accountability has been slowly building throughout the world. There have been a half dozen docs who’ve been subject to licensing-board hearings, and in all cases the licensing board has declined to get involved. These have been War on Terror cases.

There is a law in the U.S. against torture. Theoretically these people could be charged for violations of that federal law. But the DOJ basically said, “Since we all said this was legal at the time, we’re not going to prosecute them.”

The licensing board in these cases has several options. They can suspend a license, which is the typical punishment around the world, or they can revoke the license. So the licensing board hearings here could address that. Significantly, the American Medical Association still hasn’t commented on the Senate report [as of Thursday]. The AMA is not exerting leadership here.

[Ed.: The AMA's official policy on torture reads, in part: "Physicians must oppose and must not participate in torture for any reason. Participation in torture includes, but is not limited to, providing or withholding any services, substances, or knowledge to facilitate the practice of torture. Physicians must not be present when torture is used or threatened ... Physicians may treat prisoners or detainees if doing so is in their best interest, but physicians should not treat individuals to verify their health so that torture can begin or continue.]

Beck: Do other countries have different laws or standards of punishment in these cases?

Miles: Brazil, Chile, Argentina, and Uruguay have punished bunches of doctors. Rwanda punished bunches of doctors. Rwanda probably punished the largest percentage of its physician workforce of any country on the planet. Then you’ve got countries like Great Britain, Guyana, India, Pakistan, Sri Lanka, Greece, and these countries have punished a token number of physicians, one or two, even though the involvement of physicians in torture has been much more widespread.

Beck: Are there any other important aspects of this that we haven’t talked about yet?

Miles: The first question I asked when I saw the Abu Ghraib pictures was, “My god, where were the doctors when all this was going on? How did the government turn off the protests from the medical system?” What I discovered instead was that the doctors and psychologists were built into the interrogational abuses. So it wasn’t a matter of turning off their protests, it was a matter of a structured system of complicity. This has greatly harmed the U.S. medical community’s ability to speak on behalf of doctors who are protesting torture around the world.

Let me give you a few examples. There was a psychiatrist in Russia, in the Soviet Union, who was pointing out Russia had built psychiatric prisons to punish dissidents. His name was Anatoly Koryagin. He smuggled out a secret paper in a medical journal called The Lancet, and he was immediately sent to [prison]. The medical community in the U.S. and Europe was able to secure his release.

There was a doctor by the name of Pourandarjani in Iran who told of torture in Iranian prisons. But his testimony in Iran happened [in 2009] after the medical abuses in Abu Ghraib were out. [Ed. Pourandarjani died of an alleged heart attack in November 2009—some human rights groups have called his death “suspicious.”] Our ability to be a leader in these areas has huge consequences for people who are doing very dangerous human rights work around the world. And we’ve totally compromised ourselves.