Today, Dr. William G. Plested, president of the American Medical Association, wrote a letter to Leonard Rubenstein, executive director of Physicians for Human Rights, to counter recent claims by Stephen Behnke [pdf], director of the American Psychological Association Ethics Office, that the APA and AMA have similar positions on their members' participation in interrogations. The letter is now circulating widely among psychologists and other health care professionals.
Plested wrote to Rubenstein:
The AMA is aware of the article published in the July/August issue of the Monitor on Psychology. We have found that the commentary analyzing the AMA and the American Psychological Association positions did not accurately represent our ethical guidelines. By arguing that the two positions are similar and by failing to point out critical differences, we believe the readers of the Monitor could be induced in serious error regarding the ethically acceptable role for physicians. For this reason, the chair of CEJA, Dr. Robert Sade, has submitted a letter to the editor of the Monitor to refute the proposition that the policies are similar. In his words: "AMA and APA policy differ substantially in ethical acceptability of supporting interrogation." [Emphasis added.]
Lest there be any confusion about the AMA's position, Plested reiterated the AMA's policy:
I certainly believe that the recommendations pertaining to the ethical role of physicians are unambiguous; in part, they state:
- Physicians must neither conduct nor directly participate in an interrogation, because a role as physician-interrogator undermines the physician's role as healer and thereby erodes trust in the individual physician-interrogator and in the medical profession.
- Physicians must not monitor interrogations with the intention of intervening in the process, because this constitutes direct participation in interrogation.
- Physicians may participate in developing effective interrogation strategies for general training purposes. These strategies must not threaten or cause physical injury or mental suffering and must be humane and respect the rights of individuals.
In developing its recommendations, I know that the members of CEJA deliberated the meaning of every word; I also know that the AMA Code of Medical Ethics does not use the words "must not" lightly. The guidelines, therefore, leave no room for confusion. The AMA has adopted a strict prohibition on physician participation in the interrogation of an individual, and only permits that medical knowledge be used to develop strategies that can be presented in the context of general training [emphasis added]. This was clearly reiterated in the statement the AMA released on June 12, 2006.
It is time for those in the APA who claim that the positions of the APA and AMA positions are "not significantly different" to face the facts. The AMA prohibits "physician participation in the interrogation of an individual." The APA allows its members to be calibrators of physical and psychological pain.
Let us be clear what the apologetics of some psychologists give cover for:
It may come as no surprise to some that being forced to urinate and defecate on oneself has a long history at Gitmo. At a recent conference featuring interviews with four released Gitmo detainees, there was repeated mention of the tactic (Voices of Guantánamo, George Washington Law School, 20 march 2006). I heard first hand of their ordeal of being “processed” for 8–10 hours by U.S. troops at Bagram air field base. Skimpily dressed in freezing cold weather, the detainees were made to walk in circles with bare feet on sand mixed with shards of glass. Denied the use of toilets, they were forced to urinate and defecate on themselves. They then were shackled in stress positions for the 10-hour flight to Guantánamo Bay; they were hooded, with their eyes taped, and, again, denied the use of toilets.
It is important to be clear about the nature of this form of degradation. However one defines either torture or cruel, inhumane, and degrading treatment, one common element is that victims often are made to feel complicit in their own abuse. The sense of self-betrayal, of shame, of self-contempt that so many torture victims feel reflects a feeling of compromised agency, of turning against oneself through the very exercise of one’s own will.
Urinating or defecating on oneself, because one is denied more decent forms of relief, is a way of experiencing oneself as an agent without agency—one let’s oneself “do it;” the case is different from that of a toddler who has not yet mastered bladder or sphincter control or an infirm person who has lost full control. Rather, this is actively “doing it,” and yet still, it is being made to “do it” on oneself. It is experiencing oneself as helpless in one’s agency. The victim is prevented from exercising control of body functions that are basic loci of self-control, and this is humiliating.
(Nancy Sherman, "Holding Doctors Responsible at Gitmo," Kennedy Institute of Ethics Journal Vol. 16, No. 2, 201–202 (2006))
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Disclosure: I am employed by Physicians for Human Rights.
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