Tuesday, January 11, 2005

More Bad Apples

The prisoner abuse scandal keeps getting worse.  Alberto "Torture Al" Gonzales probably will be the next Attorney General of the United States of America.  Low-level grunts are getting punished, but there appears to be no interest in the Administration for fingering higher level authorities.  This appears to be the case, despite the following:
Rumsfeld: 'I Take Full Responsibility'
NewsMax.com Wires
Friday, May 7, 2004

WASHINGTON – Defense Secretary Donald Rumsfeld on Friday extended his "deepest apologies" to Iraqi prisoners abused by U.S. military personnel, told Congress he accepted full responsibility and favored compensating prisoners for their suffering.

"These events occurred on my watch. As Secretary of Defense, I am accountable for them. I take full responsibility," Rumsfeld told the Senate Armed Services Committee.
Obviously, that is a damn lie.  He does not take full responsibility.  If he did, he would not stand for low-ranking service personnel being punished, while he himself gets reappointed.  What Rumsfeld said, "I take full responsibility," is ridiculous.

Through some bizarre, contorted logic, the Administration feels that the Commander-in-Chief has the authority to abrogate international treaties, condone torture, yet not take responsibility.  The media seem content to let them get away with this.  Even the medical profession has colluded with this, although some are speaking out...

The latest NEJM has an article (Volume 352:3-6, January 6, 2005), When Doctors Go to War, by M. Gregg Bloche, M.D., J.D., and Jonathan H. Marks, M.A., B.C.L.  Irritatingly, they do not provide open access to the article, but I have cited it liberally here. 
When military forces go into combat, they are typically accompanied by medical personnel (physicians, physician assistants, nurses, and medics) who serve in noncombat roles. These professionals are bound by international law to treat wounded combatants from all sides and to care for injured civilians. They are also required to care for enemy prisoners and to report any evidence of abuse of detainees. In exchange, the Geneva Conventions protect them from direct attack, so long as they themselves do not become combatants.

Recently, there have been accounts of failure by U.S. medical personnel to report evidence of detainee abuse, even murder, in Iraq and Afghanistan.1 There have also been claims, less well supported, that medics and others neglected the clinical needs of some detainees. The Department of Defense says it is investigating these allegations, though no charges have been brought against caregivers.

But Pentagon officials deny another set of allegations: that physicians and other medical professionals breached their professional ethics and the laws of war by participating in abusive interrogation practices. The International Committee of the Red Cross (ICRC) has concluded that medical personnel at Guantanamo Bay shared health information, including patient records, with army units that planned interrogations.2 The ICRC called this "a flagrant violation of medical ethics" and said some of the interrogation methods used were "tantamount to torture."2 The Pentagon answered that its detention operations are "safe, humane, and professional" and that "the allegation that detainee medical files were used to harm detainees is false."2

Our own inquiry into medical involvement in military intelligence gathering in Iraq and Guantanamo Bay has revealed a more troublesome picture. Recently released documents and interviews with military sources point to a pattern of such involvement, including participation in interrogation procedures that violate the laws of war. Not only did caregivers pass health information to military intelligence personnel; physicians assisted in the design of interrogation strategies, including sleep deprivation and other coercive methods tailored to detainees' medical conditions. Medical personnel also coached interrogators on questioning technique. [...]
The authors go on to cite the arguments that the Pentagon uses to try to justify the actions of its medical personnel. 
In helping to plan and execute interrogation strategies, did doctors breach medical ethics? Military physicians and Pentagon officials make a case to the contrary. Doctors, they argue, act as combatants, not physicians, when they put their knowledge to use for military ends. A medical degree, Tornberg said, is not a "sacramental vow" — it is a certification of skill. When a doctor participates in interrogation, "he's not functioning as a physician," and the Hippocratic ethic of commitment to patient welfare does not apply. According to this view, as long as the military maintains a separation of roles between clinical caregivers and physicians with intelligence-gathering responsibilities, assisting interrogators is legitimate. [...]
What this would imply, of course, is that such medical personnel are note entitled to any protection as noncombatants.  Is that really a good idea?  I think not.  That point, however, is not argued in the article.

More contorted logic is evident here:
In testimony taken in February 2004, as part of an inquiry into abuses at Abu Ghraib (and recently made public under the Freedom of Information Act and posted on the Web site of the American Civil Liberties Union [ACLU] at www.aclu.org), Colonel Thomas M. Pappas, chief of military intelligence at the prison, described physicians' systematic role in developing and executing interrogation strategies. Military intelligence teams, Pappas said, prepared individualized "interrogation plans" for detainees that included a "sleep plan" and medical standards. "A physician and a psychiatrist," he added, "are on hand to monitor what we are doing."
If they are actings as combatants, are they really "monitoring" what is being done?  Colonel Pappas seems to imply that the fact that the interrogation is medically monitored means that the interrogation methods are OK: since they are medically monitored, they do not endanger the prisoners.  But if the medical personnel take that role, then they are acting in the interest of the prisoner, which implies a noncombatant status.  If the noncombatant status is rejected, then the fact that the interrogations are medically monitored is meaningless. 

Furthermore, what does it mean that the medical personnel were monitoring what was going on?
Most people we interviewed who had served or spent time in detention facilities in Iraq or Guantanamo Bay reported being told not to talk about their experiences and impressions. Dr. David Auch, commander of the medical unit that staffed Abu Ghraib during the time of the abuses made notorious by soldiers' photographs, said military intelligence personnel told his medics and physician assistants not to discuss deaths that occurred in detention. Physicians who cared for so-called high-value detainees were especially hesitant to share their observations.
So they were there to monitor what was going on, but were told not to talk about it? 

The article concludes with some commentary that is not flattering to the Administration:
The conclusion that doctors participated in torture is premature, but there is probable cause for suspecting it. Follow-up investigation is essential to determine whether they helped to craft and carry out the counter-resistance strategies — e.g., prolonged isolation and exposure to temperature extremes — that rise to the level of torture.

But, clearly, the medical personnel who helped to develop and execute aggressive counter-resistance plans thereby breached the laws of war. The Third Geneva Convention states that "[n]o physical or mental torture, nor any other form of coercion, may be inflicted on prisoners of war to secure from them information of any kind whatever." It adds that "prisoners of war who refuse to answer [questions] may not be threatened, insulted, or exposed to any unpleasant or disadvantageous treatment of any kind." The tactics used at Abu Ghraib and Guantanamo were transparently coercive, threatening, unpleasant, and disadvantageous. Although the Bush administration took the position (rejected by the ICRC) that none of the Guantanamo detainees were "prisoners of war," entitled to the full protections of the Third Geneva Convention, it has acknowledged that combatants detained in Iraq are indeed prisoners of war, fully protected under this Convention.

The Surgeon General of the U.S. Army has begun a confidential effort to develop rules for health care professionals who work with detainees. Such an initiative is much needed, but it ought not to happen behind a veil of secrecy. Ethicists, legal scholars, and civilian professional leaders should participate, and the process should address role conflict in medicine more generally. An Institute of Medicine study committee, broadly representative of competing concerns (including the military's), would be a more suitable venue. To their credit, some military physicians in leadership roles have tried to involve outside ethicists in discussion of duties toward detainees. The Pentagon's civilian leadership has blocked these efforts.

Military physicians, nurses, and other health care professionals have served with courage in Iraq and other theatres of war since September 11, 2001. Some have received serious wounds, and some have died in the line of duty. By most accounts, they have delivered superb care to U.S. soldiers, enemy combatants, and wounded civilians alike. We owe them our gratitude and respect. We would affirm their honor, not besmirch it, by acknowledging the tensions between their Hippocratic and national service commitments and by working with them to map a course between the two.
If Rumsfeld really took full responsibility for all of this, he would not allow the Pentagon to block the involvement of nonmilitary experts in the development of rules for medical personnel who work with detainees. 

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