Leaders in medicine and mental health care in the U.S. are divided over whether people in their professions should take part in U.S. military interrogations of alleged terrorists.
Specifically, psychiatrists and psychologists are reported to have advised the military on ways to produce mental duress, through sleep deprivation, isolation, humiliation, and anxiety- and phobia-inducing questioning. News reports say U.S. military personnel at the detention center in Guantanamo Bay, Cuba, have reportedly received guidance from healthcare professionals on these kinds of interrogation techniques.
In response to the reports, Dr. Steven Sharfstein, the president of the American Psychiatric Association, says the organization is drafting new guidelines prohibiting its members from taking part. "As physicians, we are concerned that that kind of process, that kind of situation," he says, "which is involuntary and by its very nature coercive -- that it can slip very easily into an 'ethical no-man's land -- a kind of 'slippery slope,' if you will -- where the advice given to interrogators could be used against detainees in a way that would be medically unethical."
The American Medical Association, or AMA, the nation's largest physicians group, has issued a statement saying that physician participation in torture and/or abuse is unethical and unacceptable.
Both the AMA and the American Psychiatric Association have scheduled a vote at member meetings next year to formally adopt new ethical guidelines for doctors and psychiatrists working for the military. But there is some dissent on this issue among mental health care professionals. Dr. Stephen Behnke is the director of ethics at the American Psychological Association, the largest U.S. mental health care society, with about 150,000 members.
"By virtue of the complexity of the issues, there may be differences in how people view these issues," Dr Behnke says. But he emphasizes that news reports that psychologists under contract with the military have been involved in detainee abuse have not been verified. And on the wider issue of whether or not psychologists should be involved at all in military interrogations, Dr. Behnke says his association has a longstanding policy on that issue.
"For over 20 years, the American Psychological Association's position on this issue has been clear and unwavering: it is unethical for a psychologist to participate in torture or other cruel, inhuman, or degrading treatment under any circumstances, at any time, for any reasons," he says. "There are no exceptions. A threat of war, a national emergency, or law, regulation, or order can never justify a psychologist's participation in any of these acts."
But Dr. Behnke says the organization does not oppose some forms of participation in some forms of interrogation. "We talk about words like 'isolation' and 'sleep deprivation.' We need to be careful," he says. "If one talks about isolation about a very few minutes, say, five minutes, I don't think anyone would argue seriously that isolating someone for five minutes rises to the level of torture or cruel, inhuman, or degrading treatment. So isolation, in and of itself, needs to be further defined to make sure it never rises to the level of cruel, inhuman, or degrading treatment. Now, stripping, disrobing someone for the purpose of eliciting information, clearly is going to constitute degrading treatment. That is a clear violation of the statements contained in the American Psychological Association report."
The APA's director of ethics believes psychologists have an obligation to take part in prisoner interrogations -- in an ethical manner, when doing so can help protect Americans from terrorists and other dangerous criminals.
"Take as an example an individual that law enforcement believes has abducted a young child," he says. "Law enforcement comes to a psychologist and says, 'Please help us develop ways to question the individual so we may learn information that would protect that innocent child's life.' The American Psychological Association says 'we absolutely want psychologists involved in those processes, in contributing to law enforcement in that manner.' That is an ethical thing to do. That is an appropriate thing to do, contributing our expertise in important valuable ways to society."
Dr. Nancy Sherman, an expert on military ethics with Georgetown University in Washington, D.C., disagrees. "Putting doctors in roles and even psychologists in roles where they could potentially harm individuals, violate Geneva Accords [on the humane treatment of prisoners], not take seriously enough the claims of the dignity of a person, is morally objectionable," she says.
About 15 civilian experts on ethics in the fields of medicine and psychology were invited last month by the U.S. Department of Defense to visit the detention center at Guantanamo Bay, which houses some 500 prisoners alleged to have ties with global terror networks. Dr. Sherman was among them.
"We were given about a five- or six-hour tour of the base by the general in charge there, [U.S. Army Brig.] Gen. [Jay W.] Hood," she recalls. "There was a genuine and earnest concern (among our group) to have some more input on the nature of the [Pentagon] regulations on the role of doctors and other health providers and non-clinical psychologists in detention centers."
A top Defense Department official, Assistant Secretary for Health Affairs William Winkenwerder , recently issued a statement asserting that, "health care personnel working for the armed forces have a duty to…protect the physical and mental health [of detainees]…and to uphold the humane treatment of detainees."
The U.S. Congress is currently considering legislation that would ban all U.S. military or civilian personnel from engaging in cruel, inhumane, and degrading treatment. Whether the ban is approved or not, the debate over the role of health care professionals in military interrogations is likely to continue.