A detainee is escorted to interrogation by US military guards at Camp X-Ray at Guantanamo Bay US Naval Base
The U.S. Defense Department is involved in a dispute with a prominent medical journal, which is alleging inappropriate involvement by medical personnel in the interrogation of detainees at the Guantanamo detention center. The issue involves international law, medical ethics and the war on terrorism.

In its July 7 issue, the New England Journal of Medicine reports that military doctors at Guantanamo have passed detainees' medical information that should be kept confidential to interrogators, and have helped develop aggressive interrogation plans that violate international law. The article by two lawyers, one of whom is also a doctor, charges that Defense Department policy on medical confidentiality for detainees violates the norms of law and medical ethics, and that some doctors and psychologists at Guantanamo are using their expertise to help interrogators identify physical or psychological weaknesses of specific detainees.

One of the authors, British lawyer Jonathan Marks, says he does not object to all involvement by medical specialists in interrogations.

"In the most benign form of interrogation - interrogations that are compatible with international law and ethics - there may be a role for physicians, provided that they don't also have care-giving relationships with detainees, and that they have not established any professional relationship with detainees," said Jonathan Marks.

But Mr. Marks says Defense Department documents and interviews with people who have worked at Guantanamo led him to conclude that what is going on at Guantanamo goes well beyond that.

"We have been able to put together from all that a picture of physician involvement in some interrogations using information that comes from the physician-patient relationship to assist in devising strategies, often the more aggressive strategies, in order to obtain intelligence from detainees," he said.

U.S. officials have said no illegal interrogation techniques are used at Guantanamo. And on Wednesday, senior U.S. military officers at Guantanamo responded to the specific charges in Mr. Marks' article during a hearing at the U.S. Congress. The base commander, Brigadier General Jay Hood, said the most effective interrogation technique has been long-term rapport-building, and that health care providers are not involved.

"There is a permanent firewall between the medical community and the intelligence-gathering efforts of our interrogators," said General Hood.

The chairman of the House of Representatives Armed Services Committee, Congressman Duncan Hunter, questioned one of Guantanamo's senior doctors about the issue directly. The doctor is Commander Cary Ostergaard.

Hunter: "Has an interrogator ever asked you how they could hurt detainees?"

Ostergaard: "Never, sir."

Hunter: "Have you ever told interrogators ways that you thought they could get more information from the detainees?"

Ostergaard: "Absolutely 100 per cent no, sir. In fact, I have never talked to an interrogator in any fashion such as that."

Article co-author Jonathan Marks is not convinced.

"Nothing that was said in the course of the hearing actually undermines, in our view, the force of the story that we are telling," said Jonathan Marks.

In an official response to Mr. Marks' article, the Defense Department noted that it has ordered military doctors to not only provide top quality medical care to detainees, but also to protect their physical and mental health. The statement refers to a memo from the senior Department official for health issues, which orders a "clear separation of duties" - what General Hood called a "firewall" - between healthcare providers and teams of behavioral specialists who do consult with interrogators.

The Pentagon statement also appears to go farther than the official policy guidance, stating that "although detainees do not have an absolute right of confidentiality" for their medical records, doctors should disclose such information only for what it calls "approved and documented specific reasons." It does not say what those reasons might be, but it says the confidentiality rights of detainees at Guantanamo are similar to those of people in ordinary U.S. prisons.

There are some gray areas on the issue of detainees' rights, but the senior Defense Department spokesman, Lawrence DiRita, made clear Thursday what the Department's priorities are.

"The balance that we strike will be toward getting more intelligence and stopping future attacks on the United States," said Lawrence DiRita. "And that's the balance that we're working on. There is no handbook on how to do this. It's never been done before. So we're trying to be very careful about it, with the objective of gaining intelligence to stop Americans from being killed."

And General Hood, the Guantanamo commander, says interrogators are still getting useful information from detainees at the base, even though some of them have been in custody for as long as three years.

"We continue to exploit, collect and exploit, actionable intelligence that has helped our nation prosecute the war on terrorism," he said. "Every week, we learn something that assists in piecing together the strategic mosaic of international terrorism. Information our detainees have provided has been instrumental in learning how terrorist organizations recruit, train, launder money and plan operations."

General Hood said some of the long-term detainees have only recently begun to provide information.

The authors of the New England Journal of Medicine article say they have no problem with that, as long as the detainees are not abused, and as long as the doctors and nurses who treat them do not provide medical information to the interrogators.