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    Saturday, August 07, 2004

    Medical Complicity: A couple of readers have sent me links to this New England Journal of Medicine essay on torture (available in full without registration or subscription.) It's from the July 29 issue, but appears to be making the internet rounds just now. Evidently the Democratic convention distracted everyone, including the mainstream media, from noticing it.

    I should have known it would be a topic of interest when I found my husband reading the essay in my dead-wood copy of the Journal. He never touches my medical journals, having zero interest in all things medical and a tendency toward squeamishness. But he saw the title "Doctors and Tortures" on the cover and couldn't resist. And, though I've touched on the subject before, it's worth revisiting, especially since one of my most prolific correspondents sent the link with the comment, "Ahhh, Germany 1936....."

    Here's the essay in a nutshell:

    There is increasing evidence that U.S. doctors, nurses, and medics have been complicit in torture and other illegal procedures in Iraq, Afghanistan, and Guantanamo Bay. Such medical complicity suggests still another disturbing dimension of this broadening scandal.

    ...American doctors at Abu Ghraib and elsewhere have undoubtedly been aware of their medical responsibility to document injuries and raise questions about their possible source in abuse. But those doctors and other medical personnel were part of a command structure that permitted, encouraged, and sometimes orchestrated torture to a degree that it became the norm — with which they were expected to comply — in the immediate prison environment.

    The doctors thus brought a medical component to what I call an "atrocity-producing situation" — one so structured, psychologically and militarily, that ordinary people can readily engage in atrocities. Even without directly participating in the abuse, doctors may have become socialized to an environment of torture and by virtue of their medical authority helped sustain it. In studying various forms of medical abuse, I have found that the participation of doctors can confer an aura of legitimacy and can even create an illusion of therapy and healing.

    The author is Robert J. Lifton, a psychiatrist, and the author of the excellent, The Nazi Doctors: Medical Killing and the Psychology of Genocide. He knows something about doctors and complicity. But he bases his essay, as did a similar New York Times op-ed, entirely on press reports - namely, this, this, and this.

    The first is a New York Times story that mentions two doctors, two medics, and a nurse who noted suspicious injuries and did nothing at Abu Ghraib. The story makes it seem as if the entire prison medical staff was complicit in the torture, just as most of the media coverage has made it seem that torture was more wide-spread than it was at the prison. Other first hand accounts suggest this isn't true. No doubt, there were some doctors and medics who noticed suspicious injuries - and the sum total of them were mentioned in the New York Times article. Abu Ghraib was a very big place. Torture happened in a small portion of it, under the command of some very bad apples. Bad apples, it should be pointed out, who are now facing the possibility of a life in prison themselves - up to 38 years in prison for Lynndie England.

    The second source is a story from the Washington Post that says that interrogators were allowed access to Guantanomo prisoners' medical records. The implication is that they could use information from the records to gain leverage in their interrogations. This may come as a surprise to most people, but even here in the United States, law enforcement officials have access to medical records. This particular issue isn't a clear-cut example of complicity in torture on the part of U.S. military doctors. For one thing, there's no torture involved, only interrogating. For another, whether or not captors should have access to captives' medical records is a matter of some controversy.

    The third is a story from USA Today on deaths of Iraqi prisoners which a medical examiner ruled were due to cardiovascular causes, but which may - or may not - have been heat-related. The deaths are all under investigation by the military. The medical examiners in each case but one, listed the cause of death as "cardiovacular related" rather than heat related. Lifton accuses them of falsifying death certificates, but there's a good chance that those medical examiners believed the cause to be cardiovascular and did not suspect the heat. There would be no way to tell the difference, not even with an autopsy. The medical examiners would have to rely on the history given by the dead man's keepers. And they, too, may have not credited the heat. The cases are still under investigation, in any case. It's a stretch, and a libelous one at that, to accuse the medical examiners of falsifying death certificates at this stage of the game.

    To his credit, Lifton acknowledges that the U.S. military doctors in the press stories are far from the Nazis he interviewed for his book. But still, he makes too many sweeping generalizations about U.S. military medical personnel and torture. The majority of doctors, medics, and nurses in the military, and the military in general, I believe, hold themselves to a higher standard than those five whose stories made it to the New York Times.

    UPDATE: Jim Miller has more info on the cause of injuries at Abu Ghraib.

    posted by Sydney on 8/07/2004 07:30:00 PM 0 comments


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