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    Tuesday, January 11, 2005

    Ethics: Regarding coverage responsibilities, from a reader:

    Sorry the ice storm has you off the net. Of course, the ethical thing would be for you to refer your readership to a blog that is online or get someone to cover your call.

    Well, there is the list of medical blogs over to the left that all provide excellent coverage.

    He also sends a link to this paper from last week's New England Journal of Medicine about the role of physicians assigned to military intelligence in interrogation:

    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."

    What was in these interrogation plans? None have become public, though Pappas's testimony indicates that he showed army investigators a sample, including a sleep deprivation schedule. However, a January 2004 "Memorandum for Record" (also available on the ACLU Web site) lays out an "Interrogation and Counter-Resistance Policy" calling for aggressive measures. Among these approaches are "dietary manipulation — minimum bread and water, monitored by medics"; "environmental manipulation — i.e., reducing A.C. [air conditioning] in summer, lower[ing] heat in winter"; "sleep management — for 72-hour time period maximum, monitored by medics"; "sensory deprivation — for 72-hour time period maximum, monitored by medics"; "isolation — for longer than 30 days"; "stress positions"; and "presence of working dogs."

    Physicians collaborated with prison guards and military interrogators to put such approaches into practice. "Typically," said Pappas, military intelligence personnel give guards "a copy of the interrogation plan and a written note as to how to execute [it]. . . . The doctor and psychiatrist also look at the files to see what the interrogation plan recommends; they have the final say as to what is implemented." The psychiatrist would accompany interrogators to the prison and "review all those people under a management plan and provide feedback as to whether they were being medically and physically taken care of," said Pappas. These practices, he conceded, were without precedent. "The execution of this type of operation . . . is not codified in doctrine," he said. "Except for Guantanamo Bay, this sort of thing was a first."

    At both Abu Ghraib and Guantanamo, "behavioral science consultation teams" advised military intelligence personnel on interrogation tactics. These teams, each of which included psychologists and a psychiatrist, functioned more formally at Guantanamo; staff shortages and other administrative difficulties reduced their role at Abu Ghraib.

    A slide presentation prepared by medical ethics advisors to the military as a starting point for internal discussion poses a hypothetical case that, we were told, is a "thinly veiled" account of actual events. A physician newly deployed to "Irakistan" must decide whether to post physician assistants and medics behind a one-way mirror during interrogations. A military police commander tells the doctor that "the way this worked with the unit here before you was: We'd capture a guy; the medic would screen him and ensure he was fit for interrogation. If he had questions he'd check with the supervising doctor. The medic would get his screening signed by the doc. After that, the medic would watch over the interrogation from behind the glass."

    The Army argues that the physicians and medics in these situations are functioning in much the same way that doctors do in occupational medicine, and that seems exactly right. As described above, their main role seems to be to insure that interrogation techniques cause no harm and that the detainees are physically strong enough to withstand them. They are there, in other words, to make sure their fellow soldiers don't cross the line.

    posted by Sydney on 1/11/2005 07:32:00 AM 0 comments


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