Blog Spotlight: Elaine on medical ethics

When we were still doing our news review, one issue that was touched upon was the issue of the ethics of the medical professionals participating with interrogations. Elaine and C.I. felt very strongly about the issue and we once had a commentary for the news review by Elaine that we ran out of time for. We kept hoping to include it at a future date but, to quote John Lennon, life is what happens while you're busy making other plans. So when Elaine tackled this issue, we knew we'd have to highlight it because it's an important one.

"Expectations (personal and professional)"

Happy holidays. I hope you are enjoying the weekend whether it's a time for celebration or not. Gatherings this time of year can be filled with expectations and frustrations so if you're struggling or worried, do not feel that you are alone or that "It's just you." Rebecca wrote about this last night in her "christmas and no nerves of steel" post. If you think you can relate to that, please check it out. If you don't think it has anything to do with you, please consider reading it because it probably will reflect someone in any gathering. Expectations, both real and imagined, weigh heavy this time of year.

Also check out Mike's Mikey Likes It! because he's writing at the same time. We're in his room and he's on his computer and I'm on my laptop. Which is a good time to say thank you to the McKinnon family for inviting me to spend the holidays with them. (A thank you to Nina, Mike's girlfriend, as well.) I know I noted this at The Third Estate Sunday Review and, I believe, also at Sex and Politics and Screeds and Attitude while I was filling in for Rebecca, but I'm not sure it's up here. So if anyone's wondering why I'm spending Christmas with the McKinnons or spent Thanksgiving with C.I., my parents died while I was a young teenager. My only surviving family is a very wonderful older brother who now lives in Europe. Originally, he would fly in for the holidays but, quite honestly, the two of us together at the holidays can sometimes be depressing. He now makes a point to avoid the holidays. I usually grab Thanksgiving with C.I. who is a friend of many years and I'm welcome (C.I. would say "more than welcome") to grab Christmas as well. However, the guest list at Christmas triples from the list for Thanksgiving and I'll usually either spend Christmas alone, with a date's family or with friends. This year I'm very fortunate to be spending it with friends and I thank the McKinnon's for their hospitality.Now here are two items from Democracy Now! Friday that you're hopefully already aware of but are worth noting.

Federal Judge Calls Gitmo Detentions "Unlawful" (Democracy Now!)
This news on Guantanamo Bay: the Washington Post is reporting a federal judge has ruled the detention of two ethnic Uighurs at the U.S. prison is "unlawful", but says he does not have the authority to release them. On Thursday, U.S. District Judge James Robertson said the government has taken too long to release Abu Bakker Qassim and Adel Abdu Hakim -- who have been jailed for four years. The two have been cleared for release, but not returned to China where they would likely face torture or execution.. The two men are among nine detainees that remain at Guantanamo despite having been declared "no longer enemy combatants." In his ruling, Judge Robertson wrote: "The government's use of the Kafka-esque term 'no longer enemy combatants' deliberately begs the question of whether these petitioners ever were enemy combatants."

Justice Dept. Admits Spy Program Does Not Comply With FISA (Democracy Now!):
The disclosure comes as the Justice Department has admitted that the President's eavesdropping program does not comply with the Foreign Intelligence Surveillance Act. Along with another wiretapping statute, FISA defines itself as: "the exclusive means by which electronic surveillance . . . may be conducted." The admission came in a letter to Congress Thursday.

Mike's providing commentary on those so be sure to check out his site; I'm just noting them because there's something else I want to focus on.

I'm utilizing two articles for this, an Associated Press article that ran in most papers (including the New York Times) and an article from The Nation. The link I provide to the AP article is care of the Mercury News which does not require registration to be read. With regards to The Nation, you need to be a subscriber to read the article online. I don't subscribe to The Nation. That's not a slap at that magazine. I subscribe to periodicals and journals for my profession. Otherwise, I utilize book stores. (Sadly, a very large chain.) I prefer to purchase magazines. I usually purchase every issue of The Nation (so subscribing would be cheaper) but I enjoy walking up to the sales counter with my purchases as well as having the ability not to purchase an issue of any magazine containing a story or stories that I have no interest in (or may have a strong objection to). One of the things my father was big on was taking us to the bookstore every Saturday. We'd be encouraged to pick out a book or magazine (toys weren't as prevalent at bookstores when I was a child and videos -- videotapes or DVD -- had yet to emerge). From there, we'd go to lunch at my father's favorite deli. (My mother, in case you're wondering, had Saturday afternoon's "off." This was something that began after I was born when my mother, rightly, gave an ultimatum that she couldn't work full time, be the primary person responsible for keeping the house clean and raise two children without any break. For the first seven years of my brother's life she had struggled to be everything to everyone. After I was born, she stayed home three weeks with me before returning to work and quickly realized that attempting to do everything would drive her crazy. Fortunately, my father was smart enough to grasp both that she was serious and that she did, indeed, deserve at least five hours to herself once a week.)

I thought I was just attempting to make sure that no Nation reader took it as an insult that I didn't subsribe (I do read the magazine regularly); however, probably due to the season, I obviously wanted to take a trip down memory lane. Thanks to everyone reading for their indulgence.

Thank you as well to C.I. because I didn't pack the issue, the December 26th issue devoted to exploring torture, and the article isn't available to nonsubscribers online. C.I. scanned the article and e-mailed it to me. The link I'll provide for the article does allow you to read the opening.

Starting Thursday, and continuing through today, various papers have run an obit onHeinrich Gross who passed away December 15th at the age of 90. The name may not be familiar to you. "Heinrich Gross, accused of Nazi experiments" is the headline the AP article ran under in the San Jose Mercury News. In the New York Times, on Thursday, the article ran under the heading "Heinrich Gross, 90, Psychiatrist At Nazi Death Clinic in Austria."

"Heinrich Gross, accused of Nazi experiments: PROMINENT DOCTOR ESCAPED PROSECUTION" (William J. Cole, Associated Press):
Dr. Heinrich Gross, a psychiatrist who worked at a clinic where the Nazis killed and conducted cruel experiments on thousands of children, died Dec. 15, his family announced Thursday. He was 90.Dr. Gross, who was implicated in nine deaths as part of a Nazi plot to eliminate "worthless lives,'' had escaped trial in March after a court ruled he suffered from severe dementia. No cause of death was given in a brief statement issued by his family.
Dr. Gross was a leading doctor in Vienna's infamous Am Spiegelgrund clinic. Historians and survivors of the clinic had accused him of killing or taking part in the clinic's experiments on thousands of children deemed by the Nazis to be physically, mentally or otherwise unfit for Adolf Hitler's vision of a perfect world.

The article explains how three times, Gross (I'm refusing to call him "Doctor") was tried but escaped conviction. In the 50s, "the case was thrown out because of a legal technicality." In the eighties, a case was "dismissed because the 30-year statute of limitations on manslaughter had expired." When Gross stood trial in 2000, he escaped conviction because he was found "unfit for trial because of advanced dementia."

Gross is accused (in my opinion, for good reason) of perverting science and his oath to aid the Nazis in torture and killings. This is a perversion of his profession.

He misused science. (Gross maintained his innocence until the end, again, my opinion is he was guilty.) He forsook his oath, he betrayed the principle of first do no harm. He placed a government's interest over the interests of of providing care. He allowed politics to trump medicine. We can look back in horror (and should) but despite all the "never again"s that greeted the revelations of the crimes committed under the Nazi regimes (torture, genocide, etc.), we shouldn't take comfort in the fact that we all learned something from it.That's not the case. Were it the case, the revelations in Jane Mayer's "The Experiment" (The New Yorker) wouldn't have been so appalling. I've addressed this topic at The Third Estate Sunday Review and C.I.'s addressed it several times at The Common Ills.

"Jane Mayer's 'The Experiment' (The New Yorker)" (The Common Ills):
I'll try to summarize the article but that's not an easy task. Mayer's taken a trip to Guantanamo Bay. It was an orchestrated trip by the military. At one point, a prisoner starts speaking to her of how he's been treated and her military guide hustles her out of the area quickly and to the charges made by the prisoner offers a "joke" about how the prisoner can speak English pretty well.
Time and again, Mayer's told there's no problem, that it's isolated individuals when there are problems. But via other sources, she's able to make an argument that the incidents are not only not isolated, they're the result of research and planning.SERE comes into the story. SERE is a military unit that pops up in the aftermath of WWII. It was supposed to gather information that would help American troops to withstand pressure (and torture) if they were captured. SERE stands for Survival, Evasion, Resistance and Escape. Originally created for the Air Force, post Vietnam, it grows to include the Navy and the Army.
At Guantamano, there are "bisquits." Bisquits is "military jargon" for Behavioral Science Consultation Teams. These behavioral scientists appear to be utilizing techniques developed to help American troops resist during capture in an inverse manner -- using techniques to break the imprisoned at Guantamano down.
This raises ethical issues (which Mayer deals with, this is a summary of her article). Apparently prisoners medical files (containing information gathered by doctors) are raided to help with brainstorming ideas. Is someone afraid of the dark? Well, let's use that.
While the bisquists (Behavioral Science Consultation Teams) have apparent free access to medical files, that's not the case for everyone. Dr. John S. Edmondson ("a Navy captain who oversees the facility's medical command") claims that, "I believe we've complied with the requests [for medical records] that have reached me." Rob Kirsh ("who represents six Guantanamo detaineeds") has a paper trail that proves otherwise. Even with waivers from his clients, his requests for their medical records has been denied in multiple letters "from the Justice Department." Regarding this denial, Mayer quotes Arthur Caplan ("a bioethicist at the University of Pennsylvania") who notes, "Prisoners, even terrorists, have the right to their medical records, according to federal laws, common laws, the American Medical Association, and court trials."
With various documents and various sources (including a graduate of SERE who had posted at Juan Cole's Informed Comment) "The Experiment" gathers together the "isolated incidents" and demonstrates a pattern (in my reading of the article).
Techniques and actions used on American soldiers to keep them from "cracking" (my term, not Mayer's) are apparently now being used to "crack" (see previous parenthetical) prisoners.
The SERE program has always been shrouded in the secrecy of national security. Which is not unlike the attempts to find out what the Bully Boy did or did not authorize (or Donald Rumsfeld for that matter).
Would someone crack to stop a woman from being raped? Well, hey, let's try that. That appears to be the motivation and why one prisoner was told if he talked the (fake) rape would stop. There's also the case of a man and a woman having sex in a computer room next to an interrogation room with the door open.
How does that get approved? "Give it up for your country?" I'm not quite sure and I'm trying very hard not to interject my own thoughts here and provide a summary of the article so I'll move on.
There have been people pointing out that the actions were unethical or illegal or immoral (or two or all three). One person who speaks to Mayer, former FBI official who was at Guantanamo, states that he and other FBI agents did not want to participate in these actions:
Some of these techniques, I don't want to see, or be part of. I took an oath to the Constitution to uphold the laws against enemies both inside the U.S. and out. The D.O.D. [Department of Defense] guy got really upset. He said he took the oath, too. I told him that we must have different interpretations.
Concerns are raised regarding "force drift." That's when "interrogators encountering resistance begin to lose the ability to restrain themselves." If you'll think of it in terms of parenting, you'll relate that to the "power struggle." There's also a "seductive" component of these techniques, as an attorney for several prisoners -- Marc Falkoff -- notes. Falkoff asserts that "a mass suicide attempt at Guantanamo, in August 2003, in which two dozens or so detainees tried to hang or strangle themselves, was provoked by Koran mistreatment . . ."
That's a SERE technique. Only on American soil, while "testing" American soldiers, they used a Bible. They might tear pages out of it or kick it around or some other method. But it was developed here with the Bible. (Again, I'm holding my tongue and just attempting to summarize.)
The question is posed (and I'd argue throughout the article) by at least one person in the article of what are we becoming? What does it say about us when we "do things that our enemies do, like using torture?"
We'll close out this summary by noting that doctors have participated as "bisquits" (though not all "bisquits" are doctors -- some are p.h.d.s) with the comments of Jonathan Moreno (bioethicist):
Guantanamo is going to haunt us for a long time. The Hippocratic oath is the oldest ethical code we have. We might abandon our morality about other professions. But the medical profession is sort of the last gasp. If we give that up, we've given up our core values.What does it say about us when we accept this behavior?

A debate has raged in the medical professions largely behind closed doors. The Nation addresses this debate.

"The Silence of the Doctors" (Jonathan H. Marks, The Nation):
After 9/11 some American healthcare personnel were once again asked to step into the breach and help Army interrogators conduct aggressive interrogations. They have, among others, Maj. Gen. Geoffrey Miller -- former camp commander at Guantanamo Bay -- to thank for this. Miller considered the participation of Behavioral Science Consultation Teams -- known colloquially as "Biscuits" -- to be an "essential" part of the interrogation process. Having introduced the first Biscuit to the Guantanamo facility in late 2002, Miller urged the deployment of a similar team at Abu Ghraib in late 2003. These Biscuits were staffed at various times by psychologists and/or psychiatrists.
[. . .]
One of the functions of Biscuit health professionals is to help interrogators tailor interrogation "stressors" to the personality of each detainee -- particularly "high-value detainees." In one example -- reported by Neil [A.] Lewis in the New York Times -- interrogators were told by a Biscuit that a detainee's medical files recorded his severe phobia of the dark, and the Biscuit suggested ways that fear could be manipulated to make the detainees cooperate.
[. . .]
According to a resolution of the General Assembly adopted without dissent in 1982, it is a "gross contravention of medical ethics" for health professionals to be complicit in torture or cruel, inhuman or degrading treatment. They are also required not to use their knowledge and skills to assist with an interrogation that may adversely affect a detainee's health and is not in accordance with international law. Medical personnel who helped design and monitor aggressive interrogations like those [. . .] have undoubtedly fallen afoul of this ethical mandate.

Marks notes that the American Psychiatric Association, Physicians for Human Rights, and Physicians for Social Responsibility have spoken out against medical professional participating in programs that aid torture; however, the American Medical Association and the American Psychological Association have struggled (to put it mildly) to find their voice. As C.I. noted (no link because I'm rushing to finish this) at some point, Marks does as well, the American Psychological Association included on its task force to explore this issue "psychologists who work or have worked for the military -- in some cases at SERE schools."

As I stated, I'm rushing. (I'm attending mass with the McKinnons shortly.) But to nutshell this, what is going on is unacceptable. The death of Heinrich Gross should be an occasion to review how a climate for perversion of medical ethics can take place and it should make us take a serious look at what road we're currently on when medical professionals are using their skills and knowledge to assist interrogators in devising 'pressure points' (my term) for interrogations. That is a perversion of the profession. If we allow this perversion to continue, we aid in the creation of a climate that allowed Gross and others actions to be seen as worthy to their own government, as useful, as helping. We have duties and obligations. We take an oath. We betray that, our training and our very reason for existance when we put serving a governmental policy ahead of the aims of our profession.

In closing, I'll recommend that you check out "Kat's Korner: Breaking through the 'conventional truths' with No Secrets" and "Kat's Korner: Blunt's got the goods" which are two musical commentaries Kat has provided and a third one will go up Sunday at The Common Ills so look for that as well.

Happy Holidays and Peace on Earth.