Following the September 11th attacks, physicians and other medical professionals, “particularly psychologists,” were involved in the “design and administration” of harsh treatment and torture.  This conduct was “in clear conflict with established international and national professional principles and laws,” a new report from a task force convened by the Institute on Medicine as a Profession (IMAP) and the Open Society Foundations finds.

The report details how medical professionals working for the CIA and United States military were directed to deviate from professional standards and ethical conduct, which they are expected to follow. It calls attention to the role that medical personnel played in inflicting torture and causing cruel, inhuman and degrading treatment in prisons like Guantanamo Bay, Abu Ghraib or various secret prisons operated by the CIA.

The US Justice Department played a key role in this deviation by approving “interrogation methods” that constituted torture. Prisoners captured were also classified in the “war on terror” as “unlawful combatants,” and were not considered individuals who qualified as prisoners of war under the Geneva Conventions.

“The secrecy surrounding detention policies that prevailed until 2004–2005, when leaked documents began to reveal those policies” played a key role in medical personnel’s involvement in torture too. “Secrecy allowed the unlawful and unethical interrogation and mistreatment of detainees to proceed unfettered by established ethical principles and standards of conduct as well as societal, professional, and nongovernmental commentary and legal review.”

In the CIA, those working for the Office of Medical Services were expected to help assess any potential harm that might be caused by torture techniques. They “advised limits, such as stopping exposure to cold just at the point where hypothermia would likely set in.” They stopped loud noises just before “permanent hearing loss would occur.” They restricted the use of stress positions to 48 hours. And, when the CIA wanted to use waterboarding, they would ensure that “resuscitation equipment and supplies for an emergency tracheotomy” were readily available.

During waterboarding, according to the report, “guidelines advised that an unresponsive subject must be righted immediately and a thrust just below the breastbone administered by the interrogator.” These guidelines also indicated, “If this fails to restore normal breathing, aggressive medical intervention is required. Any subject who has reached degree of compromise is not considered an appropriate candidatefor the waterboard, and the physician on the scene cannot concur in the further use of the waterboard without c/oMs consultation and approval.”

Clinical medical personnel working for the US military were engaged in “various aspects of interrogation as well as other security functions.”

One of the earliest examples was the torture of Mohammed al-Qahtani, who was suspected of being involved in the 9/11 hijackings but never made it into the US. He was interrogated for a period of 54 days. The military used loud noises, yelling and forced standing. They subjected al-Qahtani to “multiple forms of sexual and religious humiliation.” They “doused him with cold water (including when he was naked).” They strapped him “into painful stressful positions.” All of this took place while a member of the military’s Behavioral Science Consultant Teams (BSCTs) was present.

BSCTs were developed, according to the Task Force report, to advise “intelligence and detention officials on conditions of confinement that would enhance capture shock, dislocate expectations, foster dependence, and support exploitation of detainees to advance intelligence gathering.” They would give advice on how harsh a prisoner’s interrogation should be. They would recommend that fans and generators be used to create “white noise” that could act “as a form of psychological pressure.” They would restrict detainees to only four hours of sleep in one day or they would advise that the military deprive detainees of “basic living items,” such as “sheets, blankets, mattresses and washcloths.” Controlling access to the Koran was also suggested as well.

A section of the report on medical care available to detainees indicates that “no official clinical investigations of the circumstances or causes” of any detainee’s suffering was conducted. Any diagnosis for post-traumatic stress disorder was done by “independent medical evaluations,” which were arranged by lawyers representing detainees.

“In cases where the connection between abusive practices and psychological deterioration was self-evident, such as the use of isolation leading to severe anxiety, depression, or psychosis, clinicians lacked the authority to change the circumstances of confinement,” the report states.

The Task Force points to three “key changes in policy standards” that directly led to professionals becoming involved in abuse and torture.

The Defense Department adopted a standard that members of BSCTs were not “subject to all ethical duties of their profession even though they are required to hold a license.” They reclassified these doctors as “combatants” so they no longer were bound by a duty to “avoid or minimize harm.”

Also, the Defense Department chose to conflate legal standards with ethical standards. The Task Force explains that a “health professional has an obligation not to participate in acts that deliberately impose pain or suffering on a person.” Yet, by replacing ethical standards with a legal standard, the Defense Department “eviscerated” the ethical standards medical personnel are supposed to follow.

BSCTs were also reclassified as “safety officers” after much criticism on the role of health professionals in interrogations. That reclassification, which makes it possible for the US government to authorize medical personnel to participate in acts that result in suffering, remains in place today.

As the Task Force report describes:

These descriptions rationalized the participation of health professionals in interrogation, and reveal the contradictory functions health professionals have played. The safety officer designation, for example, was accompanied by the responsibility to identify vulnerabilities of detainees and collaborate with interrogators in exploiting them. The DoD has never addressed the contradiction in these roles. Further, medical ethical principles do not permit any role in an individual interrogation, even as a purported safety officer, as mere presence can signal approval of abusive practices so long as the health professional expresses no objection.

At Guantanamo Bay, a policy was implemented to allow interrogators to use “medical and psychological information” on detainees in order to “exploit” weaknesses during interrogations. The International Committee of the Red Cross reported in 2004 that military interrogators were able to freely access detainee medical records. Detainee medical information can be used for “intelligence gathering,” and BSCTs are allowed to perform psychological assessments, which are passed on to interrogators, so long as that information is not used to treat a prisoner inhumanely. The Task Force urges this practice be brought to an end.

The Task Force report addresses the role of medical personnel in force-feedings. It does not accept the Defense Department’s claim that force-feedings are undertaken to save lives. They have been “used commonly, not just in rare instances where a detainee’s life was threatened.” They have been explicitly used to break political protests. And, therefore, all force-feedings should be “prohibited.”

Finally, the report proposes that medical personnel be held accountable for their role in torture or inhumane treatment by further informing the public of the role of medical personnel in what has happened. There should be more “fact-finding and investigations” along with “stronger disciplinary action through state health professional licensing boards.”

It suggests that military and intelligence health professionals be subject to the same civilian disciplinary system as other health professionals because, no matter where they are working, all military and intelligence medical personnel are US physicians and psychologists.

Alabama, California, Georgia, Louisiana, New York, Ohio and Texas have all dismissed complaints brought against health professionals allegedly involved in torture at Guantanamo Bay or in secret CIA prisons. No complaints have led to formal hearings that would hold any individual to account.

State licensing bodies have not been willing to “address complaints of misconduct within national security agencies.” The Task Force recommends this be changed, especially since it would empower “health professionals to resist demands by authorities to engage in acts that violate their professional responsibilities and to report abuse when they believe it has occurred.”

In conclusion, while it is not stated by the Task Force, this failure to hold medical professionals accountable should be understood in the context of the larger issue of impunity for those involved in authorizing and carrying out torture in the “war on terrorism” under President George W. Bush. It has been policy under President Barack Obama to decriminalize torture and not prosecute former Bush administration officials responsible for cruel and inhuman treatment. The administration is also presiding over military commissions at Guantanamo that will not permit evidence of torture to be mentioned in court by the very few defendants that have been granted some modicum of due process after actually being charged with committing crimes.

A 6,300-page report by the Senate intelligence committee details the CIA’s role in torture and likely contains critical details on medical personnel’s role in torture yet it remains secret. The CIA has effectively managed to resist or prevent the release thus far and the Obama administration has not taken the step of ordering that it be released in some form, which has enabled the CIA to continue to escape full responsibility for its role in the torture of prisoners.

Full report, “Ethics Abandoned: Medical Professionalism and Detainee Abuse in the War on Terror,” can be read here.