Friday, September 12, 2008

The Ethics of Interrogation - The U.S. Military's Ongoing Use of Psychiatrists

The Ethics of Interrogation - The U.S. Military's Ongoing Use of Psychiatrists

Jonathan H. Marks, M.A., B.C.L., and M. Gregg Bloche,

M.D., J.D.

The New England Journal of Medicine

Volume 359:1090-1092 September 11, 2008 Number 11

In May 2006, the American Psychiatric Association (APA)

adopted a position statement prohibiting psychiatrists

from "direct participation" in the interrogation of any

person in military or civilian detention - including

"being present in the interrogation room, asking or

suggesting questions, or advising authorities on the

use of specific techniques of interrogation with

particular detainees."1 A few weeks later, the Council

on Ethical and Judicial Affairs of the American Medical

Association (AMA) issued a similar opinion, stating

that "physicians must neither conduct nor directly

participate in an interrogation, because a role as

physician-interrogator undermines the physician's role

as healer."2 The opinion defines direct participation

as including "monitoring interrogations with the

intention of intervening." Although the AMA and APA

conceded that physicians could participate in general

training of interrogation personnel, both organizations

firmly opposed physicians' helping to devise

interrogation plans for individual detainees. The World

Medical Association also revised its Declaration of

Tokyo in May 2006 in firm terms, asserting that "the

physician shall not use nor allow to be used, as far as

he or she can, medical knowledge or skills, or health

information specific to individuals, to facilitate or

otherwise aid any interrogation, legal or illegal, of those individuals."3

Yet documents recently provided to us by the U.S. Army

in response to requests under the Freedom of

Information Act (FOIA) make clear that the Department

of Defense still wants doctors to be involved and

continues to resist the positions taken by medicine's

professional associations. An October 2006 memo

entitled "Behavioral Science Consultation Policy" (see

the Supplementary Appendix, available with the full

text of this article at fails to mention

the APA statement and provides a permissive gloss on

the AMA's policy, at some points contradicting it

outright. The memo appears to claim that psychiatrists

should be able to provide advice regarding the

interrogation of individual detainees if they are not

providing medical care to detainees, their advice is

not based on medical information they originally

obtained for medical purposes, and their input is

"warranted by compelling national security interests."

The advice envisaged by the memo includes "evaluat[ing]

the psychological strengths and vulnerabilities of

detainees" and "assist[ing] in integrating these

factors into a successful interrogation."

The new Army field manual issued in September 2006

allayed some concerns about the use of coercive

interrogation tactics by the military (though not by

the Central Intelligence Agency [CIA]). The manual

prohibits some aggressive techniques, such as

waterboarding, hooding, and the use of military dogs.

However, it still permits "physical separation" for an

initial period of up to 30 days, which may be renewed.

Given that prolonged isolation has serious

psychological consequences and can cause post-traumatic

stress, the prospect that physicians might still be

advising interrogators on its effective use for

"conditioning" detainees should be cause for concern.

The policy memo also states that a "behavioral science

consultant" may not be a "medical monitor during

interrogation" and suggests that this is a "healthcare

function." However, it appears to authorize monitoring

as part of consultants' intelligence functions, since

"physicians may protect interrogatees if, by

monitoring, they prevent coercive interrogations." It

asserts, more specifically, that "the presence of a

physician at an interrogation, particularly an

appropriately trained psychiatrist, may benefit the

interrogatees because of the belief held by many

psychiatrists that kind and compassionate treatment of

detainees can establish rapport that may result in

eliciting more useful information."

This statement is troubling. First, it seeks to

undermine the positions taken by the AMA and APA

concerning physicians' monitoring of interrogations.

Second, it suggests that the officials who signed off

on this memo (the Army's former surgeon general and

former assistant surgeon general for force protection)

were skeptical about the merits of rapport-building

detainee interviews. It also hints at the rationale

that the military may be using to encourage

psychiatrists to reject the positions of their professional associations.

To their credit, the memo's authors instruct physicians

to report coercive interrogations to "the appropriate

authorities" and, if necessary, to "independent

authorities that have the power to investigate or

adjudicate such allegations." But physicians' reporting

obligations do not in themselves require that they

adopt a direct monitoring function, and this role

creates the potential moral hazard that interrogators

will "push the envelope" while waiting for the physician to intervene.

Other documents obtained under FOIA indicate that

between July 2006 and October 2007, five Army

psychiatrists were put through the "behavioral science

consultation" training course. The policy memo raises

critical questions about that course, among them, Why

are consultants receiving training in "learned

helplessness" - a term that invokes the work of

psychologist Martin Seligman, who used electric shocks

to induce passive behavior in dogs and destroy their

will to escape? As Jane Mayer has revealed, Seligman

was invited by the CIA to give a lecture in learned

helplessness at the Navy's Survival, Evasion,

Resistance, and Escape school in 2002, purportedly to

help U.S. soldiers to resist torture rather than enable

them to inflict it.4 According to Mayer, at least one

experienced interrogator has claimed that learned

helplessness was the paradigm for some of the most

aggressive interrogations in the war on terror. If

coercive interrogations are supposed to be off the

table, why teach this theory to behavioral science consultants?

Although the authors of the 2006 policy memo should be

credited for requiring behavioral science consultants

not to "perform any duties they believe are illegal,

immoral or unethical," the value of such a mandate is

undermined by the confusion the memo introduces

regarding the ethical obligations of health

professionals who serve as consultants. The memo is set

to expire this October 20. The Army should take this

opportunity to clarify the guidance and to embrace the

positions of the AMA and the APA. In a high-pressure

interrogation environment, unnecessary uncertainty

about ethical constraints can only lead to mischief.

No potential conflict of interest relevant to this article was reported.

Source Information

Mr. Marks is an associate professor of bioethics,

humanities, and law at the Pennsylvania State

University at University Park and at the College of

Medicine in Hershey, and a barrister and academic

member of Matrix Chambers, London . Dr. Bloche is a

professor of law at Georgetown University and a

Nonresident Senior Fellow at the Brookings Institution,

Washington, DC, and an adjunct professor at the

Bloomberg School of Public Health, Johns Hopkins University , Baltimore .


1. American Psychiatric Association. Psychiatric

participation in interrogation of detainees: position

statement. May 2006. (Accessed August 22, 2008, at

2. American Medical Association. Physician

participation in interrogation: report 10-A-06 of the

Council on Ethical and Judicial Affairs.

(Accessed August 22, 2008, at

3. World Medical Association. Declaration of Tokyo (as

amended, May 2006). (Accessed August 22, 2008, at

4. Mayer J. The dark side: the inside story of how the war on terror turned into a war on American ideals. New York : Doubleday, 2008.

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