Of Many Things

A basic requirement for any endeavor to be counted as a profession is a set of ethical standards. They guarantee the integrity of practice, bind the members of the profession to one another and build trust on the part of the public in the services rendered by the profession.

Medicine is one of the oldest professions in the West; its ethical standards reach back to the Greek physician Hippocrates (fifth century B.C.). Medical students who still swear the Hippocratic Oath pledge that “in every house where I come I will enter only for the good of my patients, keeping myself from all intentional ill-doing.” Medical professionalism rises and falls on that double commitment: the good of the patient and the avoidance of harm.

For that reason, a new report from Physicians for Human Rights, which provides evidence of the participation of medical professionals (physicians, psychiatrists and others) in the torture of “high-value” detainees held by the Central Intelligence Agency after September 2001, is distressing. There is no smoking gun in the report, only careful re-examination of the declassified public record. There is sufficient data, however, to suggest high-level inquiries are in order, as the physicians’ group and the National Religious Campaign Against Torture have urged.

Among the practices in which doctors and others are said to have engaged are these: determining how far harsh interrogation could go before suspects would suffer irreparable harm, providing a defense against potential prosecution and designing procedures for future interrogations.

According to the report, one technical adjustment introduced by medical personnel was the use of saline solution instead of plain water during waterboarding to prevent pneumonia and a drop in blood pressure. A finding that multiple techniques used in combination produced no more pain than when they were applied singly provided justification for combined use of torture methods—e.g., waterboarding a suspect in a protracted kneeling position.

The C.I.A. has denied that the health personnel in its employ were engaged in unlawful “human experimentation” and asserts their activities were under government supervision, including that of the Justice Department. The problem is, however, that this is the same Justice Department that under George W. Bush rewrote the rules on torture. Unfortunately, the Obama administration has backed off from prosecuting Bush-era employees and is ambiguous about its own detainee policies.

While the P.H.R. report is not conclusive, it has assembled enough information to merit further investigation. Though the administration may not pursue this question, Congress and associations of health professionals should do so. Congress possesses the subpoena power to bring to light the data still held from public view, and professional associations have the responsibility to investigate violations of professional integrity.

In recent decades, professional associations have too often deteriorated into little more than trade groups and have been reluctant to police their members. I hope Physicians for Human Rights will succeed in persuading the American Medical Association and other organizations of health professionals to investigate the suspicions of participation by some of their colleagues in torture. The trust of the public that physicians and other health care providers will work only in their patients’ interest and never intentionally consent to harm them is essential to their social contract as well as to their professional integrity. It is also necessary to resist the erosion of ethical standards by the national security state.

This article appears in June 21 2010.