Report contends Gitmo doctors went beyond their “do no harm” principle through force-feeding.
WASHINGTON – Physicians, nurses and psychologists working with detainees at the detention center at Guantanamo Bay have systematically breached nationally and internationally accepted medical ethics and responsibilities, according to a major new task force report released this week.
The report focuses particularly on the role played by medical personnel in carrying out the force-feeding of detainees engaged in extended hunger strikes, an issue that received considerable attention earlier this year when several dozen men went on strike to protest their continued detention.
Yet the new analysis also warns that medical personnel at Guantanamo, at the behest of the military and the Central Intelligence Agency, have broken some of their vocation’s central creeds for much of the past decade, including through their role in interrogations and inability to report abuse against detainees. The report also notes that medical evidence – almost universally seen as private – has been used as targeted leverage by interrogators.
“Contrary to ethical standards adopted by all medical and psychological associations … [the Department of Defense] limited the professional duty to not do harm. The duty to avoid or minimize harm, the DoD holds, does not apply to the [Guantanamo medical teams] involved in interrogation because they are not involved in clinical treatment,” the report, published by the Institute on Medicine as a Profession (IMAP) and the Open Society Foundation, states.
“The DoD went so far as classifying physicians and psychologists … as combatants who are not subject to all ethical duties of their profession, even though they are required to hold a professional license. American and international medical associations have, by contrast, made clear that a physician using professional skills is always a physician subject to the ethical requirements of the profession.”
The 269-page report is the result of two years of work by the 19-member Task Force on Preserving Medical Professionalism in National Security Detention Centers, comprising medical, military and legal experts. Using sometimes-patchy public records, the task force members conclude that the CIA and the Defense Department inappropriately ordered health personnel at Guantanamo to break a suite of vows, and are calling for a range of changes to ensure conformity with international protocol.
“When in 2003 the secretary of defense announced that the Geneva Conventions would no longer apply [for detainees in the war on terror], that changed the rules that military physicians and officers had been living by for decades,” Dr. Stephen Xenakis, a retired U.S. Army brigadier and member of the task force, told reporters Tuesday.
“This current practice of hunger strikes is the most vivid legacy of these changes in practice and involvement of physicians in Guantanamo and other situations during past 11 years of war.”
Last week, Xenakis and some three dozen other prominent health practitioners, including six Nobel laureates and a former U.S. surgeon general, released an open letter calling on President Barack Obama to end force-feeding at Guantanamo as a “severe breach” of professional principles.
While many of the hunger strikers at Guantanamo have been caught in a legal limbo in the context of the ongoing war on terror, Xenakis warns that this context will soon be changing.
“It is very important to take corrective action now and rebalance what we’re doing as we move forward and troops are leaving Afghanistan,” he says. “With the war formally over, we’re going to go back to a situation where we’re not actively engaged. Therefore, the rules that apply will be those that apply to a peacetime army.”
Protest vs. death wish
The Pentagon roundly rejects the report’s findings, with a Pentagon spokesperson telling Mint Press News that the allegations are “almost comically absurd.”
“The allegations made in the report are not new. They have been subject to numerous investigations over the years, and those investigations – which had access to more information than the authors of this report – have never substantiated these claims,” the Pentagon spokesperson says.
“We remain committed to President Obama’s goal of closing the detention facility at Guantanamo Bay, Cuba. It is wildly expensive, it is inefficient, and it operates outside America’s best interests. However, until Congress changes the law, we will continue to humanely safeguard those held in our charge there.”
As of Tuesday, the Pentagon confirms, 14 detainees in Guantanamo Bay were formally considered to be on hunger strike. This means that, twice a day, military medical personnel were strapping detainees to a chair, inserting a tube through their nose into their stomach, and “feeding” them a liquid and nutritional supplement. This process can reportedly take an hour or more, and is repeated if detainees vomit following the procedure
Earlier this year, the number of hunger strikers at Guantanamo was near 100, during a wave of strikes in which detainees – many of whom have not been charged, have been formally cleared for release and have been imprisoned for close to a decade – were reportedly protesting their indefinite detention.
“The Department of Defense will not knowingly allow a detainee to commit suicide – not by means of a weapon, medication, nor self- or peer-imposed starvation,” a Pentagon spokesperson told Mint Press News.
“The policy on treatment of those not eating is focused solely on preserving the life and health of detainees in DoD custody, and is line with well-established U.S. law. The enteral feeding procedure is medically sound, and is based on procedures performed not only in U.S. prisons, but in hospitals and nursing homes worldwide.”
Indeed, President Obama has offered a similar rationale for the continued force-feedings, noting that he doesn’t want the hunger strikers to die. Yet others say this understanding of the strikers’ motivation and aim is flawed.
“The hunger strikers have no intention of dying – these actions are a form of protest, an attempt to shame the authorities into action by individuals desperate to have some control over their lives,” Dr. Vincent Iacopino, a member of the task force and a senior medical advisor with Physicians for Human Rights, a global advocacy group, said Tuesday.
“Physicians and nurses must be able to act independently – to perform assessments, refrain from use of force, counsel detainees on their options, respond to and adhere to their duties to advance detainees’ well being. These are not respected at Guantanamo, and won’t be as long as these medical personnel are subordinate to the military command.”
The military is not the only institution called out by the new report for failing to ensure that medical ethics are respected at Guantanamo. In the United States, professional protocol is codified largely by two trade organizations, the American Medical Association and the American Psychological Association.
In addition, all health personnel at Guantanamo are licensed by state licensing boards. This would seem to offer a potent point of leverage: after all, if any medical practitioner is accused of unethical behavior, he or she runs the risk of losing the license required to continue operating.
“Medical professional organizations generally don’t have the power to revoke a license or enact punitive sanctions, whereas the state licensing boards do,” Dr. Iacopino told Mint Press News. “Yet while there have been several such cases in which they have tried to do that, thus far it hasn’t worked.”
Still, the task force is calling on the country’s most prominent health trade associations to tighten their ethical standards. The group particularly highlights the American Psychological Association for “support[ing] the role of psychologists in interrogation, and … reject[ing] the claim that professional obligations differ depending on role.”
In response, the APA says it has “absolutely condemned any psychologist participation in torture” and notes that its policy for a quarter century has been that torture and degrading treatment are “never acceptable regardless of circumstances, including war or the threat of war”.
On Monday, President Obama met with his two special envoys tasked with overseeing the closure of the detention center at Guantanamo Bay, both of whom were appointed in recent months. According to a statement, the president “reiterated that he remains fully committed to closing” the facility, noting that it “continues to drain our resources and harm our standing in the world.”
However, despite some recent progress toward this closure, including the imminent start of case reviews to facilitate the potential release of some detainees, many observers remain pessimistic that major action will be taken anytime soon. If so, the soured relationships between Guantanamo doctors and detainees could pose a major problem well into the future.
“The detainees know that these doctors don’t have independence or autonomy when it comes to directing their medical care, in addition to longstanding reservations given that many were subjected to enhanced interrogations in which these physicians were involved,” Dr. Iacopino says.
“For this reason, military doctors will now need to make a special effort to establish trust with the detainees – this population is aging and will need more care. Yet force-feeding stands in the way of doing that, so this is a really pernicious situation.”