Saturday, February 25, 2006

Experts see medical ethics violations at Guantanamo

Experts see medical ethics violations at Guantanamo
By Alan Elsner

WASHINGTON (Reuters) - Doctors and psychologists at the U.S. military prison in Guantanamo Bay are taking part in practices, including force feeding, that violate medical ethics, say ethicists and medical associations.

Doctors at Guantanamo have inserted feeding tubes through the noses of prisoners on hunger strike. Psychiatrists and psychologists have observed harsh interrogations and advised interrogators on ways to persuade detainees to cooperate.

"These are fundamental violations. When doctors join the military, their medical ethics should not change. Medical personnel should not participate in any procedures harmful to the patient," said Leonard Rubinstein, executive director of Physicians for Human Rights.

The United States acknowledges using some aggressive interrogation techniques but insists it does not torture of detainees. But a U.N. human rights team this month said the treatment of detainees "amounted to torture."

The United States is holding around 500 suspected terrorists at Guantanamo Bay, Cuba. Many have been there for over four years, all but a handful without charges.

The debate over medical ethics has heated up with the recent disclosure that hunger strikers at Guantanamo had been forcibly tied down in "restraint chairs" for force feedings. Some detainees said the feedings had been made intentionally painful to break the hunger strike.

Defense Department officials denied this, and said they were acting to keep the prisoners alive.

In a letter last month to David Nicholl, chairman of the British Medical Association's ethics committee, the chief medical officer at Guantanamo, Capt. John Edmondson, said the detainees' motivation was to protest their confinement rather than to kill themselves. He said his staff was "providing nutritional supplementation on a voluntary basis to detainees who wish to protest their confinement by not taking oral nourishment."

Officers said they were proud that not a single detainee had died at the prison and were determined to maintain that record.


U.S. professional medical associations have been slow to take a position on the ethics of such practices as force feeding and coercive interrogations but that is now changing.

The American Medical Association has said that medical ethics preclude physician participation in the intentional infliction of physical or mental harm.

On force feeding, the AMA says: "When a patient is capable of forming an unimpaired or rational judgment concerning the consequences of refusing nourishment, a physician should respect such a refusal."

Steven Miles of the University of Minnesota's Center for Bioethics said medical organizations had been reluctant to speak out for fear of alienating politicians whose support they need on issues such as malpractice reform, but the flow of news from Guantanamo had forced their hand.

"There's enough smoke now to suggest that bad things are happening," he said.

Last October, the Pentagon flew several leaders of U.S. medical organizations to Guantanamo to dispel their concerns but allowed them no access to detainees.

A month later, the assembly of the American Psychiatric Association endorsed a statement that psychiatrists "should not participate or serve as consultants for coercive interrogations involving methods such as degradation, threats, isolation, imposition of fear, humiliation, sleep deprivation" and others widely reported to have been used at Guantanamo.

And an American Psychological Association task force last year said psychologists could ethically serve in consultative roles to interrogations as long as they stayed within the bounds of their professional code of conduct which forbids torture or cruel, inhumane or degrading treatment.