Physician, Torture Thyself

by Sean Philpott-Jones, Director of the Center for Bioethics and Clinical Leadership

Last week, the US Senate Intelligence Committee released its long awaited report describing the techniques that the Central Intelligence Agency (CIA) used to interrogate suspected terrorists and other combatants captured during our long running War on Terror.

The so-called Torture Report, the product of a five-year investigation by the Democrat-led Senate, described in harrowing detail the methods used by CIA agents to extract information from detainees, including: waterboarding; sleep deprivation; light deprivation; threats to physically harm or sexually assault individuals, their children or their adult relatives; and “rectal feeding”. Many of these techniques blatantly violated the Geneva Conventions and other international agreements on humanitarian treatment of prisoners of war.

Not surprisingly, the political firestorm that release of this 6,700-page report ignited has been fierce. Many Republican politicians and conservative pundits have condemned the investigation as flawed, biased, and potentially damaging to US interests.

Others, including former Vice President Dick Cheney and key architects of the War on Terror, have defended the use of enhanced interrogation techniques, claiming that countless lives were saved and disputing allegations that any US laws or international treaties were violated. Only a few politicians and pundits on the right, most notably Arizona Senator John McCain (himself a former POW who was tortured), have stood up to defend the report.

On the other side of the political aisle, the response has been fairly muted. While progressive organizations and advocacy groups like Human Rights Watch have called for criminal investigation of senior Bush Administration officials and CIA operatives involved in the interrogation of prisoners, Democratic politicians and the Obama Administration have largely rejected calls to prosecute those involved. This is, I believe, a rather shrewd and calculated political move.

For this commentary, however, I don’t want dwell on the issue of whether or not the activities described in the Senate’s report question long-standing notions of American exceptionalism: the idea our country stands as a moral exemplar for the rest of the world. Instead, I want to focus on a more practical question: what does the fact that hundreds of doctors, nurses, and psychologists participated in the interrogation of CIA prisoners say about the healthcare profession as a whole?

We now know that CIA staff physicians and psychologists were involved in almost every interrogation session. This is in direct violation of all known codes of medical ethics, including the Hippocratic Oath, the American Medical Association’s (AMA) Code of Medical Ethics, the American Psychological Association’s (APA) Ethical Principles of Psychologists and Code of Conduct, and the World Medical Association’s Declaration of Tokyo. Despite a primary duty to “do no harm” (primum non nocere), a number of medical professionals have been directly involved in helping the US government, the CIA, and other military and intelligence agencies come up with new and creative ways of torturing prisoners.

For some healthcare professionals, torture is also a lucrative business. Two psychologists, Jim Mitchell and Bruce Jessen, helped the CIA develop its interrogation program. In exchange, they received more than $80 million from the US government.

Consider a few examples of physician involvement in torture outlined in the Senate report: Clinicians with the CIA’s Office of Medical Services, which provides healthcare to Agency employees, decided when detainees’ injuries were sufficiently healed such that agents could again interrogating them. A team of physicians determined which prisoners should be waterboarded, an interrogation technique that simulates drowning.

At one detention site, even though a prisoner’s feet were badly broken, the examining doctor nevertheless recommended that he be forced to stand for nearly 52 hours in order to extract information. Nurses and doctors also used rectal feeding and hydration — forcible injection of water, saline and even a pureed mix of hummus, nuts and pasta through the anus — despite the fact there is no physiological benefit or medical purpose to rectal feeding.

Few of these healthcare professionals are likely to face any consequences. To date, only one clinician has ever been sanctioned for their involvement in torture: a Navy nurse who refused to force-feed prisoners who were on an extended hunger strike at Guantanamo. He will probably be discharged from the military. He may also face criminal prosecution for failing to obey orders.

He will likely be the only medical professional prosecuted. The Obama Administration has largely given a “Get Out of Jail Free” card to everyone involved. In a briefing given by the White House following the release of the Torture Report, for example, a senior official with the US Department of Justice concluded that the CIA’s enhanced interrogation activities were “authorized” and “reviewed as legal” at the time they occurred.

While the AMA and the APA have condemned the actions of the clinicians and psychologists mentioned in the report, as professional organizations with no legal or licensing authority, there is little they can do to punish those involved. State medical licensing boards could suspect or revoke permission to practice, they probably won’t.

It is sad that the perpetrators of these crimes will face no sanction. It is sadder still that politicians, policymakers and the general public will largely ignore the Senate’s report. I can only hope that outrage in the medical community over these and other acts (such as physician involvement in state-sanctioned executions) leads to a change in the way healthcare workers treat suspected terrorists and other prisoners.

[This blog entry was originally presented as an oral commentary on Northeast Public Radio on December 18, 2014, and is available on the WAMC website. The contents of this post are solely the responsibility of the author alone and do not represent the views of the Bioethics Program or Union Graduate College.]

Does A Just Society Use the “R” Word?

by Susan Mathews, Bioethics Program Alumna (2014)

Healthcare spending in the U.S. is expected to grow by more than 5 percent annually over the next ten years. Should that prediction hold true, by 2023 health care spending will account for a fifth of the nation’s gross domestic product (GDP). Unfortunately, this level of spending is not sustainable and physicians, policymakers and patients will be forced to make difficult choices about how to ration limited medical resources.

How should the principle of distributive justice, one of the four tenets of medical ethics, guide decisions about the dreaded ‘R’ word: rationing of medical resources?

To read more, click here.

[This post is a summary of an article published on Life Matters Media on December 13, 2014. The contents of this blog are solely the responsibility of the author and do not represent the views of the Bioethics Program or Union Graduate College.]

Protecting Transgender Students

by Sean Philpott-Jones, Director of the Center for Bioethics and Clinical Leadership

Two nights ago, the Shenendehowa Board of Education voted 4 to 2 in favor of a new policy designed to protect the rights and safety of transgender students. High school students in the district will now be allowed to use bathrooms and locker rooms that correspond to their gender identity. The new policy also allows all students, regardless of sex or gender, to access single-user bathrooms and private changing areas.

Located just north of Albany, New York, Shenendehowa Central School District is now one of but a few districts nationwide that provide recognition and support to transgendered youth. Only California has passed a statewide law that allows transgender students to use bathroom and locker facilities that match their gender identities. While the New York City Board of Education released new guidelines in support of transgender students earlier this year – including a recommendation that students never be made to use a locker room or restroom that conflicts with their gender identity – these are only suggestions and not binding policies. Sadly, the New York State Board of Education has been largely silent on this issue.

The US Federal government has also been relatively quiet on the topic of transgendered youth. The US Department of Education’s Office for Civil Rights has stated that Title IX of the Education Amendments of 1972, which protects students from sex discrimination, also applies to transgender students. This allows transgendered students to file legal action in federal court should local authorities fail to protect them from discrimination and violence while at school. But the US Department of Education failed to provide specific examples of Title IX-prohibited discrimination or provide school districts with clear guidance on how to create trans-inclusive policies. Finally, the Obama Administration has been reluctant to push Congress to pass legislation that will protect transgendered youth, such as the Safe Schools Improvement Act and the Student Non-Discrimination Act.

Such laws and policies are desperately needed. Lesbian, gay, bisexual and transgendered (LGBT) youth are at increased risk of bullying, physical violence and sexual assault at school. In 2011, for instance, a survey conducted by the Gay, Lesbian & Straight Education Network (GLSEN) found more than half of LGBT youth report being harassed at school. For transgendered students in particular, however, the problem is much much worse.

The National Transgender Discrimination Survey, a study of over 6,000 people, found that transgender and gender-nonconforming students experienced very high rates of harassment (78 percent), physical violence (35 percent) and sexual assault (12 percent). Alarmingly, a third of this harassment and violence occurred at the hands of teachers, staff and school officials themselves. It should come as no surprise, therefore, that many transgendered students drop out of school. Still more report having suicidal thoughts, and a quarter have attempted to take their own lives.

This is a tragedy of considerable proportion, one that can only be addressed by implementing and enforcing policies that prohibit discrimination on the basis of gender identity. That is what makes the recent vote by the Shenendehowa Board of Education so groundbreaking. But it is also what makes the acrimonious nature of the debate over this policy so disheartening.

When local news stations posted the story on their websites and Facebook pages, for example, a majority of the comments submitted online were in opposition to Shenendehowa’s new policy. Many people posted comments that made it clear that they did not understand the new policy. Others made rude statements that were based on ill-informed stereotypes of transgendered kids: that they are confused, that they need to see psychiatrists, that they should use the staff bathrooms, or that they are sexual predators who are only interested in seeing other children naked.

I’m chalking up most of the opposition to fear, ignorance and campaigns that falsely claim that students and staff will exploit these policies to use opposite-sex restrooms in order to sexually harass and assault other children. When California’s legislature was debating the School Success and Opportunity Act, which gave transgender students the same rights and protections covered by Shenendehowa’s new policy, the conservative Pacific Justice Institute invented a now discredited story about a transgender student harassing her peers in a Colorado school restroom. Similarly, when the town of Fayetteville, Arkansas was considering a law that prohibit discrimination on the basis of gender identity, reality TV star Michelle Duggar falsely claimed that the law would allow men “with past child predator convictions to claim they are female [and] use womens’ and girls’ restrooms, locker rooms and showers.“

Nothing could be further from the truth. Consider what is happening in California. In the year since they passed the School Success and Opportunity Act, not a single school district in that state has reported an instance of inappropriate behavior, harassment or physical assault stemming from the new law. The experience of the Shenendehowa Central School District is likely to be the same.

Kudos to the Shenendehowa Board of Education for standing up for the rights of transgendered kids. Now if the rest of the school districts in the US could do the same.

[This blog entry was originally presented as an oral commentary on Northeast Public Radio on December 4, 2014, and is available on the WAMC website. The contents of this post are solely the responsibility of the author alone and do not represent the views of the Bioethics Program or Union Graduate College.]