No Comment — August 4, 2010, 11:10 am

More on the CIA’s Torture Doctors

The current issue of the Journal of the American Medical Association carries an important new study (sub only) by Len Rubenstein and Brigadier General Stephen Xenakis, probing more deeply into the role that physicians working for the CIA played in torturing and abusing prisoners. The evidence that CIA doctors were engaged in the torture process was marshaled in a prior report by Physicians for Human Rights. Evidence subsequently emerged suggesting that they had criminally experimented on human subjects, as they sought to calibrate torture sessions to the guidelines established by Jay Bybee, John Yoo, and Stephen Bradbury–guidelines since rescinded and acknowledged by the Justice Department to constitute torture practices. But Rubenstein and Xenakis focus on a document released (PDF) by the Obama Administration, which shows that the CIA’s Office of Medical Services (“OMS”) provided guidance that facilitated torture and mistreatment.

Enhanced interrogation methods were applied in escalating fashion. Interrogators typically began by removing the detainee’s clothes, limiting food, and depriving him of sleep through the use of stress positions. If this failed to produce intelligence, interrogators introduced “corrective” and “coercive” methods, including facial and abdominal slaps, dousing with cold water, stress positions and wall standing, confinement in a small or large box, and “walling” (throwing a detainee against a wall up to 20-30 times). If the detainee still did not provide information, interrogators could use waterboarding (simulated drowning). These methods have been recognized to constitute torture under international and domestic law by inflicting severe physical or mental pain or anguish on a person.

According to OMS guidelines, physicians and other health care professionals performed on-site medical evaluations before and during interrogation, and waterboarding required the presence of a physician. Exercising these functions violated the ethical standard that physicians may never use their medical skills to facilitate torture or be present when torture is taking place. In 2003, partially in response to a CIA Inspector General investigation that questioned the use of enhanced interrogation methods and criticized the agency’s failure to consult with OMS about the risks to detainees of waterboarding, OMS physicians assumed another role, providing opinions to the agency and lawyers whether the techniques used would be expected to cause severe pain or suffering and thus constitute torture. Physicians provided opinions on potential health effects of enhanced interrogation, described medical “limitations” on their use, and listed references. The OMS analysis is summarized in part in an appendix to OMS guidelines issued in May 2004, which are reproduced in the TABLE (these were slightly revised in December 2004). In some cases, the guidelines also urged documentation of the effects of enhanced interrogations on detainees. The guidelines recognized that waterboarding creates risks of drowning, hypothermia, aspiration pneumonia, or laryngospasm; cramped confinement could result in deep vein thrombosis; and death could result from lengthy exposure to cold water.

The duplicity in this affair is amazingly circular. The Justice Department’s torture lawyers relied on the CIA’s torture doctors for the conclusion that specific techniques did not produce “severe pain” that ran afoul of the criminal law prohibition on torture; the CIA doctors relied on the Justice Department lawyers for the same conclusion. It looks like a compact, and an alert prosecutor would no doubt call it a joint criminal enterprise: I’ll shield you, and you’ll shield me. But the conduct of the OMS involves laughable games with the ethics requirements. The obligation to “do no harm,” the physician’s foremost ethical injunction, is converted by OMS into an injunction to avoid “severe pain.” In other words, in the OMS’s book, anything that falls one iota short of prosecutable torture, including cruel, inhuman, and degrading treatment (which is also prosecutable) is just fine. It’s hard to see at this point whose behavior was the more ethically odious, though evidence suggests that both engaged in professional misconduct so egregious as to warrant formal disciplinary proceedings.

The table that Rubenstein and Xenakis have prepared offers an illuminating glimpse into the potentially criminal sophistry of the CIA torture doctors. It shows that OMS:

  • purported to subject some techniques to “medical limitations,” but those claimed limitations imposed no constraint on use of torture, e.g., allowing weight loss up to serious malnutrition, noise up to level of permanent hearing damage, exposure to cold water right up to development of hypothermia, shackling in upright sitting or horizontal position for 48 hours (and longer with medical monitoring);

  • placed no medical limitations at all on the use of isolation, hooding, walling, cramped confinement or stress positions except in some cases avoidance of aggravation of pre-existing injury;

  • ignored medical and other literature on effects of these forms of torture, and instead cited sources like NIH web site, wilderness manuals and WHO guidelines.

  • recognized dangers of certain enhanced methods but nevertheless approved them, e.g., that waterboarding risks drowning, aspiration pneumonia, and laryngospasm; sleep deprivation can degrade cognitive performance, lead to visual disturbances and reduce immune competence acutely; prolonged standing can induce dependent edeme, increased risk for DVT, cellulitis.

The positions that OMS took were professionally incompetent because they were clearly completely at odds with the established medical literature. Thus the OMS doctors, like the OLC lawyers, gave their bosses exactly what was expected of them: a green light to torture.

The torture doctors expect to have their identities protected, and thus to escape the natural consequences of their gross professional misconduct. This helps us understand why senior figures in the intelligence community are today ferociously pressuring the Justice Department to criminalize anyone who attempts to discover the identities of those involved. They assert that those identified would be terrorist targets. In fact, those who are unmasked face likely professional ethics proceedings, as well as the long-term risk of criminal prosecution, particularly if they ever venture beyond the borders of the United States.

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Ashley arrived for her prenatal appointment at Black Hills Obstetrics and Gynecology, in Rapid City, South Dakota, wearing a black zip-up hoodie and Converse sneakers.1 To explain her absence from work that morning — a Tuesday in April 2015 — she had told a co-worker that she was having “female issues.” She was twenty-five years old and eight weeks pregnant. She had been separated from her husband, with whom she had a five-year-old son, for the better part of a year. The guy who’d gotten her pregnant was someone she’d met at the gym, and he’d made it abundantly clear that he wanted nothing more to do with her. Ashley found herself hoping that the doctor would discover some kind of fetal defect, so that her decision would be easier. She glanced across the waiting room at a television playing a birth-control ad and laughed darkly. “Jesus, Lord, it would be so nice if someone just pushed me down a flight of stairs.”

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Ashley arrived for her prenatal appointment at Black Hills Obstetrics and Gynecology, in Rapid City, South Dakota, wearing a black zip-up hoodie and Converse sneakers.1 To explain her absence from work that morning — a Tuesday in April 2015 — she had told a co-worker that she was having “female issues.” She was twenty-five years old and eight weeks pregnant. She had been separated from her husband, with whom she had a five-year-old son, for the better part of a year. The guy who’d gotten her pregnant was someone she’d met at the gym, and he’d made it abundantly clear that he wanted nothing more to do with her. Ashley found herself hoping that the doctor would discover some kind of fetal defect, so that her decision would be easier. She glanced across the waiting room at a television playing a birth-control ad and laughed darkly. “Jesus, Lord, it would be so nice if someone just pushed me down a flight of stairs.”

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The baby was due in November, when Ashley, who was a nurse, hoped to be enrolled in a graduate program to become a nurse practitioner. Getting pregnant as a teenager had forced her to put that dream on hold, but she had thought that she was finally ready; she had even submitted her application shortly before the March 15 deadline. For the first time in her adult life, Ashley felt as if her plans were coming together. Then she missed her period.

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Ashley arrived for her prenatal appointment at Black Hills Obstetrics and Gynecology, in Rapid City, South Dakota, wearing a black zip-up hoodie and Converse sneakers.1 To explain her absence from work that morning — a Tuesday in April 2015 — she had told a co-worker that she was having “female issues.” She was twenty-five years old and eight weeks pregnant. She had been separated from her husband, with whom she had a five-year-old son, for the better part of a year. The guy who’d gotten her pregnant was someone she’d met at the gym, and he’d made it abundantly clear that he wanted nothing more to do with her. Ashley found herself hoping that the doctor would discover some kind of fetal defect, so that her decision would be easier. She glanced across the waiting room at a television playing a birth-control ad and laughed darkly. “Jesus, Lord, it would be so nice if someone just pushed me down a flight of stairs.”

In the exam room, she perched on the table with her feet crossed at the ankles, her blond hair brushing the back of her pink hospital gown. “I don’t know what’s available for me here,” she told her doctor, Katherine Degen, who sat facing her on a stool. “I figured nothing.”

 Some names and identifying details have been changed. 

“Big, fat zero, unfortunately,” Degen said, making a 0 with her fingers. The last doctor who provided abortions in Rapid City retired in 1986, three years before Ashley was born.

The baby was due in November, when Ashley, who was a nurse, hoped to be enrolled in a graduate program to become a nurse practitioner. Getting pregnant as a teenager had forced her to put that dream on hold, but she had thought that she was finally ready; she had even submitted her application shortly before the March 15 deadline. For the first time in her adult life, Ashley felt as if her plans were coming together. Then she missed her period.

It would be too difficult to attend school as a single mother of two, Ashley knew. She had made an appointment for three weeks from now at the nearest abortion clinic, in Billings, Montana, 318 miles away. But just a week and a half ago, her husband had said he wanted to get back together and offered to raise the child as his own. Was it a sign that she was meant to continue the pregnancy? As a rule, Ashley approached her problems with resolve. She was capable and tough; she liked shooting guns and lifting weights. She kept track of her stats and checked off her goals as she achieved them one by one. Yet the dilemma before her had shaken her confidence. She leaned back and turned to watch the ultrasound screen. The black-and-white image danced. A sharp, fast thumping emerged from the machine. As Degen removed the wand, Ashley wiped the corner of her eye.

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