The Hippocratic corpus, which requires that a physician “first do no harm” to his patient, lies at the heart of medical ethics. Now, an important independent study of the conduct of doctors engaged by the CIA and Defense Department at the Guantánamo Bay detention facility has concluded that the U.S. government forced these doctors to systematically violate their oaths by aiding in the torture and abuse of patients in their care. The study also makes clear that CIA and Defense Department officials were conscious of the ethics guidelines their policies would violate, and took measures to exempt medical professionals in their service from ethics requirements. The DoD and CIA also consistently refused to cooperate with state ethics boards investigating the unethical conduct of physicians at Guantánamo, effectively leaving the boards unable to act.
The two-year study, whose findings were issued in a report called “Ethics Abandoned: Medical Professionalism and Detainee Abuse in the “War on Terror,” was conducted by the Institute on Medicine as a Profession at Columbia University, and was supervised by a board of nineteen preeminent physicians, lawyers, and health-policy experts. After extensively surveying publicly available information, the report’s authors concluded that health professionals at Guantánamo had “designed and participated in cruel, inhumane and degrading treatment and torture of detainees.”
The report acknowledges that the Obama Administration has made changes to the Guantánamo system, but expresses serious concerns about systematic and ongoing ethics lapses in the detention center’s notorious force-feeding program. The Pentagon, it notes, “continues to follow policies that undermine standards of professional conduct” with respect to interrogation, hunger strikes, and the reporting of abuse. Doctors and nurses at Gitmo are required to participate in the force-feeding of detainees, who are placed in extensive bodily restraints for up to two hours twice a day, which the report’s authors conclude (as the American Medical Association did earlier this year) violates basic ethical rules.
The report leaves little doubt that intelligence services and the Pentagon have offered doctors a sort of pact, amounting to: Leave your professional ethics behind when you come to work with us, and torture your patients if we ask you to. In exchange, we will keep quiet about what you’ve done, and will ensure that the ethics bodies responsible for policing the medical profession won’t get the evidence they need to act against you. What this equation leaves out, of course, is the patients — both those who were abused, and the ones these doctors might treat in the future, who have a right to know who is treating them. A doctor who is willing to torture his patients can hardly be counted upon to render the highest standards of professional care, even without the CIA standing over his or her shoulder. Or, as one of the study’s researchers, Columbia University professor of medicine Gerald Thomson, put it:
The American public has a right to know that the covenant with its physicians to follow professional ethical expectations is firm regardless of where they serve. It’s clear that in the name of national security the military trumped that covenant, and physicians were transformed into agents of the military and performed acts that were contrary to medical ethics and practice. We have a responsibility to make sure this never happens again.