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calibrate torture sessions to the guidelines established by Jay Bybee, John Yoo, and Stephen Bradbury–guidelines since rescinded and acknowledged by the Justice Department to constitute torture practices.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.

Share
Single Page

More from Scott Horton:

Conversation August 5, 2016, 12:08 pm

Lincoln’s Party

Sidney Blumenthal on the origins of the Republican Party, the fallout from Clinton’s emails, and his new biography of Abraham Lincoln

Conversation March 30, 2016, 3:44 pm

Burn Pits

Joseph Hickman discusses his new book, The Burn Pits, which tells the story of thousands of U.S. soldiers who, after returning from Iraq and Afghanistan, have developed rare cancers and respiratory diseases.

Context, No Comment August 28, 2015, 12:16 pm

Beltway Secrecy

In five easy lessons

Get access to 169 years of
Harper’s for only $23.99

United States Canada

CATEGORIES

THE CURRENT ISSUE

March 2020

The Old Normal

= Subscribers only.
Sign in here.
Subscribe here.

Out of Africa

= Subscribers only.
Sign in here.
Subscribe here.

Waiting for the End of the World

= Subscribers only.
Sign in here.
Subscribe here.

In Harm’s Way

= Subscribers only.
Sign in here.
Subscribe here.

The Fifth Step

= Subscribers only.
Sign in here.
Subscribe here.

A View to a Krill

= Subscribers only.
Sign in here.
Subscribe here.

view Table Content

FEATURED ON HARPERS.ORG

Article
The Old Normal·

= Subscribers only.
Sign in here.
Subscribe here.

Addressing the graduating cadets at West Point in May 1942, General George C. Marshall, then the Army chief of staff, reduced the nation’s purpose in the global war it had recently joined to a single emphatic sentence. “We are determined,” he remarked, “that before the sun sets on this terrible struggle, our flag will be recognized throughout the world as a symbol of freedom on the one hand and of overwhelming force on the other.”

At the time Marshall spoke, mere months after the Japanese attack on Pearl Harbor, U.S. forces had sustained a string of painful setbacks and had yet to win a major battle. Eventual victory over Japan and Germany seemed anything but assured. Yet Marshall was already looking beyond the immediate challenges to define what that victory, when ultimately— and, in his view, inevitably—achieved, was going to signify.

This second world war of the twentieth century, Marshall understood, was going to be immense and immensely destructive. But if vast in scope, it would be limited in duration. The sun would set; the war would end. Today no such expectation exists. Marshall’s successors have come to view armed conflict as an open-ended proposition. The alarming turn in U.S.–Iranian relations is another reminder that war has become normal for the United States.

Article
Waiting for the End of the World·

= Subscribers only.
Sign in here.
Subscribe here.

1.

A man is to carry himself in the presence of all opposition, as if every thing were titular and ephemeral but he.

I rose long before dawn, too thrilled to sleep, and set off to find my tribe. North from Greenville in the dark, past towns with names like Sans Souci and Travelers Rest, over the border into North Carolina, through land so choked by kudzu that the overgrown trees in the dark looked like great creatures petrified in mid-flight. The weirdness of this scene would, by the end of the weekend, show itself to be appropriate: my trip would be all about romanticism, and romanticism is a human collision with place that results, as Baudelaire put it, “neither in choice of subject nor exact truth, but in a way of feeling.” My rental car’s engine whined as it climbed the mountains. Day was just breaking when I nosed down a hill to Orchard Lake Campground, where tents were still being erected in the dimness.

Article
The Fifth Step·

= Subscribers only.
Sign in here.
Subscribe here.

Harold Jamieson, once chief engineer of New York City’s sanitation department, enjoyed retirement. He knew from his small circle of friends that some didn’t, so he considered himself lucky. He had an acre of garden in Queens that he shared with several like-minded horticulturists, he had discovered Netflix, and he was making inroads in the books he’d always meant to read. He still missed his wife—a victim of breast cancer five years previous—but aside from that persistent ache, his life was quite full. Before rising every morning, he reminded himself to enjoy the day. At sixty-eight, he liked to think he had a fair amount of road left, but there was no denying it had begun to narrow.

The best part of those days—assuming it wasn’t raining, snowing, or too cold—was the nine-block walk to Central Park after breakfast. Although he carried a cell phone and used an electronic tablet (had grown dependent on it, in fact), he still preferred the print version of the Times. In the park, he would settle on his favorite bench and spend an hour with it, reading the sections back to front, telling himself he was progressing from the sublime to the ridiculous.

Article
Out of Africa·

= Subscribers only.
Sign in here.
Subscribe here.

1. In 2014, Deepti Gurdasani, a genetic epidemiologist at the Wellcome Sanger Institute in England, coauthored a paper in Nature on human genetic variation in Africa, from which this image is taken. A recent study had found that DNA from people of European descent made up 96 percent of genetic samples worldwide, reflecting the historical tendency among scientists and doctors to view the male, European body as a global archetype. “There wasn’t very much data available from Africa at all,” Gurdasani told me. To help rectify the imbalance, her research team collected samples from eighteen African ethnolinguistic groups across the continent—such as the Kalenjin of Uganda and the Oromo of Ethiopia—most of whom had not previously been included in genomic research. They analyzed the data using an admixture algorithm, which visualizes the statistical genetic differences among groups by representing them as color clusters. The top chart shows genetic differences among the sampled African populations, in increasing degrees of granularity from top to bottom, and the bottom chart shows how they compare with ethnic groups in the rest of the world. The areas where the colors mix and overlap imply that groups commingled. The Yoruba, for instance, show remarkable homogeneity—their column is almost entirely green and purple—while the Kalenjin seem to have associated with many populations across the continent.

Article
In Harm’s Way·

= Subscribers only.
Sign in here.
Subscribe here.

Ten yards was the nearest we could get to the river. Any closer and the smell was too much to bear. The water was a milky gray color, as if mixed with ashes, and the passage of floating trash was ceaseless. Plastic bags and bottles, coffee lids, yogurt cups, flip-flops, and sodden stuffed animals drifted past, coated in yellow scum. Amid the old tires and mattresses dumped on the riverbank, mounds of rank green weeds gave refuge to birds and grasshoppers, which didn’t seem bothered by the fecal stench.

El Río de los Remedios, or the River of Remedies, runs through the city of Ecatepec, a densely populated satellite of Mexico City. Confined mostly to concrete channels, the river serves as the main drainage line for the vast monochrome barrios that surround the capital. That day, I was standing on a stretch of the canal just north of Ecatepec, with a twenty-three-year-old photographer named Reyna Leynez. Reyna was the one who’d told me about the place and what it represents. This ruined river, this open sewer, is said to be one of the largest mass graves in Mexico.

Cost of renting a giant panda from the Chinese government, per day:

$1,500

A recent earthquake in Chile was found to have shifted the city of Concepción ten feet to the west, shortened Earth’s days by 1.26 microseconds, and shifted the planet’s axis by nearly three inches.

The commissioner of CPB admitted that “leadership just got a little overzealous” when detaining hundreds of U.S. citizens of Iranian descent in the wake of Qassem Soleimani’s assassination.

Subscribe to the Weekly Review newsletter. Don’t worry, we won’t sell your email address!

HARPER’S FINEST

Jesus Plus Nothing

= Subscribers only.
Sign in here.
Subscribe here.

By

At Ivanwald, men learn to be leaders by loving their leaders. “They’re so busy loving us,” a brother once explained to me, “but who’s loving them?” We were. The brothers each paid $400 per month for room and board, but we were also the caretakers of The Cedars, cleaning its gutters, mowing its lawns, whacking weeds and blowing leaves and sanding. And we were called to serve on Tuesday mornings, when The Cedars hosted a regular prayer breakfast typically presided over by Ed Meese, the former attorney general. Each week the breakfast brought together a rotating group of ambassadors, businessmen, and American politicians. Three of Ivanwald’s brothers also attended, wearing crisp shirts starched just for the occasion; one would sit at the table while the other two poured coffee. 

Subscribe Today