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How complicit are doctors in
abuses of detainees?
The Lancet Journal (UK Medical Journal)
August 21, 2004
Editoral
Almost 3 years ago, we asked, "Does the western world still
take human rights seriously?" We did so in response to the UK's
2001 Anti-terrorism, Crime, and Security Act, which itself was a
reaction to the events of Sept 11 that year. We were disturbed by
a Newsweek columnist's suggestion that the use of torture on
suspected terrorists should be considered as a legitimate means
of obtaining information. As more details about the treatment of
detainees in the Abu Ghraib prison in Iraq and the US Guantanamo
Bay detention centre in Cuba come to light, disquiet about
contemplating or debating the use of torture to secure
information has given way to certainty that this is precisely
what took place under US command. The answer to our question
posed three years ago is clearly "no"; human rights have become a
casualty in the desperate attempt to get results in the war
against terrorism. The question we now need to ask is, what part
have doctors played in these abuses?
The UK Court of Appeal ruled last week in a two-to-one
judgment that evidence obtained by torture is admissible as long
as it is not procured by British officials. The ruling was made
in response to an appeal brought by 10 foreign nationals detained
in the UK for more than 2 years without charge or trial under the
Anti-terrorism, Crime and Security Act. The dissenting judge,
Lord Justice Neumeister, argued that "by using torture or even by
adopting the fruits of torture, a democratic state is weakening
its case against terrorists, by adopting their methods, thereby
losing the moral high ground an open democratic society enjoys".
The case will almost certainly go on to the House of Lords.
Currently, 585 people are held in Guantanamo Bay without
charge and many have been there for 2 years or longer. 156 have
so far been released. The official number of suicide attempts is
given as 34. None has been successful because detainees are
checked by guards every 45 s. According to the Guantanamo Bay
press officer, about 10% are receiving counselling or medical
treatment for mental illness. However the number of detainees
with mental health problems may be much higher, given the details
of detention conditions and methods of interrogations that are
coming to light through the reports of those released. Lawyers
for three UK citizens arrested in Afghanistan and held in
Guantanamo Bay, who were sent back to the UK in March this year
only to be released without charges by UK authorities, have
compiled a report based on interviews with their clients. This
report describes how confessions that were later proven by MI5 to
be false were made allegedly under coercive conditions. How can
the UK Home Secretary David Blunkett and the Court of Appeal
justify using, for example, such evidence to detain people
indefinitely?
Even more disturbing is the emerging evidence that doctors and
other medical personnel have helped, covered up, or stood by
silently when humiliation, degrading treatment, and physical
abuses have taken place. As Steven Miles describes in this week's
issue of The Lancet, there are now reports of medical personnel
in Afghanistan and Iraq allegedly abusing detainees, falsifying
and delaying death certificates, and covering up homicides. No
unprompted reports of abuses were initiated by medical personnel
before the official investigation into practices at Abu Ghraib.
At Guantanamo Bay, medical records were routinely shared with
interrogators in a clear breach of confidentiality and with the
knowledge that such information can be misused despite objections
by the medical team of the International Committee of the Red
Cross, who in protest suspended their medical visits.
Military doctors can be placed in a difficult position, but
the problem of dual loyalty, to patients and to their employers,
is well recognised. Guidelines and codes of practice state that
doctors, even in military forces, must first and foremost be
concerned about their patients and bound by principles of medical
ethics. Given these events, the World Medical Association saw the
need to re-emphasise its strong and unambiguous 1975 Tokyo
Declaration in June: "Doctors shall not countenance, condone, or
participate in torture or other forms of degrading procedures . .
. in all situations, including armed conflict and civil strife".
As one of the other few medical bodies to speak out, members of
Physicians for Human Rights wrote an open letter on Aug 6 to
James Schlesinger, Chair of the independent panel to review US
Department of Defense detention operations (and due to report
later this month), questioning the role and use of physicians and
other medical personnel in detention centres in Afghanistan,
Iraq, and Guantanamo Bay.
Health-care workers should now break their silence. Those who
were involved in or witnessed ill-treatment need to give a full
and accurate account of events at Abu Ghraib and Guantanamo Bay.
Those who are still in positions where dual commitments prevent
them from putting the rights of their patients above other
interests, should protest loudly and refuse cooperation with
authorities. The wider non-military medical community should
unite in support of their colleagues and condemn torture and
inhumane and degrading practices against detainees. Abu Ghraib
should serve as an eleventh hour wake-up call for the western
world to rediscover and live by the values enshrined in its
international treaties and democratic constitutions. * The
Lancet
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