Abu Ghraib Doctors Face Ethical Questions

By MARILYNN MARCHIONE
AP Medical Writer

Associated Press

August 22, 2004

Suspected of having condoned the torture of Iraqi prisoners, some American military doctors now face ugly comparisons to soldier-physicians who conspired in abuses by Saddam Hussein, Adolf Hitler and other dictators.

Although the Americans' alleged misconduct is far less severe, some say it is made worse because they did not have to fear being killed if they didn't cooperate.

"I don't think there are shades of gray," said Dr. Vincent Iacopino, director of research for Physicians for Human Rights. "If they did not have the immediate threat of harm, they had the obligation if they witnessed abuses to say something about them."

The Defense Department issued a statement Friday taking "strong exception" to allegations made last week in the British medical journal The Lancet. An article by an American professor said doctors at Baghdad's Abu Ghraib prison falsified death certificates to hide killings, hid evidence of beatings and revived a prisoner so he could be tortured more.

The Defense Department says there is "no evidence" of that and objects to what it calls the "wholesale indictment" of U.S. medical personnel and care in Iraq. The statement says that if an ongoing investigation finds guilt, "those responsible will be held accountable."

Medical ethicists say that being silent while patients are harmed is a profound breach of ethics and the oath that doctors take. They have called for reforms of military medicine, more training for doctors to recognize signs of torture, and an independent, non-military-led investigation of the scandal.

The Lancet article was written by Steven Miles, a University of Minnesota professor who has researched human rights issues for 20 years. It was based on media reports, congressional testimony, sworn statements of detainees and soldiers, and medical journal accounts - not events he witnessed firsthand.

Miles, who unsuccessfully ran for a U.S. Senate nomination in 2000 as a Democrat in Minnesota, does not shed light on how many doctors were involved or how widespread the problem of medical complicity was, aspects he says he is now investigating.

The Lancet report follows an essay in the July 29 New England Journal of Medicine by Dr. Robert Jay Lifton, a Harvard Medical School psychiatrist, noting mounting reports of abuses and urging military doctors to come forward with what they know. He alluded to incidents in the past where doctors had roles in torture or abuse, including the brutal experiments by Joseph Mengele and other Nazi doctors during World War II.

Being a doctor and being a soldier are not conflicting duties, said Martha Huggins, an author, sociologist and longtime torture researcher from Tulane University who spoke in June at an American Association for the Advancement of Science conference on the topic.

Even if officers or other military personnel were abusing prisoners and detainees, it doesn't mean the system expects a doctor to be complicit, she said.

"They put you in that position. They have validated that they want you to be a doctor," and that means doing no harm, Huggins said.

The American Medical Association has long had a policy against doctors joining in abuse "in any form," said Dr. Michael Goldrich, chairman of its council on ethical and judicial affairs.

"Participation in torture by physicians is the most egregious concern, but there are other levels that can range from physicians caring for patients to facilitate their return to interrogation and torture, or just awareness of the ongoing presence of torture," he said.

But written policies against abuse often fall away under the pressure of the kind of counterinsurgency war going on in Iraq, Lifton said. It's especially dangerous when the enemy is unclear and elusive, the war is on foreign and hostile territory, and involves non-whites, he said.

"In that kind of situation, you're likely to get atrocities that can include doctors," he said.

The messages doctors get from their leaders is important, Lifton said.

"It's one thing to have principles. It's another to be in a particular situation where the command environment powerfully either endorses, promotes or at least does little to discourage torture or abuse of prisoners," he said.

How this scandal is investigated and whether better monitoring and accountability come out of it are important, Iacopino said.

"There needs to be leadership to enforce effective documentation (of abuses) and to send a clear signal that this is what's wanted from health professionals, not complicity," he said.

Scandals like this also could undermine humanitarian work that many doctors do in war-torn countries for groups like the International Committee of the Red Cross and Doctors Without Borders.

"A doctor in a military prison or a prisoner of war camp is the first and last defense against human rights abuse," Miles said. "It is very important the doctors take seriously their independent stature...from the prisoner's side, if the doctor is silent or actively complicit in abuses, it tells the prisoner that you are completely beyond human concern, that you are completely lost."