1. Torture offends health professional ethics and culture
   

   Preventing torture and ill-treatment of those in custody and prohibiting health professional participation in such abuse are integral to the ethical obligations and culture of the health professions.

   The American Medical Association “opposes torture in any country for any reason” as a matter of policy. The AMA’s Code of Medical Ethics provides that “Physicians must oppose and must not participate in torture for any reason.” The AMA Code further provides that “[p]hysicians must not be present when torture is used or threatened,” and that “physicians should not treat individuals to verify their health so that torture can begin or continue.”

   The World Medical Association’s “Declaration of Tokyo,” endorsed by the AMA, provides that “[t]he doctor shall not countenance, condone or participate in the practice of torture or other forms of cruel, inhuman or degrading procedures, whatever the offense of which the victim of such procedures is suspected, accused or guilty, and whatever the victim’s beliefs or motives, and in all situations, including armed conflict and civil strife.” The WMA Declaration also provides that the “doctor shall not be present during any procedure during which torture or other forms of cruel, inhuman or degrading treatment is used or threatened.”

   The UN Principles of Medical Ethics relevant to the Role of Health Personnel, particularly Physicians, in the Protection of Prisoners and Detainees against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment concur: “It is a gross contravention of medical ethics, as well as an offence under applicable international instruments, for health personnel, particularly physicians, to engage, actively or passively, in acts which constitute participation in, complicity in, incitement to or attempts to commit torture or other cruel, inhuman or degrading treatment or punishment.”

   The policy of the mental health professions is equally unambiguous: “the American Psychiatric Association and the American Psychological Association condemn torture wherever it occurs.”

   The American Nurses Association makes it clear that “Abuses of prisoners . . . by a registered nurse would be in conflict with our professional code and other guiding documents.”

2. Health professionals are leaders in torture prevention

   Health professionals have long served in the vanguard of the international effort to eradicate torture and cruel, inhuman or degrading treatment throughout the world.

   Through the unique capacity to rigorously and credibly document medical and psychological evidence of torture and ill-treatment, health professionals have played a leading role in exposing, preventing, and ensuring accountability for torture worldwide. The “Istanbul Protocol,” the international standard for documentation of torture, was developed through an extraordinary international collaboration of health professionals and has served as a key instrument in prevention of torture and accountability for perpetrators throughout the world.

   Health professionals also play a leadership role in redressing the consequences of torture, providing medical, mental health, and other services to survivors of torture at treatment centers around the world.

3. Infliction of torture is unworthy of the traditions and character of the United States and the U.S. military

   U.S. interrogation policies and practices historically have adhered strictly to a tradition of justice, humanitarian standards, and the rule of law as expressed in the Geneva Conventions, the Convention Against Torture, the U.S. anti-torture statute, decisions of the U.S. courts, the Uniform Code of Military Justice, and more.

   Consistent with both the law and practical considerations, the U.S. Army Field Manual on interrogations has long prohibited the use of torture, including psychological coercion, recognizing among other factors that such force is “a poor technique” which “yields unreliable results.” The growing evidence of systematic torture and ill-treatment by U.S. personnel undermines our legacy of justice and our commitment to humane treatment of prisoners and detainees.

4. Infliction of torture by the United States undermines torture prevention worldwide

   The United States has long served as a leader in opposing torture throughout the world. The State Department’s annual human rights reports, for example, have served as a valuable international resource, exposing, condemning, and pressuring oppressive regimes that engage in torture – including many of the psychological techniques reportedly used by U.S. interrogators. The use of such techniques by U.S. personnel greatly diminishes the United States’ moral credibility and effectiveness as a defender of human rights, and offers tacit approval to repressive governments to inflict torture with impunity.

5. There is substantial evidence that U.S. forces have engaged in torture and ill-treatment

   A growing body of evidence shows that prisoners and detainees in U.S. custody in Afghanistan, Iraq, and Guantanamo Bay, Cuba have been subjected to a systematic pattern of torture and ill-treatment – and may still be subjected to psychological torture.

   A wide range of sources, including witness accounts, official investigations, government documents released under the Freedom of Information Act, leaked reports from the International Committee of the Red Cross, and media reports, offer extensive, credible evidence of physical and psychological torture inflicted by U.S. personnel. It is now clear that the alarming images from Abu Ghraib Prison were indicative of a broader pattern of ill-treatment in Afghanistan, Iraq, and Guantanamo. The record shows that this pattern has included physical abuse such as beatings, shackling in stress positions, exposure to extreme hot and cold temperatures, and deprivation of food. At least 28 detainees have died in circumstances classified by the U.S. Army as suspected homicides.⁴ The record also shows that this physical torture has punctuated a pervasive and systematic regime of psychological torture, including sleep and sensory deprivation, isolation, forced nudity, cultural and sexual humiliation, mock executions, use of dogs to exploit fear and instill terror, and threats of violence or death against detainees or their loved ones. These techniques often have been applied in combination to maximize their impact. (For a review of the evidence, see the Physicians for Human Rights report, Break Them Down: Systematic Use of Psychological Torture by U.S. Forces.)

6. Health professionals appear to have been complicit in ill-treatment of prisoners and detainees

   Available evidence suggests that some military medical personnel have participated in torture and abuse of detainees. Reports indicate, for example, that medical personnel were aware of prisoner abuse but failed to report or properly document it; that interrogators were given access to detainees’ confidential medical records; that health professionals participated directly in the development and implementation of abusive interrogation plans; and that doctors, other medical personnel, and “behavioral science consultation teams” of psychiatrists and psychologists may have facilitated abuse by giving interrogators information about detainees’ mental health and vulnerabilities. Indicative of the problem, the International Committee of the Red Cross described what it observed at Guantanamo in June 2004 as a “flagrant violation of medical ethics.” (See Break Them Down, pages 45-47.)

   On June 16, 2005, the U.S. Department of Defense issued new “Principles and Procedures” for the treatment of detainees by military medical personnel. These new guidelines explicitly distinguish the ethical obligations of health personnel involved in “provider-patient treatment” relationships from the obligations of those who are not. This significant deviation from internationally accepted standards for the medical role in interrogations effectively authorizes medical personnel who are not involved in a provider-patient relationship with a detainee to take part in abusive interrogations. Basing a health professional’s ethical duties on the nature of his or her professional relationship with a detainee has no foundation in medical ethics. The duty not to participate in, facilitate, or be present during torture and other cruel, inhuman and degrading treatment or punishment is absolute. The military’s new guidelines perpetuate the risk of medical complicity in torture. (See the Physicians for Human Rights letter on this subject to the Assistant Secretary of Defense for Health Affairs, June 17, 2005.)

7. Torture and abuse of detainees appear to stem from official policy

   The public record indicates that torture and abuse by U.S. interrogators may have stemmed directly from decisions made at the highest levels of government.

   In a dramatic departure from the United States’ traditional commitment to humane interrogations and the rule of law, the public record shows that government officials have created a new legal framework that appears to have led directly to the infliction of physical and psychological torture. Legal opinions by government officials deny or confuse the applicability of the Geneva Conventions and other sources of protection to prisoners and detainees in U.S. custody. Other official opinions have sought to define “torture” so narrowly as to exclude previously prohibited forms of psychological abuse, including sensory and sleep deprivation, forced nudity, hooding, exploitation of phobias, isolation, and more – techniques which were, at various times, explicitly authorized and employed in Afghanistan, Guantanamo Bay, or Iraq.

   Some forms of psychological torture may remain in use, authorized by still-operative official opinions and directives. (For background on this new legal framework, see Break Them Down, pages 12-16 and 72-100.).

8. Military investigations to date have been inadequate

   The U.S. military’s investigations to date have failed to provide adequate disclosure of, and accountability for, past abuses or to ensure that U.S. interrogators and medical personnel will not engage in torture or cruel, inhuman or degrading treatment going forward.

   Investigations to date have lacked necessary independence, have been limited in scope, have focused largely on the Abu Ghraib Prison scandal, have failed to provide accountability for torture and abuse up the chain of command, have failed to examine adequately the health professional role, and have ended in limited punishment for some low-level personnel and virtual exoneration of commanding officers.

¹ Code of Medical Ethics, E-2.067 Torture (Issued December 1999).

² "Against Torture: Joint Resolution of the American Psychiatric Association and the American Psychological Association," 1985 and 1986.

³ Jehl, D. "Pentagon Will Not Try 17 G.I.'s Implicated in Prisoners' Deaths." New York Times. March 26, 2005.

⁴ Golden T. “In U.S. Report, Brutal Details of 2 Afghan Inmates’ Deaths.” New York Times. May 20, 2005. The article summarizes a 2,000-page military file on two such detainees’ deaths in Afghanistan. The two had been beaten severely. Military coroners attributed their deaths to “blunt force trauma.” Some of the interrogators and guards allegedly involved were later transferred to the Abu Ghraib Prison in Iraq.