Latest American Psychological Association Board Letter on Interrogations Policy - Response

Bioethicist Steven Miles Responds to Latest American Psychological Association Board Letter on Interrogations Policy

June 18, 2009

APA Board of Directors

Re: Your Open Letter to APA Membership
of June 18, 2009 on Psychologists and Torture

Dear Board,

I have been extensively involved in studying the issue of health professional involvement in abusive interrogations in the war on terror prisons. Your June 18, 2009 letter to the APA membership is a welcome but incomplete shift of APA policy.

It is welcome because it states that the APA has retreated from its untenable insistence that no psychologists were involved in torture or other forms of cruel, inhuman, or degrading treatment. This official acknowledgment is new but the fact of these abuses has been established for several years. Speaking in their official capacities, APA’s former President, Dr. Gerald Kootcher, and its ethics officer, Dr. Stephen Behnke, have repeatedly issued ungrounded denials of these facts despite having ample information that those denials were false.

The APA Board’s letter was also welcome because, it states that the 2008 petition, Psychologists and Unlawful Detention Settings with a Focus on National Security, would be fully integrated into APA policy. That resolution was openly opposed by the Defense Department operating those same detention centers. After passage by the membership who voted in accordance with APA by-laws, APA governance gave that position second class status by asserting that since it did not pass through the conventional internal ethics policy making process, it could not serve as a standard for assessing the conduct of APA members.

The current Board’s position, as outlined in the June 18 letter, remains incomplete.

1. It lays out a process for incorporating the 2008 referendum into APA policy but it does not give a timeline.

2. Its newly passed “No defense to torture under the APA ethics code” statement (http://www.apa.org/releases/ethics-statement-torture.pdf) is a hastily written statement that does not define torture; ignores the concept of cruel, inhuman, and degrading treatment; does not address the duty to report observing such abuse and so on.

3. It does not acknowledge the failure of the APA to manage the conflicts of interest in membership and process of the PENS Task Force. These failures stained the reputation of APA, divided APA’s membership, separated APA from the larger community of health oriented professionals and produced a report that was tailor made to the design, policies, and operation of previous United States system of abusive interrogations.

4. It states the APA will monitor and will investigate reports of ethical misconduct by APA members but it does not address the status of previously filed allegations.

This progress and these omissions suggest steps that the APA Board should now take.

1. It should entirely retract the PENS Task Force report.

2. It should reassign Dr. Stephen Behnke from the position of Director of the APA Ethics Office. His credibility in that position has been irredeemably compromised by his management of the conflicts of interest of the PENS Task Force, his repeated categorical denials of psychologist and APA member involvement in abusive interrogations, and his Office’s handling of formal allegations about the APA member’s complicity with abusive interrogations. He cannot serve effectively in his position.

3. It should endorse the Declaration of Madrid and Declaration of Tokyo, substituting in the word psychologist for psychiatrist or physician. Perhaps this could be a provisional time-limited measure until APA reconstitutes a process for creating a specific standard for psychologists.

4. The Ethics Office should clarify the status of proceedings and findings (if upheld) of psychologists against whom formal complaints of complicity with abusive interrogation have been filed.

These steps would go a long way to putting the APA on a new direction. They would create a clean break with its past. They would bring the APA back into the international community of health professions. They would enable it to speak with moral authority on behalf of psychologists who are endangered by speaking out against torture in other nations.

Sincerely,

Steven H. Miles, MD
Professor of Medicine
Center for Bioethics
University of Minnesota
N504 Boynton
410 Church Street SE
Minneapolis, MN 55455
612-624-9440
miles001@umn.edu

"Medical Ethics and Torture: Revising the Declaration of Tokyo"

Extracted From the Blog Invictus ( click here to be redirected):

The following is a press release from The Lancet, describing an important new article on the question of medical ethics in relation to the torture of prisoners. It is reproduced here:

A Viewpoint in this week’s edition of The Lancet discusses how the 1975 Declaration of Tokyo, on Medical Ethics and Torture, could be further revised to make it more relevant to the world today — making sure that physicians who are complicit in torture of prisoners are held to account. The Viewpoint is written by Dr Steven Miles, Center for Bioethics, University of Minnesota, MN, USA, and Dr Alfred Freedman, New York Medical College, USA.

Medical complicity with torture and abuse of prisoners is common in the roughly 100 countries that practise torture. Physicians devise ways to keep physical scars to a minimum, certify prisoners as fit for abuse, monitor vital signs during mistreatment, and give approval to intensify abuse. A third to half of torture survivors report physicians overseeing the abuse; this number does not include those who do not see physicians being accomplices of the abuse and those who die of torture that a physician, either willingly or under coercion, certifies as death by natural causes. Many more physicians are complicit with abusing prisoners than work in programmes to treat torture survivors.

The World Medical Association’s (WMA) Declaration of Tokyo has been a landmark event in medical ethics. It was passed in 1975, and has undergone several revisions. The declaration condemns medical participation in torture, and cruel, inhuman, or degrading treatment, or any act to diminish the ability of the victim to resist such treatment. It serves as a template for many medical codes. Although the WMA updated the Declaration of Tokyo in 2006, a revised version might further clarify medical roles and duties in countries where prisoners are abused.

The authors propose four manners in which the code should be revised. First, it should incorporate authoritative definitions of torture and cruel, inhuman, and degrading treatment, to harmonise this medical ethics code with international law and, thereby, communicate the accountability of physicians to international law. Second, a revision of the Declaration of Tokyo should incorporate some of the good ideas recently endorsed by various clinical societies — for example, a death certificate should be publicly posted for every death in custody, as is currently mandated for prisoners of war by a Geneva Convention. False or non-issued death certificates conceal torture. Third, a revision of the Declaration of Tokyo must commend ways for holding physicians professionally and criminally accountable for abetting abuse of prisoners — including those who flee the country where the abuse occurred and attempt to obtain a licence to practice elsewhere. Finally, a revision of the Declaration of Tokyo should be readable by a person with 12 years of education — the current version needs advanced collegiate-grade reading skills, with its average sentence containing more than 30 words.

The authors conclude: “The medical community is key to the campaign against torture. Governments that practice torture need complicity of prison medical personnel. Furthermore, a profound link exists between domestic torture and worldwide medical solidarity against torture. A physician community that acquiesces to abuses by its members undermines its credibility in protesting against foreign medical communities or colleagues who abet torture. Accordingly, physicians and their societies must act on their duty to promote prisoners’ wellbeing, access to prisons, skills at identifying abuse, and membership of civil society.”

Of special interest in Miles and Freedman's article is their delineation of what they call unofficial teaching definitions of torture and cruel, inhumane, and degrading treatment or punishment. (The article covers the de jure definitions, as well). These two categories are often buried in legalese and, therefore, confusion. Their "unofficial definition" is meant to cut through the obfuscations:

Torture is any act that intends to cause a prisoner to feel severe physical or mental pain or suffering. Torture occurs when a government official orders, supervises, consents to, allows, or performs acts that cause such pain or suffering.

Torture is unacceptable for any reason, including when it is used to:

-- obtain information or a confession from the tortured person or someone else or
-- punish the tortured person or someone else for an act that he or she has done or is suspected of having done or
-- frighten or coerce the tortured person or someone else or
-- discriminate against a race, religion, political belief
-- or any other reason

This definition does not include pain or suffering that is caused by legal prison conditions and sentences

Cruel, inhumane, or degrading treatment or punishment is any physical or mental abuse. Among other things, it includes depriving a prisoner of sight, hearing, and awareness of place or the passing of time.

Furthermore:

A physician [or any treating professional, such as a psychologist] should not:

-- assist with torture and cruel, inhuman, or degrading treatment or punishment
-- be present when a prisoner is subject to, or threatened with, torture and cruel, inhumane, or degrading treatment
-- provide or withhold clinical facilities, equipment, supplies, or knowledge to support torture and cruel, inhuman, or degrading treatment
-- assist procedures that aim to decrease a prisoner's ability to resist interrogation or punishment;
-- withhold, or threaten to withhold, medical assessment or treatment from a prisoner who is not cooperating with officials;
-- assist in certifying a prisoner's fitness for interrogation, treatment, or punishment that might harm that person's physical or mental health
-- assist in monitoring an interrogation, treatment, or punishment to advise officials to modify procedures that might harm a prisoner's physical or mental health.

Miles and Freedman note that there is a "pandemic of torture" going on in the world. The attempt to squeeze torture techniques into the U.S. Army Field Manual, and furthermore cover up the attempt, is only one aspect of this frightening spread of the torture cancer. Arm in arm with it, there is an attack on civil liberties in general, and a glorification of militarism and brutality in public life and political action. The invasion and attack on Gaza, the missile attacks by U.S. robot aircraft in Afghanistan and Pakistan, the massive death of civilians in Iraq, the Congo, Somalia, and elsewhere around the world are part and parcel of the torture ethic, which reduces human beings to mere things, despised objects, and victims of national greed and will.