Just about anyone who ever goes to see a doctor grows accustomed to the idea that healers sometimes hurt us. They prick us with needles, cut us with knives, tell us the hard truths about our unhealthy lives. Me, I once passed a month during which a whole team of medical professionals daily aimed a particle accelerator at my groin and blasted away. We put up with all this poking and prodding and radiating because we trust that the doctors -- despite whatever biases may be introduced by financial enticements -- fundamentally intend to help us.
But what happens when, instead of helping us, the healers are in the service of people trying to hurt us? What if the doctors are working for torturers? "Medical complicity shows a prisoner that he or she is utterly beyond human appeal; complicit clinicians inflict the torture of despair." So says Dr. Steven H. Miles in Oath Betrayed: Torture, Medical Complicity, and the War on Terror.
Miles' book is an extensive investigation into the collaboration of military medical professionals with systemic torture practices at US prisons in Iraq, Afghanistan and Guantanamo Bay, Cuba. Miles allows that, for the most part, the participation of US physicians in the torture of these prisoners does not sink to the most absurd depravities of the Nazi concentration camp architects or the quack psychiatrists of Stalin's regime, but he insists on a higher standard than that.
He goes on to document how military medical professionals are, through sins of both omission and commission, aiding military interrogators in planning devastating torture programs and helping the military cover up the injuries and deaths that follow.
Military medical professionals in these prisons are consulted for advice on how to apply sufficient physical or psychological stress so as to break the prisoner into compliance, but not so much that the prisoner is no longer able to respond coherently to questions. (Note that humane behavior is not the limiting factor here.) In a blatant abuse of their profession, psychologists and psychiatrists interview prisoners, then, as part of "Behavioral Science Consultation Teams," advise interrogators on the prisoner's psychological vulnerabilities.
In most cases, the medical professionals' participation is less direct. The US government had, as of Miles' writing, acknowledged 19 prisoners' deaths during interrogation, but Miles offers extensive evidence that the number may be much higher. Death certificates are routinely delayed for months, even years, then signed by doctors either who have apparently not seen the body at all or who have been given insufficient access to relevant evidence. Multiple death certificates for the same person, often listing contradictory causes of death, raise questions about the validity of any of them. And Miles describes several suspicious deaths ruled due to "natural causes" despite glaring evidence that, say, the prisoner's heart attack was directly caused by torture.
While acknowledging the dilemmas created by the dual loyalties of military physicians, nurses and medics -- to both the medical profession and the military command structure -- Miles is uncompromising in holding them accountable (along with the American Medical Association, the US government, and a broader American culture that dehumanizes enemies and fantasizes torture).
"A prison medical staff is the front line of torture prevention," writes Miles. "Unlike Red Cross monitors, doctors, nurses and medics are in nearly all prisons at all times. They see most, if not all, prisoners. They are most likely to witness abuse or neglect. They are most likely to see signs of abuse before the bruises heal. Prison medical professionals and their counterparts in civilian society must choose to acquiesce or oppose, to be accomplices or healers."
Oath Betrayed sometimes strays too far and too long from what should be a tightly focused topic. That prisoners are kept in prisons insufficiently protected from weapons fire is certainly a problem worthy of attention, but like several other issues Miles raises, it is in no way under the control of the military medical staff. This dilutes an otherwise potent ethical argument. Despite this, Miles' clear prose and unparsed moral imperatives have the brace of one of those blunt examination room conversations: We're hurting ourselves as a nation by engaging in torture. If we keep it up, it will kill us. "Societies that torture light the fuse on a real time bomb," he writes. If we change our ways, a better life awaits.
Oath Betrayed: Torture, Medical Complicity, and the War on Terror
Steven H. Miles, M.D. (Random House, 222 pages, $23.95)