MD's broke Geneva Conventions, Says N. Engl. Journal of Medicine:

Joe Stephens for Washington Post, 1/8/2005

By Joe Stephen

** Medical Workers Helped Tailor Interrogations of Detainees, Article Says **

Washington Post January 6, 2005 Page A08

U.S. Army doctors violated the Geneva Conventions by helping intelligence officers carry out abusive interrogations at military detention centers, perhaps participating in torture, according to an article in today's edition of the *New England Journal of Medicine*.

Medical personnel helped tailor interrogations to the physical and mental conditions of individual detainees at Abu Ghraib prison in Iraq and the U.S. military prison at Guantanamo Bay, Cuba, according to the article. It say that medical workers gave interrogators access to patient medical files, and that psychiatrists and other physicians collaborated with interrogators and guards who, in turn, deprived detainees of sleep, restricted them to diets of bread and water and exposed them to extreme heat and cold.

"Clearly, the medical personnel who helped to develop and execute aggressive counter-resistance plans thereby breached the laws of war," says the four-page article labeled "Perspective."

"The conclusion that doctors participated in torture is premature, but there is probable cause for suspecting it."

The article was written by M. Gregg Bloche, a law professor at Georgetown University and adjunct professor at Johns Hopkins University, and by Jonathan H. Marks, a London barrister who is a bioethics fellow at Georgetown University Law Center and Johns Hopkins. It is based on interviews with more than two dozen military personnel and on a review of documents released to the American Civil Liberties Union under the Freedom of Information Act.

Pentagon officials said yesterday that the article is inaccurate and misrepresents military officials' positions and acts. Doctors did not violate the Geneva Conventions, said William Winkenwerder Jr., assistant secretary of defense for health affairs. Some functioned as consultants to intelligence officers but never acted unethically, he said.

"We have no evidence of maltreatment by physicians, or of physician participating in torture or torturous activity," he said. "We just do not have evidence of that."

The article in the medical journal purports to add new facts to the public record and put others in context. But it is most significant because it add to a chorus of concern expressed by respected medical institutions, said Arthur L. Caplan, director of the Center for Bioethics at the University of Pennsylvania.

"The *New England Journal of Medicine* plays a unique role in serving as a moral beacon for the health profession; when they take it on, it's important," Caplan said.

Leonard S. Rubenstein, executive director of Physicians for Human Rights, an advocacy organization based in Cambridge, Mass., added: "This underscores the pressing need for a transparent and full investigation, which the Pentagon ha consistently refused to initiate."

The Geneva Conventions forbid the use of abusive techniques in questioning prisoners of war. Tactics used in Iraq and Cuba were "transparently coercive," the article says. It discloses that the Army's surgeon general i developing new rules for medical personnel who work with detainees, and it authors call for a broad, public effort to develop new guidelines for military doctors.

"The therapeutic mission is the profession's primary role and the core of physicians' professional identity. If this mission and identity are to be preserved, there are some things doctors must not do," the article says. "They should not be party to interrogation practices contrary to human right law or the laws of war."

Doctors also have a duty to document abuse and report it to commanders, the article says, concluding that "by these standards, military medicine ha fallen short."

Defense Department officials challenged that assessment, saying that military doctors are always expected to act ethically. Doctors who function a caregivers fulfill a different role than doctors who consult with intelligence officers, they said. Often, the consulting doctors help ensure that interrogators do not inadvertently endanger a detainee's health, they said.

"We always expect a physician to behave ethically in any circumstance," Winkenwerder said. "There is no question about that. We just would take offense to the implication that there are situations or circumstances where we would advise people to look the other way."

He rejected implications that medical personnel control interrogations, and said detainees' medical records are treated in manner similar to those of U.S. prison inmates. When incarcerated, he said, "the individual does not have a complete and absolute right to privacy of medical information. That is the standard in prisons."

The article is the most recent criticizing the medical treatment of detainees. In July, an essay in the *New England Journal of Medicine* urged U.S. military doctors to come forward with any evidence of recent abuse. In August, the British medical journal the *Lancet* charged that medical worker at Abu Ghraib had falsified death certificates and did not report injurie from beatings. After an inspection at Guantanamo Bay last summer, the International Committee of the Red Cross charged that methods used there were tantamount to torture.

The *Washington Post* reported in June that military interrogators at Guantanamo Bay had been given access to the medical records of individual prisoners despite repeated objections from the Red Cross, a breach of patient confidentiality that ethicists said violated international medical standards. The article in the *New England Journal of Medicine* says that interrogator in Iraq also had access to prisoners' medical files.

The article says that David N. Tornberg, deputy assistant secretary of defense for clinical and program policy, confirmed in an interview that interrogation units at Abu Ghraib and Guantanamo Bay had access to detainee medical records. In fact, interrogators "couldn't conduct their job" without such access, Tornberg is quoted as saying.

He and other military officials argue in the article that when a doctor participates in interrogation, he is acting as a combatant, so the Hippocratic oath does not apply.

Tornberg is on leave and was unavailable to comment yesterday. Winkenwerder said that he believes Tornberg's comments were misrepresented in the article, and that they did not represent the Defense Department's views.