A watchtower is seen in the currently closed Camp X-Ray, which was the first detention facility to hold 'enemy combatants' at the U.S. Naval Station in Guantanamo Bay, Cuba. A three-year review of physicians' participation in force-feedings and detainee interrogations has concluded that military doctors engaged in abusive practices in Iraq, Afghanistan and Cuba and continue adhering to Defense Department policies that breach medical ethics. (Joe Raedle / Getty Images)
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A three-year review of physicians’ participation in force-feedings and detainee interrogations has concluded that military doctors engaged in abusive practices in Iraq, Afghanistan and Cuba and continue adhering to Defense Department policies that breach medical ethics.
The report released today by the Institute of Medicine as a Profession found that military doctors and health care personnel on behavioral science consultation teams, or BSCTs, who routinely supported interrogations and participated in force-feedings violate the primary principle of medical ethics: First, do no harm.
DoD and the CIA “required physicians, psychologists and other health professionals to act contrary to their professional obligations,” wrote the authors of “Ethics Abandoned: Medical Professionalism and Detainee Abuse in the War on Terror.”
“The agencies inappropriately held health professionals to ethical standards contrary to professional ethical principles,” the report states.
While DoD has shifted policies to protect physicians serving on BSCTs, established an ethics review board at Guantanamo Bay Detention Center and received court confirmation of the legality of hunger strike policies, more must be done to ensure U.S. military doctors adhere to the ethical principles of their professions, the report said.
The 20-member task force that drafted the study included academicians, legal experts, medical ethicists, an International Committee of the Red Cross representative, a former commander of Naval Hospital Guantanamo Bay and a retired Army general officer.
That officer, Brig. Gen. Stephen Xenakis, has testified before the Senate to recommend closing the detention facility at Guantanamo and is a longtime member of Physicians for Human Rights and Human Rights First.
In an interview with Military Times, Xenakis said the report should be a wake-up call to military physicians to stand up for their ethical practices and reassert their independence within military commands.
“Clinicians need to affirm their values and remember what got them into this profession,” he said. “Our principles are basic to human rights and we have a unique role as physicians to help people have quality of life.”
To create their report, task force members reviewed public documents as well as unclassified information and media articles. Members found that military physicians:
■ Were complicit in interrogations by recommending practices such as sleep and sensory deprivation, stress and extreme noise and temperatures changes to facilitate interrogations.
■ Sought vulnerabilities in detainees’ psychological evaluations and possibly health records to exploit in interrogations.
■ Did not appropriately provide mental health treatment for detainees with psychological conditions caused by interrogations.
■ Are innappropriately acting as agents for Guantanamo Bay Detention Center by participating in force-feeding.
“The American public has a right to know that the covenant with its physicians to follow professional ethical expectations is firm regardless of where they serve,” said Dr. Gerald Thomson of Columbia University, a task force member. “It’s clear that in the name of national security, the military trumped that covenant.”
However, the report stopped short of blaming physicians themselves for the activities. Instead, the recommendations focus on policy changes by DoD and the White House, as well as the associations that govern medical ethics and states, which license health professionals, to adopt policies and practices that protect human rights and censure those who breach professional standards.
“These young doctors, the captains, majors and lieutenant colonels, need to be fully supported. The burden rests with the senior leaders,” Xenakis said.
Joint Task Force Guantanamo spokesman Cmdr. John Filostrat said 14 detainees are receiving enteral feedings, or “e-feedings,” as they are known.
Filostrat could not comment on the task force report but said DoD policies are designed to “protect the life and health of detainees by humane and appropriate clinical means, and in accordance with all applicable law and policy.”
“The Joint Task Force Guantanamo medical staff continuously monitors and provides exemplary medical care to detainees at Guantanamo. The health and well-being of detainees is their primary mission, and they take this duty as seriously as they take their duty to provide medical treatment to U.S. service members or any other patient in their care,” Filostrat said.
DoD has taken a number of steps to shield its medical professionals, including setting policies that protect detainees’ medical records, establish certain health providers as security officers rather than practicing clinicians and establishing an abuse reporting system.
U.S. courts have upheld the practice of e-feeding. In 2009, for example, the U.S. District Court for the District of Columbia upheld DoD policies on treating detainees engaged in a hunger strike.
Defense Secretary Chuck Hagel in October appointed former Marine and attorney Paul Lewis to serve as special envoy for the closure of the Guantanamo prison.
About 160 detainees are still held at the facility.