Health Care Professionals Urge Obama to End Forced-Feeding of Guantanamo Hunger Strikers

The following is a press release from Psychologists for Social Responsibility (PsySR), who gathered hundreds of signature and the support of other human rights associations to appeal to the President to stop the forced-feeding of hunger strikers at Guantanamo. The forced-feeding policy by the Department of Defense is blatantly against the policy of health organizations around the world, including the American Medical Association, the World Medical Association (see their Declaration of Tokyo), and the British Medical Association.

DoD is on a propaganda campaign to promote their policy (see here and here). But as this UK Guardian article notes, "Force-feeding policies have never succeeded."

Force-feeding is not a new concern. It fell rapidly out of fashion in 1917 after Irish republican Thomas Ashe unexpectedly died after being fed, and again in the 1970s following IRA hunger striker Michael Gaughan's controversial death. Then, as now, medical professionals and human rights activists raised concern about the dubious use of the stomach tube to suppress hunger strikers. The World Medical Organisation's 1975 condemnation of force-feeding as torturous and degrading seemed to signal an end to the practice. Indeed, one of the key reasons why Thatcher was left with few options but to allow IRA hunger striker Bobby Sands and his fellow prisoners to starve – in the face of politically damaging controversy – was because she knew that force-feeding was no longer ethically viable.

What follows is PsySR's press release:

On August 12th, over 400 health care professionals and human rights leaders sent an urgent appeal to President Obama to order Guantánamo detention camp officials to stop force-feeding hunger strikers, immediately release the detainees approved for release, and make closing Guantánamo his first priority. Now in its seventh month, the hunger strike included 106 detainees at its peak, with as many as 46 of them force-fed.

The letter states that force-feeding mentally competent adults is a violation of medical and nursing ethics, and emphasizes that the method of force feeding in Guantánamo is “exceptionally brutal.” In describing the procedure in which the detainee is forcefully extracted from the cell by several soldiers and strapped into a restraint chair for up to two hours, the letter also notes that “Men weakened by significant weight loss are particularly at risk for serious injury during this regimen.”

Sponsored by Psychologists for Social Responsibility and signed by ten additional organizations, including the Center for Constitutional Rights and Physicians for Human Rights, the letter focuses on the ethical and professional dilemmas of Guantánamo health personnel who force-feed the detainees:

“Health care professionals, including those in the military, must maintain their licenses in good standing, and to do so they must follow standards of good ethical practice. This is not what is happening during the hunger strike.”

Because information is classified at Guantánamo, doctors, nurses and psychologists cannot honor their ethical obligations to confer with independent experts in such dilemmas, and are “constrained from securing the support of their professional colleagues if they experience reprisals for registering a complaint or refusing to participate further.”

The signers urge President Obama to “act immediately before more prisoners die” and argue that as Commander-in-Chief he has the power to immediately stop the force-feeding, release the detainees approved for release, and make closing Guantánamo his top priority.

The full text of the letter with the list of all signers is available online at www.psysr.org/GTMO-Letter.

"Faustian Bargains": Jay Katz on the History of Human Medical Experimentation

The following is a reprint of a presentation given during a public meeting of the Advisory Committee on Human Radiation Experiments (ACHRE) by Dr. Jay Katz, a nationally-renowned doctor and ethicist, who was also a professor at Yale Law School. Dr. Katz died in November 2008. The presentation is in the public domain, and reprinted here as a public service.

One of the great problems with the public discussion of these issues is that they remain restricted to difficult to access professional journals, or expensive books generally unavailable to the average person (though the advent of Google Books has changed that somewhat). Keeping the discussion of informed consent and research issues out of the general public discourse has been one of the primary reasons that violations of ethical standards remains such a serious societal problem.

The New York Times obituary for Dr. Katz describes him as "an outspoken public advocate" about ethical rules for medical experimentation and the need for patient consent, who wrote about "the sometimes blurred line between medical ethics and the law" in books such as Catastrophic Diseases: Who Decides What? (1975) (written with Alexander M. Capron). Dr. Katz also served on the Tuskegee syphilis study ad hoc advisory committee that examined the ethical breaches of that study and made recommendations about strengthening informed consent rules and oversight.

Amazingly, this discussion has not been reprinted anywhere, but only appears on the National Security Archives (NSA) site at George Washington University, a real treasure for researchers, journalists and historians. The NSA obtained the Advisory Committee on Human Radiation Experiments (ACHRE) documents after ACHRE was dissolved in October 1995. (Readers trying to access that report from the NSA page will have trouble, as the link apparently changed. The ACHRE Final Report is now available at this link.)

Readers might wish to follow up Dr. Katz's presentation by reading the Truthout article by Jason Leopold and Jeffrey Kaye, Wolfowitz Directive Gave Legal Cover to Detainee Experimentation Program. This article, which includes comments by Prof. Capron, discusses changes to U.S. laws and Department of Defense policies on "informed consent" that took place in the months following 9/11. These changes significantly weakened informed consent rules and policies. Other articles that touch on possible recent government experiments on prisoners in the "war on terror" are also worth reading in light of the issues discussed here, including another recent article by Leopold and Kaye on dubious use of antimalarial drugs (for possible torture) at Guantanamo (and also here), a Seton Hall study on the same, and a Physicians for Human Rights report on CIA experiments on torture.

In the following article, all subheads have been editorially added, mainly to enhance article readability. I have added a few editorial remarks and notations, reformatted line breaks for flow and readability, and quietly fixed a few typos. Finally, I bold emphasized a few portions of the presentation for editorial emphasis.

The day for the presentation, the fourth such public meeting by the ACHRE advisory committee, was Wednesday, July 6, 1994. The place was the ballroom of the Vista Hotel, Washington, D.C.

++++++++++++++++++++++++++++++++++++++++

HISTORY OF HUMAN EXPERIMENTATION

DR. KATZ: I've assigned myself three tasks. I'll try to, of course, be as brief as possible. One is to present to you with some commentary the more significant dates in the history of the regulation of human experimentation; two, to make some comments on the inherent tension in the conduct of research; and, finally, to share with you, albeit most briefly, some of the lessons that I have learned during my 30 years' reflection on this history and the implications for the future regulation of human research.

So first the dates. In my prepared comments, which I hope will be eventually distributed to the Committee, I made some more extensive commentaries on the wonderful presentation of Susan Lederer's. And here because of the constraints of time, I only want to highlight one of the things that she told us during her presentation, namely, and I quote, "that many physicians believe that introducing an explicit requirement for consent would interfere not only with the practice of medicine, but also with the progress of medical science," end quote.

I think in a few words and with an economy of words, she captured one of the most important problems inherent in human research, to which I will come back again and again during this talk, because Susan alerts us here to the fact that investigators' concern that an abiding commitment to informed consent has far-reaching implications for the physician-patient relationship as well as for the conduct of research. And I believe that to this date, these concerns still pervade what is going on in human experimentation.

Early Codes of Medical Ethics as Regards Human Experimentation

Now to the dates: first, 1803. Thomas Percival at the request of the Manchester Infirmary of England published his code of medical ethics which with minor modifications became in 1947 the American Medical Association's first code of medical ethics.

Percival appreciated that medicine must develop innovative therapies in order to advance medical practice and admonish physicians only that in doing so, quote, "The gentlemen of the faculty should be scrupulously and conscientiously governed by sound reason, just analogy, or well-authenticated fact," end quote.

He said nothing about consent. Indeed, he commanded patients that, quote, "their obedience to the prescriptions of their physicians should be prompt and implicit. They should never permit their own crude opinions as to their fitness to influence the attention to them," end quote.

The AMA's code incorporated these instructions to patients. It omitted any reference to the ethics of innovative treatment or to human experimentation.

Eighteen thirty-three, William Beaumont's code, which Susan did discuss. [Editor note: Lederer was at the time assistant professor of the history of medicine at Yale. On May 18, 1994 ACHRE public meeting in the Washington Room at the Ramada Plaza Hotel in Washington, D.C., Dr. Lederer gave a presentation on the history of human experimentation in the United States. Regarding William Beaumont, she said:

One of the most famous instances of nontherapeutic human experimentation in the 19th century was the study of human digestion conducted by Army physician William Beaumont in the 1820s and 1830s. This story may be familiar to many of you, but it's an important milestone.

Beaumont was called in to treat a French-Canadian trapper, Alexis St. Martin, who had received a gunshot wound to the abdomen. Unable to close the wound, Beaumont realized his unprecedented opportunity to study the process of digestion in a living human being. In an unusual step, he actually contracted with St. Martin for permission and cooperation in his experimental program. St. Martin agreed in exchange for board, lodging, and $150 a year to assist and promote by all means in his power "such philosophical and medical experiments as the said William shall direct or cause to be made on or in the stomach" of him.

Now from all accounts, Beaumont and St. Martin had a difficult relationship. (Laughter.) St. Martin, who found many of the experiments uncomfortable -- these include, for example, tying a piece of meat on a string and putting it into the fistula and timing the digestive powers. St. Martin was often absent for projected periods of time, and Beaumont greatly resented the apparent ingratitude of his often recalcitrant subject. At no point, however, were there public criticisms voiced about these experiments and there was great interest in them.

Before the Civil War, such contractual arrangements between subjects and experimenters were unnecessary when white physicians used slaves as research subjects. In some instances physicians advertised and purchased blacks for the sole purpose of experiment.

Much more on medical experimentation on Black Americans in the early history of the United States can be found in Harriet A. Washington's book, Medical Apartheid. -- End editorial note.]

Three, 1865, Claude Bernard laid down his principles for the ethical pursuits of human experimentation. He enjoined the medical profession from doing anything that may be harmful to patients.

Bernard limited his focus to situations in which patient care, innovative therapy, and therapeutic experimentation become merged, excluding from consideration non-therapeutic research. Throughout he said nothing about patient subject consent.

Four, 1900. The Prussian Minister of Religious, Educational, and Medical Affairs' directive on human experimentation may be the first regulatory action that specifically addressed human experimentation. It set forth that research is prohibited unless, quote, "the person concerned has been clear unequivocally that he consents to the intervention," end quote.

In 1931 the German Reich Minister of the Interior promulgated regulations which were even more stringent and comprehensive than the Nuremberg Code.

Ethical Principles Disregarded

And I will not say more about these interesting historical events except they demonstrate to my satisfactions that we shouldn't pay too much attention to codes of ethics. They are largely being regarded [disregarded?]. Codes of ethics are written to the stars and to the heavens, and they only require meaning if they are surrounded by detailed commentary.

Remember what Rabbi Hillel said when a pagan said, "If you can tell me the essence of Judaism while standing on one leg, then I will join your religion." Rabbi Hillel thought for a moment, stood on one leg, and said, "Do unto others as you do unto yourself. The rest is just commentary. Go and learn it." It's the going and learning it which is the important issue, not the prescription.

And let me here only observe in passing because Susan talked about it at some length that, really, these kinds of principles were disregarded by the European and American research profession.

In the mid-Nineteenth Century, to add just one example, a famous investigator wrote this in an article published in a major scientific journal, quote, "Perhaps others will not be restrained from making further experiments often leading to the complete wrecking of the lives of the persons subjected to them.

"It would add considerably to my peace of mind in respect to the victims' state if these experiments were to spread the conviction" -- that's his experiments -- "that the secondary stage is contagious if they lead to the establishing of such an important truth, the suffering of a few individuals were not too high a price to be paid by mankind," by mankind, mind you, "for the attainment of such a truly beneficial and practical result," end quote.

Nineteen forty-seven, the Nuremberg Code. Since many of you have read my article on -- I hope that some of you have read my article on the consent principle of the Nuremberg Code. [Ed Note: Dr. Katz is most likely referring to his 1992 article, "The Consent Principle of the Nuremberg Code: Its Significance Then and Now."] Therefore, I shall limit myself to the briefest of observations.

The Nuremberg Code

Never before in the history of human experimentation, again, of course, except for the 1900 and 1931-1930 German regulations, and never since has any code or regulation put it so uncompromisingly, quote, "The voluntary consent of the human subject is absolutely essential," end quote.

But there is more. Principally one of the codes then immediately goes on to emphasize not the subjects' capacities to understand, but the investigators' obligation to desist from introducing into the consent process, quote, "any element of force, fraud, deceit, duress, overreaching, or other ulterior form of constraints or coercion," end quote.

The judges of the Allied military tribunal, thus, placed the emphasis where it first belongs, on the physician investigator, and not on the patient subjects, who are so frequently not only mistreated but then further degraded by allegations that they are too anxiety-ridden, too ignorant, too stupid to understand.

The Nuremberg judges did not appreciate the code's radical break with the past. Indeed, before setting forth their 10 principles the court observed that even, quote, "The protagonists of human experimentation agree that certain basic principles must be observed in order to satisfy moral, ethical, and legal concepts," end quote, and that, therefore, their code only lists them once again.

The tribunal had done more than that. Perhaps it was misled by the prosecution's chief medical witnesses and Alexander Ivy and Leo Alexander. Particularly Ivy invoked again and again the authority of the Hippocratic oath for the proper conduct of research since it is, and I quote here Ivy, "the golden rule of the medical profession necessary for the survival of the scientific and technical philosophy of medicine," end quote.

He was quite actually disingenuous in what he had done because he averred that these principles had been accepted by the American Medical Association.

On cross-examination, however, the defense made him admit that the guidelines Ivy cited in his June 1947 testimony had been published only 19 days after the prosecution's opening arguments. It is most likely that Ivy, who had studied the prosecution's pretrial records, reported his views on the ethics of medical experimentation to the AMA's Board of Trustees, who then, in turn, quickly issued their guidelines.

Seven, 1969. The Nuremberg Code was superseded by the World Medical Association's Declaration of Helsinki, which was revised twice. The requirement of informed consent is much less stringently reworded in Helsinki one than in the Nuremberg Code. It is not even listed as a basic principle.

To be sure, the Nuremberg Code requires modification, particularly with regard to research with children and mentally incompetent patients. But here is my question: Should its first principle have retained its majestic force?

New Regulations in the 1960s

Eight, 1962. In the wake of the Thalidomide tragedy, extensive congressional hearings were held on the adequacy of the then existing FDA regulations. Eventually they were revised, now requiring investigators to obtain the consent of human subjects in research with investigational drugs unless the investigators believed that obtaining consent was not feasible or in their professional judgment contrary to the best interests of such human beings. The Lord giveth, and the Lord taketh away.

The ambiguous language of these new consent provisions was never clarified, thus inviting wide variations in the application of the law.

In 1966, following the revelations of the Jewish Chronic Disease Hospital in Brooklyn, Brooklyn's experiments, during which elderly patients were injected with cancer cells to study the rate of rejection of live cancer cells in the wake of these revelations, the FDA regulations on consent were once again tightened.

But old problems remained. Let me only mention two: one, in abrogating the investigators' authority to dispense with consent on grounds that, quote, "the best interests," end quote, of patients required them to do so and in not doing so, doctors continued to wear two hats, that of investigator and that of physician for the patient; two, omitting patients in coma or otherwise incapable of giving consent to be enrolled in studies, sanctioned experiments, and seriously ill and terminally ill patients, even those in coma or close to death.

Nine, 1966, following a series of preliminary policy statements, the Surgeon General, William Stewart, issued three key guidelines which from then on should govern the conduct of human research of grantee institutions.

The guidelines were to assure that: one, the rights involved here of research subjects would be protected; two, investigators would obtain informed consent; and, three, the risks and potential benefits of the investigations would be assessed.

The implementation of these guidelines were vested in a review panel of investigators' peers at the research institutions. The number of lay members serving on these panels was not clearly specified.

Institutional assurances of compliance with the guidelines were mandated. The third guideline, calling for the establishment of what are now called institutional review boards, was most novel in scope. Moreover, it established the policy that the local research community should administer and review its own research practices in compliance with any regulations promulgated by PHS [Public Health Service] or NIH [National Institute of Health].

The Tuskegee Syphilis Study

Ten, 1972. As is often the case, the right hand does not know what its left hand is doing. In this instance, while NIH, PHS debated the scope of the new regulations, the PHS did not reevaluate its Tuskegee syphilis study to determine that the study was in compliance with its guidelines. The study continued for six more years, when it became a cost liability, and then was quickly terminated.

The facts of the study are well-known to you, and I will not give you any details except to remind you that the study started before the Nazi concentration camps, continued once the Nuremberg Code had been promulgated and did so for 25 more years.

In the final report of the Tuskegee syphilis study ad hoc advisory committee, we also made extensive recommendations for the future regulations of research. The cornerstone of our proposal was the establishment of a national human investigation board.

Senator Kennedy introduced a bill that incorporated that idea, but it died in committee. And at various congressional hearings that Senator Kennedy held, representatives of HEW [former Department of Health, Education and Welfare] argued that the department was in the process of drafting new regulations for the protection of subjects of research and that, therefore, it was not necessary to go as far as the Tuskegee syphilis study ad hoc advisory committee wanted to go.

Among recommendations that they were most troubled by, it seems to me, was that we wanted that board to be independent of NIH and PHS. And they wanted to retain authority over the ethical review of research practices.

The Rise of Institutional Review Boards

Eleven, 1974. The publicity surrounding the Tuskegee syphilis study led to the federal regulations for the protection of subjects of research. These regulations strengthen the role of local institutional review boards in supervising the conduct of research, requiring them to be in compliance with the new federal mandate.

Generally the IRBs were required to determine that the risks to the subjects be minimized and be reasonable in relation to anticipated benefits, that the selection of subjects be equitable, and that appropriate informed consent be obtained and documented.

Separate specific regulations also provided additional protection to any research activities that involved fetuses, pregnant women, prisoners, and children. Actually, they came a few years later.

IRBs were also charged to report violations of the regulations to the government, but otherwise no formal mechanisms were put in place whereby the activities of IRBs or investigators would be monitored by the federal government. Initially the regulations applied only to research funded by HEW.

Twelve, 1975. Senator Kennedy, once his bill on establishing a national human education board proved unacceptable to Congress, introduced another bill that created a national commission for the protection of human subjects of biomedical and behavioral research, which was inter alia charged to identify basic ethical principles that should underlie the conduct of human subjects research.

In 1978 the commission published its Belmont report on the ethical principles and guidelines for the protection of human subjects. I shall comment on that report very briefly later on.

Nineteen ninety-one. The federal regulations were amended to include all research involving human subjects conducted or supported or otherwise subjected to regulation by any federal department or agency.

And then, last, 1994. There are a number of bills being drafted on refining the regulations on human research.

Again, I will just say a few words, and I have a little bit more to say about it in my report. There are three other historical facts that should be mentioned here.

Experimentation, Common Law, and Informed Consent

One is that common law judges have really made few pronouncements over the centuries on the conduct of research. Put most briefly, what common law judges have said is that they believe that human experimentation was necessary, talking mainly, really, about innovative therapies, rather than human experimentation in the ways in which we talk about it now.

And they then added that either that kind of investigative activity must not depart too much from common medical practices or to say to doctors when they didn't like it, "Look, you do these things at your peril. Unless you prove the success of your treatment or of your innovative treatments, then you may have to face some unspecified legal consequences."

Two, I should say something more about the history of informed consent. That is the reason why I included the second article of mine in the materials distributed to you.

Let me just only emphasize once again what I've said there, that, really, it must be remembered that the doctrine of informed consent cannot easily be transformed, and surely not without considerable thought, into an ethical medical doctrine that should govern physicians' and physician investigators' disclosure and consent obligations in their interactions with patients and patient subjects.

Recall that the idea of patient economy is not to be found in the lexicon of medicine throughout the millennia of Hippocratic practices and that it only surfaced in medical discourse once informed consent was imposed upon medicine by alien common law judges, you might say by barbarian common law judges.

Three, I should say something about the few comments in a handful of cases made by federal judges about the conduct of research. Again, in my prepared version I've included one case: the LSD experiments conducted by the CIA with completely uninformed Army personnel.

The CIA LSD Experiments

When one of these cases ultimately ended up before the Supreme Court, Justice Scalia writing for the majority concluded that permitting Stanley even to sue the Army would, quote, "call into question military discipline and decision-making." [Ed. Note: This would have been the case of James Stanley, U.S. v Stanley, 483 U.S. 669 (1987), discussed in Ch. 3 of the ACHRE's Final Report. The Supreme Court invoked the Feres Doctrine to dismiss Stanley's case. See the discussion of the government's use of sovereign immunity in these kinds of cases in this 2003  article by James Bovard at The Future of Freedom Foundation. Stanley was "an army sergeant who volunteered in the late 1950s for a program supposedly testing protective clothing. The Army covertly drugged Stanley and many other soldiers with LSD to study the drug’s effects."]

The two eloquent dissents [to the majority opinion in U.S. v Stanley] would have some implications for our work. Justice O'Connor after referring to the Nuremberg Code and its first principle went on to say that, quote, "If this principle is violated, the least society can do is to see that the victims are compensated as best they can be by the perpetrators. I'm prepared to say that our Constitution's promise of due process of law guarantees this much," end quote.

And Justice Brennan concluded his dissent with these words, quote, "The subject of experimentation who has not volunteered is treated as an object example. Soldiers ought not be asked to defend a Constitution indifferent to their essential human dignity," end quote.

While this completes my sketchy account of the history, let me remind you that Susan commented on the fact that throughout this history, some investigators, like Walter Reed and such giants of medicine as Walter Cannon and Sir William Osler, spoke eloquently to the need of obtaining patient subjects' consent.

But whatever the impact of these lonely voices, the fact is clear that neither academic medicine nor the research community has taken the time to explore in any systematic way its obligations to subjects of research. [Emphasis added]

When I arrived on the scene in the early 1960s and began to teach in the area of human experimentation, any literature on the subject barely existed. Henry Beecher would soon in 1966 publish his seminal article on ethics in clinical research, which for years exposed him to considerable criticism and to little praise. [Ed. note: A darker side to Dr. Beecher's work, particularly in relation to LSD experiments conducted by Dr. Beecher related to the CIA's MKULTRA program, see  Alfred McCoy's article, "Science in Dachau's Shadow: Hebb, Beecher, and the Development of CIA Psychological  Torture and Modern Medical Ethics," in the Journal of the  History of Behavioral Sciences, Vol. 43, No. 4, Oct. 2007.]

Again, I have some comments on the Jewish Chronic Disease Hospital case, which illustrated some of my comments. But I will omit them at this time and hopefully will read it in my comments in the next few weeks.

Reading of the Jewish Chronic Disease Hospital case -- by the way, Sullivan, who was a chief investigator in the cancer injection experiments, received the most minimal kinds of sanctions by the Board of Regents of the State of New York.

And there was a rainbow on the horizon because the following year the American Association of Cancer Research elected him vice president of the association and a year later its president, for whatever reasons.

Reading of the entire case illustrates the license physicians have taken in the past with respect to disclosure and consent in therapeutic settings and how readily such license is extended to research practices. Clearly, at least until the mid 1970s, informed consent was not taken very seriously by the medical profession and the medical research community.

Now to point Part 2. Here I must paint with an even broader brush, and I want to bring three issues to your attention with respect to the tensions inherent in human research.

"The obfuscation of therapy and research"

One is the obfuscation of therapy and research. Susan correctly observed that experimentation in medicine dates back to antiquity. Though with exceptions until the age of medical science research was by and large conducted at the bedside with physicians trying their best to learn more about the treatment of disease and at the same time to benefit the patients under their care, human experimentation as we know it today is a creature of the scientific revolution which created a new breed of physician investigators during the mid 1850s. And their activities expanded in exponential fashion following World War II.

Yet, despite a radical transformation, which enlisted patients to serve the ends of science, physician investigators continued to view patient subjects more as patients than as subjects. And having been socialized as physician first, they did not take disclosure and consent very seriously.

After all, throughout medical history patients had been deemed too ignorant to understand medicine's esoteric knowledge. And patient subjects were considered even more incompetent to understand the intricacies of scientific investigations.

Thus, having been acculturated as physicians to exercise considerable authority over the medical decision-making process, they extended this authority to research.

In the process, they overlooked that whatever mandate they enjoyed to make decisions on behalf of patients when solely committed to their patients' interests could not necessarily be transferred to research settings where human beings were also used as means for other ends. Consider Tuskegee. Consider Fernald. [Chapter 7 of the ACHRE report looked at the radiation experiments by MIT researchers on institutionalized children in Massachusetts' Fernald school in the late 1940s and early 1950s.) By what authority could these subjects have been used for science's purposes?

Since our charge to investigate human radiation research takes us back to the 1940s, let me also remind you that the doctrine of informed consent was only promulgated in 1957 and did not receive its first more detailed, though inadequate, construction until 1960.

In that case, decided by the Kansas Supreme Court, the standard for disclosure was based on, quote, "the reasonable physician standard," end quote; that is, disclosures customarily made by physicians.

This, as others and I have argued, is no standard at all since physicians are most apt to follow the Hippocratic command, quote, "to conceal most things from the patient while attending to him, to give necessary orders with cheerfulness and serenity, revealing nothing of the patient's future or present condition," end quote.

It was not until 1972 that Judge Robinson, III of the D.C. Court of Appeals announced that in his jurisdictions, now followed by many others, informed consent must be based on a standard set by law.

He correctly noted that maintaining a medical disclosure standard would make informed consent meaningless or worse, quote, "We sense the danger that what, in fact, is no custom at all may be taken as an affirmative custom to maintain silence," end quote. This needed to be said, let me remind you, in 1972.

Thus, when we evaluate the status of informed consent before the mid 1970s, we must keep in mind that no legal and surely no medical standards existed which in any way could be considered as giving any complete meaning to physicians' obligations to make disclosure for therapy or research. The Nuremberg Code comes closest to doing so.

"Corrupting the Ethics of Medicine"

In short, at least until the mid 1970s, it was the ideology of medical professionalism, its benevolent paternalism, that shaped decisively disclosure and consent practices for therapeutic research.

Indeed, from the perspective of human rights, disclosure and consent practices became further undermined once the ideology of science joined the ideology of professionalism. [Emphasis added]

The quest of so-called value-free science to add advanced knowledge for the benefit of all mankind readily subverted other moral values; for example, the inviolability of human beings to unconsented invasions of their physical integrity.

Two, second tension, the involvement of the state. Until World War II medical research was largely conducted by physicians. The state had little interest in getting actively involved in research.

Susan may correct me, but am I right in saying that the malaria experiments were more the brainchild of the physician Walter Reed than the Army high command?

Even the Nazi concentration camp experiments began innocently enough when Sigmund Rascher asked Heinrich Himmler, for only, quote, "three political prisoners," end quote, so that he could conduct lethal high-altitude experiments.

Rascher had just returned from a medical conference that had discussed the medical problems German pilots encountered after having been shot down at higher than expected altitudes due to the advances in British aviation technology. The request was granted, and the three victims would soon become legions.

In this instance, the ideology of professionalism, the ideology of science, and the ideology of the state became joined, utterly corrupting the ethics of medicine and human decency.

In our own country, the human radiation experiments, the mustard gas studies, and the mind-altering drug research are telling examples of agencies of the state prodding medical science into directions we now deplore.

I can only note in passing that the involvement of the state was vastly different in Nazi Germany than in the United States. In Germany the state ideology that certain lives were not worth living inexorably led to Jews, gypsies, and a smaller number of Russians and Poles as well to be used for research purposes with unparalleled cruelty unheard of in the annals of human research.

But the research was also conducted because of the exigencies of war. The plight of German military personnel in the civilian population required quick solutions for many medical problems: typhoid fever, malaria, burns from incendiary bombs, prolonged exposure to the icy North Atlantic Sea, et cetera.

In our own country during World War II similar concerns, the use of poison, the expected use of poison gas by the Japanese once we invaded their home islands, and during the Cold War fears of what the Russians might eventually do to us, led to agencies of our government to involve scientists and physicians in the war and Cold War efforts.

What happened, however, was not state policy. And, of course, it was never imbedded in a national genocidal policy. This difference is crucial.

Yet, parallels exist between medical research in Nazi Germany and the United States. And the lessons to be learned deserve the critical scrutiny of future historians.

Secret Medical Research

Three, secrecy. Not different, however, is this, that agencies of our government participated in medical research and that they saw to it that the activities would be carried on in secret, unbeknownst for a long time to Congress and the public.

We shall always be indebted to Hazel O'Leary for lifting the veil of secrecy. I cannot put the Secretary's implications better than she did on Pearl Harbor Day of 1993, quote, "We were stranded and clouded in an atmosphere of secrecy," end quote. And then she added, quote, "I call it repression," end quote.

Secrecy has many faces. And here I would like to add in passing that the low-visibility decision-making of local institutional review boards is another form of secrecy which only a national human investigation board can remedy. [Emphasis added]

To return to the 1940s and 1970s, as physicians we participated in the secrecy. We were not innocent victims. We struck our own Faustian bargains.

In our Advisory Committee's deliberations, we should be careful not to make too much of the Cold War mentality. It was there, but its haunting question remains: Why did medical ethics and primum non nocere ["First, do no harm"] prove to be such ineffectual counterweights?

Finally now a few reflections on the lessons learned. The problem that has preoccupied me the most in my work on human experimentation is how human beings can be protected through informed consent, not in the sense of its current formulations, but in the sense yet to be formulated and then faithfully applied.

To do so requires that informed consent be grounded in the principle of respect for person, as bioethicists call it, or respect for individual autonomy and self-determination, as law calls it.

The history of human experimentation demonstrates that, at least until the last 20 years, consent has not been an uncompromising commitment to these principles. A perusal of the literature makes it clear that investigators have placed greater faith in their being, quote, "the guarantors of patient subjects' rights and safety," end quote.

The Nuremberg Code attempted to make a radical break with that tradition, but their pronouncement and the pronouncement by the American judgments on voluntary consent expressed the basic value deeply imbedded in our American jurisprudence: the right of citizens to autonomy and self-determination.

In my review on the regulations on the conduct of research, I have tried to demonstrate that medical science's commitment to individual autonomy continues to remain ambiguous.

The call for balancing the need to advance science for mankind's benefit and to protect the inviolability of subjects of research all too commonly tilts in favor of progress. The evidence for such kind of balancing can be found in the Declaration of Helsinki and in the celebrated Belmont report.

Problems with the Belmont Report

In response to Ruth Macklin's wonderful presentation [Ed. Note: is within the body of text linked to]  of ethical principles in human research,  I already expressed most  briefly my reservations about this report.

I find the Belmont report problematic because it did not state unequivocally that in research with competent subjects, its first principle, respect for person, can never be infringed upon except perhaps for reasons that must first be most clearly and most stringently justified and then also receive public approval. [Emphasis added]

The Belmont report's other two principles, namely beneficence and justice, need deserved consideration, but their place in research with competent patient subjects deserved explication that I was unable to discern in this document. The author's silence to my mind on that issue is telling.

I appreciate that the implications of what I'm setting forth here may be far-reaching. They may impede research by requiring physician investigators to take the time to explain themselves more fully to their patient subjects. They may make some research impossible to conduct because too many patient subjects may refuse to participate.

I do not wish to be seen as too dismissive of these concerns, but if they are concerns and concerns to be taken seriously, perhaps they should lead by invoking the principle of justice to compulsory participation in research by all of us.

As you know, I do not believe that the current federal regulations on the protection of subjects of research go far enough. Again, I set all of that forth in my St. Louis article which you have, and I've made some brief comments here which I will distribute to you. [Ed Note: I'm not sure which article Dr. Katz is referring to. For a list of article he provided the advisory committee, see here.]

The Immorality of Knowing and Not Knowing

I also quote from a recent article published. It is really a quite telling article written by two, at least one I know well, a very sensitive person. It's called "The Immorality of Not Knowing." It's in defense of research. [Ed. Note: Written by Ami Klin and Donald J. Cohan, the article was published in 1994 in Ethics in Child Psychiatry, and can be read currently as a chapter in a book online.]

And let me only quote -- I have some more in my prepared statement -- one very brief paragraph, quote, "There is an ethical responsibility to acknowledge ignorance. There's also an ethical mandate to conduct investigations responsively and respectfully but also unrelentlessly in order to acknowledge the property of those members of society who are most in need of its benefits and who are victimized by research inactions."

And this is my question: How do you reconcile, quote, "the immorality of not knowing," end quote, with the immorality of knowing?

Finally and in conclusion, the revelations of the Nazi concentration camp experiments led to the Nuremberg Code.

The revelations of the carelessness with which Thalidomide was made available to pregnant women then led to the informed consent requirements of the FDA regulations.

The revelations of the Jewish Chronic Disease Hospital cancer experiments contributed to the regulations of research supported by NIH and PHS.

The revelations of the Tuskegee syphilis study led to the federal regulations for protection of the subjects of research.

We are not confronted with the regulations of the human radiation experiments. They date to a time prior to 1974. We would, however, not be true to our responsibilities if we were to rest content of telling only that story without assuring the public that it would be better protected in the post-1995 period.

As I have suggested, we have an obligation to scrutinize contemporary research practices and determine whether we can rest assured that subjects of research are now adequately protected.

Whenever egregious practices, such as stir up the public conscience, surface, as the history of human experimentation amply demonstrated, that has been the time for change to occur. That window of opportunity is open to us and to capitalize on.

I hope that we shall seize this opportunity when writing a final report that not necessarily embodies my views or not necessarily embodies the views of any individual on the Advisory Committee, but that, more importantly, makes the public aware of the tragic choices that must be made when traveling on one road or the other road in the quest to advance science for society's benefit.

Thank you.

CCR Unmasks Pentagon Lies About Guantanamo

I received this important e-mail yesterday from Vince Warren, Executive Director of Center for Constitutional Rights. It should be read in the context of the Pentagon's whitewash report on conditions at Guantanamo prison, delivered to President Obama late last week, and made public Monday.

Dear CCR Supporter,

Today, the Department of Defense issued a report that claim conditions of confinement at Guantanamo Bay uphold U.S. and international human rights law. For many of our clients, however, who have endured over seven years of arbitrary detention without charge or trial, the appalling conditions that have characterized the prison camp since its inception continue in violation of international standards to the present day.

CCR issued its own report today - "Conditions of Confinement at Guantanamo: Still in Violation of the Law" - which includes new eyewitness accounts by detainees and their attorneys.

The new report details the inhumane conditions at the base that persist despite President Obama's Executive Order of January 22, 2009, requiring humane standards of confinement at Guantanamo. These include ongoing, severe solitary confinement, other psychological abuse, incidents of violence and threats of violence from guards, religious abuse and widespread forced tube-feeding of hunger strikers. In contrast to the military's report, which appears to include very little testimony or reports from Guantanamo detainees themselves, CCR's report offers multiple cases of abuse in the last two months directly from detainees' experiences.

The report also includes a series of recommendations to ensure the conditions at Guantanamo satisfy legal standards for the humane treatment of the detainees while its closure is implemented.

Read and share "Conditions of Confinement at Guantanamo" today, and join us in encouraging President Obama to implement the recommendations offered in the report and work swiftly to close Guantanamo, prosecute individuals in federal criminal courts if necessary, or release them to their home countries, the U.S. or to safe third countries.

Yours truly,

Vincent Warren
Executive Director
Center for Constitutional Rights

Amazingly, the Reuters news story on the Pentagon review never mentioned that there was a full-blown hunger strike underway at the Guantanamo facility, where approximately 1 in 5 prisoners participating, and an untold number being force-fed by prison officials (and presumably, doctors).

The following is one view on the ethics and politics of force-feeding prisoners from an ethics expert at the American Medical Association:

Force-feeding an alert and oriented prisoner -- one strong enough to require a restraint chair -- might be a way to assert control over the prison population. It might discourage strikers, or "break" the strike. But it is not medically necessary....

The American Medical Association (AMA) has repeatedly stated opposition to force-feeding competent individuals against their will.... The World Medical Association Declaration of Malta concludes that "forced feeding contrary to an informed and voluntary refusal is...never ethically acceptable...[and] feeding accompanied by threats, coercion, force or use of physical restraints is a form of inhuman and degrading treatment....

That's my opinion. I'm Dr. Matt Wynia, Director of the Institute for Ethics at the American Medical Association.

Doc Gonzo at Daily Kos noted:

Of course the US should "permit" hunger strikers to starve themselves to death, if they insist. That is the entire point of a hunger strike. It's not just some advanced form of selfish whining. It is the ultimate form of civil disobedience noncooperation. The prisoner puts the death at the hands of the prison keepers, rather than cooperate with the imprisoners. The stark reality of the imprisonment is forced into clarity. The repercussions of the prisoner forcing the power relationship to its ultimate conclusion are some of the strongest effects the prisoner can have for their position, short of setting themselves on fire.

Their right to do it is built on their right to refuse medical treatment, which is more obvious to us in our unsophisticated modern condition. But all that is just some variations on our fundamental right to refuse, to refuse to cooperate with our controllers. When the cost of refusal is our personal destruction, it's clear how high a cost we will pay to keep ourselves, what is the value of what we're keeping.

And besides, what right does the US jailer have to intervene? "Compassion", so they can continue to torture the prisoner? Some basis in "rights", the cherry-picked ones for the jailer when any and all are arbitrarily denied the prisoner?

Yeah, people lose coherency when they're starving. But they're also starving, with food within reach. The will to starve to death anyway is not some dismissible "crazy". It's the follow-through on their determination past the point of no return.

Starving oneself to death on hunger strike is not something that torturers can spin down to anything less than an ultimate moral stand with the highest stakes.

Miles at BMJ on Sanctions for Doctors Who Torture

A new editorial by Steven Miles in the British Medical Journal, Doctors’ complicity with torture: It is time for sanctions (BMJ 2008;337:a1088), describes the serious shortcomings inherent in a society where ethical prohibitions against harm are not backed up by the instrumentation of accountability.

As Dr. Miles laid out in his excellent book, Oath Betrayed: Torture, Medical Complicity and the War on Terror, participation by physicians in the torture of detainees by the military and intelligence agencies is both rampant and uncontrolled by outside ethics or governmental watchdog agencies. While the American Medical Association formally forbids its members participate in such activities, a letter published by The Lancet last year, signed by 260 doctors, pummelled the AMA for not taking the issue of doctor complicity in torture seriously, accusing the U.S. medical establishment for turning

...a blind eye to the abuse of military medicine at the Guantanamo Bay prison in Cuba, doctors from around the world said in a letter published Friday in a prestigious British medical journal.

Health care workers in the U.S. military seem to have put their loyalty to the state above their duty to care for patients -- and American regulatory bodies have done nothing to remedy the situation....

In his new editorial at BMJ, Dr. Miles writes:

The medical profession ought to dissociate itself from torture—a practice that destroys institutions of civil society; that is used against colleagues of conscience, and that has far reaching adverse mental, physical, and social consequences. Instead, medical societies and licensing boards offer lofty condemnation, which is most ardently aimed at offenders abroad rather than accomplices at home.

Doctors who abet torture rarely face professional risks. Governments will not punish a doctor for helping them carry out their crimes. Few medical societies or licensing boards have the courage and constancy of vision to investigate or censure colleagues who carry out the law of the land.

Rather than look to the Nuremberg Trials as an instance of how to hold medical professionals responsible for illegal acts -- being the juridical proceedings of a conquering nation over its vanquished opponent -- Miles cites the attempts by governments in Greece, Chile, and Argentina to sanction and imprison doctors or medical personnel in their own countries that have been implicated in torture or other crimes carried out in the process of engaging in their medical role.

Dr. Miles continues:

A more secure foundation for this kind of accountability can and should be laid. The World Medical Association’s Declaration of Hamburg states that licensing boards should deny licences to doctors who are guilty of war crimes, including torture... Unfortunately, that declaration only applies to immigrating doctors who are accused of crimes in another country....

Countries wax and wane in their practice of torture. Foundations for making doctors accountable for this crime must be laid during periods of civil society. At such times, each national medical society and licensing agency should assert that medical complicity with torture and cruel inhuman or degrading treatment is a punishable breach of medical ethics that cannot be excused by law and for which there is no term limit....

A civilian medical community that acquiesces to torture by its military members cannot credibly protest against foreign doctors who carry out torture. Such a community can hardly support doctors who are endangered for their resistance against torture. The prestige and values of medicine make it a crucial part of the campaign to abolish torture....

The medical accomplices of torture must not rest in the confidence that they can violate civil society and the ethics of medicine with impunity.

NYT on Lancet Letter: "Doctors Decry Guantanamo Treatment"

In a letter in this week's British medical journal The Lancet, some 260 signatories, mostly doctors, described their outrage at the American Medical Association for turning a blind eye to U.S. detainee abuse, and in some cases, participating in it.

The letter is headlined "Biko to Guantanamo: 30 years of medical involvement in torture" [link requires free registration]. The Lancet correspondence caught the attention, too, of the New York Times, which printed the AP story on it.

LONDON (AP) -- The U.S. medical establishment appears to have turned a blind eye to the abuse of military medicine at the Guantanamo Bay prison in Cuba, doctors from around the world said in a letter published Friday in a prestigious British medical journal.

Health care workers in the U.S. military seem to have put their loyalty to the state above their duty to care for patients -- and American regulatory bodies have done nothing to remedy the situation....

The letter compared the ongoing role of U.S. doctors working at Guantanamo, who have been accused of ignoring torture, to the South African doctors involved in the case of anti-apartheid activist Steve Biko, who died while being detained by security police....

The American Medical Association did not immediately respond to a telephone message seeking comment left at their press office Thursday evening.

Looks like the AMA is giving the New York Times the same brush off it gave journalist Luke Mitchell of Harper's a couple of months ago when he enquired about doctor participation in torture and abuse at CIA sites. As I noted then, the AMA sought to shift the blame for collaboration with torture over to the American Psychological Association, which has not requited itself well of late on this issue, as described multiply elsewhere (here and here, for instance).

But it seems the doctors do not have clean hands themselves, despite a formal position of not participating in American detainee abuse. A huge controversy has arisen, for instance, over doctor involvement in force feeding of Guantanamo hunger strikers. From The Lancet letter:

There are strong parallels between the Biko case and the ongoing role of US military doctors in Guantanamo Bay and the War on Terror. Last year, we suggested that the physicians in Guantanamo force-feeding hunger strikers should be referred to their professional bodies for breaching internationally accepted ethical guidelines. One of us (DJN) lodged formal complaints with the medical boards for Georgia and California as well as pointing out to the American Medical Association (AMA) that the former hospital commander at Guantanamo, John Edmondson, was a member. After 18 months, there had been no reply from the AMA, the Californian authorities stated that they “do not have the jurisdiction to investigate incidents that occurred on a federal facility/military base”, and the authorities in Georgia stated that the “complaint was thoroughly investigated” but “the Board concluded that there was not sufficient evidence to support prosecution”. Yet an analysis of the same affidavit by the Royal College of Physicians concluded that “in England, this would be a criminal act”....

The attitude of the US medical establishment appears to be one of “See no evil, hear no evil, speak no evil”.

There has been a lot of suggestions on listservs and in discussions in general among medical and psychological professionals about what to do to rein in the profession and stop professionals from participating in torture. Paper resolutions seem to be worth even less than the paper they're written on. And now it appears that appeals to state medical or licensing boards have no effect. Even in England, where the RCP concludes such collaboration is a criminal act

The UK government has refused a request from the British Medical Association for a group of independent doctors to assess the detainees...

When it comes to affecting the current situation vis-a-vis doctors and psychologists assisting U.S. torture abroad, a sense of impotence and despair is permeating the health professions. In the end, the solution will not be found by appealing to narrow guild interests, whether in the associations that represent the professions or to the conservative state agencies that regulate them. The fight against torture must be part of a larger political struggle to bring down the Bush regime, and install a political order that is not dedicated to imperial conquest and nationalist supremacy, whether pushed by Republicans or Democrats.

Murkier and Murkier: "The Ongoing Medicalization of Torture"

Though almost a month old now, I can't let a fascinating commentary by Luke Mitchell over at Harper's go unremarked. Mitchell's curiosity was piqued when he watched the performance of National Security Director Michael McConnell on Meet the Press back on July 22. (McConnell is also a former director of the National Security Agency, a retired vice-admiral, and was Intelligence Officer to the Chairman of the Joint Chiefs of Staff during Bush I's Operation Desert Storm -- no small-time player he!)

McConnell was talking with Tim Russert about Bush II's executive order on CIA interrogation practices, signed only two days previously, which reiterated the Bush Administrations contention that "unlawful enemy combatants" don't deserve Geneva Convention protections. The E.O. also banned certain interrogation techniques that even an uninformed U.S. citizen could recognize as torture:

...willful and outrageous acts of personal abuse done for the purpose of humiliating or degrading the individual in a manner so serious that any reasonable person, considering the circumstances, would deem the acts to be beyond the bounds of human decency, such as sexual or sexually indecent acts undertaken for the purpose of humiliation, forcing the individual to perform sexual acts or to pose sexually, threatening the individual with sexual mutilation, or using the individual as a human shield...

But Bush's order also was mum on a number of controversial forms of torture and abuse, including waterboarding and sleep deprivation. Furthermore, the order used a definition of cruel, inhuman, degrading and inhumane treatment or punishment that relies on weak federal interpretations of the U.S. Constitution, rather than international treaties and agreements, such as the Geneva Convention, to which the U.S. is a signatory. (How like the recent parsing of the American Psychological Association in its latest "statement" on the use of psychologists in coercive interrogations!)

Unnamable Doctors & Unnamable Others

Russert asked McConnell about the CIA's now-presidentially approved "enhanced interrogation measures". McConnell was evasive, as Luke Mitchell notes:

He was clear about what was forbidden -— but perfectly unclear about what was permitted. In particular, he would neither confirm nor deny whether water boarding was permissible. “If I announce what the specific measures are,” he said, “it would aid those who want to resist those measures.” (He did allow, however, that he “would not want a U.S. citizen to go through the process,” whatever it was.)

McConnell assured Russert and his viewers that, according to Mitchell, "unnamed and unnameable techniques had in fact been approved by unnamed and unnameable medical professionals", and that all interrogations were performed under "medical supervision". The safety of these interrogation procedures are supposedly "based upon professional advice". McConnell made it clear that threats of torture, at least, were involved.

And so this, this is a program where we capture someone known to be a terrorist, we need information that they possess, and it has saved countless lives. Because, because they believe these techniques might involve torture and they don’t understand them, they tend to speak to us, talk to us in very—a very candid way. [emphasis added]

The latter set off alarm bells for Harper's columnist Mitchell, who knew, for one thing, that "threats of torture" are something prohibited by the American Medical Association (AMA), which "forbids physicians to be 'present when torture is used or threatened.'" Because McConnell had stated in interview that "doctors" monitored the CIA interrogations, Mitchell called the AMA to get clarification. What he got was the runaround, packaged within a surprising admission:

I also called AMA spokesman Robert Mills to see if the organization would be investigating McConnell’s claims. His response was a bit surprising. He suggested that perhaps McConnell had meant psychologists. Psychologists do not have medical degrees, of course, and like all other people without medical degrees, they are barred from practicing medicine in the United States. Mills’s point, though, seemed to be that psychologists, unlike physicians, have a long history of involvement with enhanced interrogation....

Mills’s concern was fine as far is it went. But I found myself in the odd position of reminding a spokesman for the American Medical Association that psychologists are not doctors. McConnell had specifically said “doctors.” Was this really the sort of ambiguity that the AMA wanted to endorse? Shortly thereafter, I received this follow-up via e-mail: “The feds commonly refer to psychologists as doctors. Psychiatrists and other M.D.s are referred to as physicians. Medical supervision is a vague term that could refer psychologist, nurse, corpsman, podiatrist or any of hundreds allied health professionals.”

Calling Dr. Behnke...

Luke Mitchell then contacted Stephen Behnke, director of the APA's Ethics Office, who assured him via quick e-mail reply that

...psychologists "do not provide ‘medical’ supervision” and second that the APA “strictly forbids the presence of a psychologist at an interrogation in which the subject is tortured or is threatened with torture.”

But even Behnke was hedging his bets, as he refused to comment on the question of psychologists being sanctioned for violations. (Of course, all this was before the passage of the APA's new resolution "reaffirming" its torture policy.)

Mitchell returned to the AMA with Behnke's denial of participation and got this statement from the director of AMA's board of trustees:

Since the questions of detainee abuse first surfaced, AMA leaders have met on several occasions with high-ranking officials at the United States Department of Defense (DoD) to advocate for the treatment of detainees that is consistent with AMA ethics policy. Representatives from the AMA have also visited the detention facilities at Guantánamo. These visits provided an opportunity for the AMA to tour the facilities, but our access was limited and at no time did we have a chance to speak with the detainees. Due to the limits placed on the AMA, we are unable to determine with any certainty if ethical policies prohibiting physician involvement in torture are being adhered to by the DoD. The AMA will continue to monitor the situation and advocate for treatment of all detainees in U.S. custody to be in accordance with our AMA Code of Medical Ethics and the medical provisions of the Geneva Conventions.

In other words: see no evil, hear no evil, which amounts to the new moral guidelines of medical and behavioral health associations embedded with Bush's "war on terror".

The non-denial denial of the AMA is disturbing, as is the refusal of the Director of the APA Ethics Office to even comment on APA sanctions against any psychologist who breaks their paper resolution on torture -- a resolution that allows certain kinds of sensory and sleep deprivation, use of drugs and other coercive measures as long as they aren't used in the undefined "interrogation process".

Psychologists and the Military

I think it's clear that psychologists play a distinctive role as consultants to the military. They do this not just in interrogations, but perhaps more broadly in assessment of military commanders, of specialized forces and personnel, as medical providers and clinicians, as designers of training programs and human factors engineering, as well as on general psychological adjustment to military life. But even in histories written on the subject, such as the collection edited by U.S. Army psychologist A. David Mangelsdorff and published by APA Press, Psychology in the Service of National Security, very little is written on the role of psychologists in counterintelligence and operational interrogations activity. This is still considered secret, despite what has been linked to the press. Not secret but suppressed is the massive participation of psychologists and psychiatrists and other social science professionals in the work of preparing modern interrogation techniques, including sensory deprivation, isolation, and use of drugs.

As Mangelsdorff put it:

Security needs of the United States shaped the evolution of its society, the roles and functions of its armed forces, the organization of national security, and the development of psychology... Psychologists play a vital role in military readiness. The story of psychologists in the armed forces addressing national security challenges is the story of the evolution of the science and practice of psychology itself.

As Mitchell's essay demonstrates, the medical sciences in general have been developmentally and organizationally warped by the demands of the neo-totalitarian national security state. Now the question is: what are we going to do about it? Or is it too late to do anything? We had better hope the answer lies in the former, as only demoralization and societal disintegration resides in the latter.

For more information on medical doctors and the ethics of interrogation, see Dr. Steven Miles' excellent article from the American Journal of Bioethics, 7(4):5, "Medical Ethics and the Interrogation of Guantanamo 063".

For more on the current situation, see psychologist-activist Stephen Soldz's recent article, "APA, torture, and the CIA", in addition to CTLiberal's excellent article on the arrest and torture by U.S. forces of Navy whistleblower Donald Vance, "Whistleblowers on Fraud are Jailed and Tortured".