American Medical Association emphasizes interrogation policy differences with APA
August 27th, 2006
One of the defenses of the American Psychological Association (APA) to charges of being soft on psychologist involvement in torture has been to claim that the APA policy is really virtually identical to the apparently much stronger American Medical Association (AMA) policy adopted in June. The AMA policy stated [thanks to Bioethics Blog]:
For this report, we define interrogation as questioning related to law enforcement or to military and national security intelligence gathering, designed to prevent harm or danger to individuals, the public, or national
security. Interrogations are distinct from questioning used by physicians to assess the physical or mental condition of an individual. To be appropriate, interrogations must avoid the use of coercion-that is, threatening or causing harm through physical injury or mental suffering. We define a “detainee” as a criminal suspect, prisoner of war, or any other individual who is being held involuntarily by legitimate authorities.Physicians who engage in any activity that relies on their medical knowledge and skills must continue to uphold ethical principles. Questions about the propriety of physician participation in interrogations and in the development of interrogation strategies may be addressed by balancing obligations to individuals with obligations to protect third parties and the public. The further removed the physician is from direct involvement with a detainee, the more justifiable is a role serving the public interest. Applying this general
approach, physician involvement with interrogations during law enforcement or intelligence gathering should be guided by the following:(1) Physicians may perform physical and mental assessments of detainees to determine the need for and to provide medical care. When so doing, physicians must disclose to the detainee the extent to which others have access to information included in medical records. Treatment must never be conditional on a patient’s participation in an interrogation.
(2) Physicians must neither conduct nor directly participate in an interrogation, because a role as physician-interrogator undermines the physician’s role as healer and thereby erodes trust in the individual physician-interrogator and in the medical profession.
(3) Physicians must not monitor interrogations with the intention of intervening in the process, because this constitutes direct participation in interrogation.
(4) Physicians may participate in developing effective interrogation strategies for general training purposes. These strategies must not threaten or cause physical injury or mental suffering and must be humane and respect the rights of individuals.
(5) When physicians have reason to believe that interrogations are coercive, they must report their observations to the appropriate authorities. If authorities are aware of coercive interrogations but have not intervened, physicians are ethically obligated to report the offenses to independent authorities that have the power to investigate or adjudicate such allegations.
In response to this apparently unequivocal policy against physician involvement in interrogation, Stephen Behnke, the APA’s Ethic Director argued in an American Psychologist article that the policies are actually virtually identical. Thus, Behnke states:
“the AMA report states that physicians may consult to interrogations by developing interrogation strategies that do “not threaten or cause physical injury or mental suffering” and that are “humane and respect the rights of individuals.” Substitute “psychologist” for “physician,” and the relevant passages in the AMA report could be inserted into the PENS report with no change in APA’s position whatsoever—that “It is consistent with the APA Ethics Code for psychologists to serve in consultative roles to interrogation and information-gathering processes for national-security related purposes” when acting in accordance with strict conditions. While one recommendation in the AMA report places physician consultation in a training context, numerous statements in the body of the report and in the report’s “Conclusion” convey a scope of involvement that extends well beyond training. As one example, the AMA report states explicitly that the presence of a psychiatrist at an interrogation may serve to benefit the individual under questioning by virtue of a trust that can facilitate the interrogation, i.e., information-eliciting process. The AMA report must be carefully read in its entirety to understand and appreciate the breadth of its position on the appropriate role for physicians in interrogations.”
In response, the President of the AMA issued a letter on August 22 denying the similarity. It states [portions of this letter appeared in Benjamin Greenberg’s “Hungry Blues blog earlier today]:
August 22, 2006
Leonard S. Rubenstein, JD
Executive Director
Physicians for Human Rights
1156 15th St. NW
Washington, DC 20005Dear Mr. Rubenstein:
Thank you for your letter regarding the AMA’s ethical guidelines regarding physician participation in interrogation. As you correctly state, the Council on Ethical and Judicial Affairs (CEJA) presented a report on this topic to the House of Delegate at its Annual Meeting in June 2006, and the report’s recommendations were adopted. I certainly believe that the recommendations pertaining to the ethical role of physicians are unambiguous; in part, they state:
(2) Physicians must neither conduct nor directly participate in an interrogation, because a role as physician-interrogator undermines the physician’s role as healer and thereby erodes trust in the individual physician-interrogator and in the medical profession.
(3) Physicians must not monitor interrogations with the intention of intervening in the process, because this constitutes direct participation in interrogation.
(4) Physicians may participate in developing effective interrogation strategies for general training purposes. These strategies must not threaten or cause physical injury or mental suffering and must be humane and respect the rights of individuals.
In developing its recommendations, I know that the members of CEJA deliberated the meaning of every word; I also know that the AMA Code of Medical Ethics does not use the words “must not” lightly. The guidelines, therefore, leave no room for confusion. The AMA has adopted a strict prohibition on physician participation in the interrogation of an individual, and only permits that medical knowledge be used to develop strategies that can be presented in the context of general training. This was clearly reiterated in the statement the AMA released on June 12, 2006 (copy enclosed).
The AMA is aware of the article published in the July/August issue of the Monitor on Psychology. We have found that the commentary analyzing the AMA and the American Psychological Association positions did not accurately represent our ethical guidelines. By arguing that the two positions are similar and by failing to point out critical differences, we believe the readers of the Monitor could be induced in serious error regarding the ethically acceptable role for physicians. For this reason, the chair of CEJA, Dr. Robert Sade, has submitted a letter to the editor of the Monitor to refute the proposition that the policies are similar. In his words: “AMA and APA policy differ substantially in ethical acceptability of supporting interrogation.”
While important differences exist between physicians and psychologists, I sincerely hope that in matters of interrogation, our respective organizations can be united in making sure that professional expertise is used to heal and to protect only, and never to exploit the physical, mental or emotional vulnerabilities of other fellow human beings.
On a final note, let me thank your organization for giving voice to concerned physicians in matters related to human rights and the treatment of detainees.
Sincerely,
William G. Plested, MD
AMA PresidentEnclosure
cc: Robert M. Sade, M.D.
To be fair, it should be noted that Behnke refers to the “body of the report” and insists that this report must be read in its entirety. I have so far not been able to get access to the text of this full report. AMA officials state that the report is being prepared for publication in a medical journal. Most such journals have a strict policy against publishing papers that have already been reported in the popular press. Thus, they refuse to release the report prior to publication. [In cases like this, of public policy relevance, I find this journal policy to be quite upsetting and immoral.]
Additionally, I was told, however, that the report has no official standing with the AMA. It was not adopted, only the above Recommendations were adopted by vote, and that the Recommendations stand on their own. Only with the publication of this full report can we be certain, but, at this point, it certainly looks like the claim that the APA’s and AMA’s policies are virtually identical is yet another cloud thrown up to obscure the APA’s long-standing policy of protecting psychologists’ participating in the abuses at Guantanamo and elsewhere.
Entry Filed under: Psychoanalysis,Psychology,Rights and Liberties,Social Issues,Terrorism,Torture