Psyche, Science, and Society

An interview with Steven Miles

Bioethicist Steven Milesis featured in the University of Minnesota alumni magazine [Taking on Torture]. A few excerpts:

“Early on, I would wake up in Abu Ghraib,” says Steven Miles (M.D. ’76), describing the toll his most recent research project took on him. “That was not a pleasant place to wake up in.” After seeing the leaked photographs of abused prisoners at the Abu Ghraib prison in Iraq in May 2004, Miles, a professor in the Medical School and the Center for Bioethics at the University of Minnesota and an attending physician at the University of Minnesota Medical Center, Fairview, wanted to know where the prison doctors were while these abuses were taking place. So he began to dig, reading through tens of thousands of pages of declassified government documents obtained by the American Civil Liberties Union (ACLU) and posted on its site.

“I’m not a professional historian,” Miles says. “I’m a doc, and so I have a special kind of expertise like, for example, the ability to read death certificates that a historian doesn’t have.” What he uncovered was extensive evidence that medical professionals in the prisons in Iraq and Afghanistan and at Guantanamo Bay were often participants in abusive interrogations, concealing and enabling torture and issuing fake death certificates. He read accounts of sodomy, pulpified legs, deaths by asphyxia and beatings, and doctors examining torture victims and then medically discharging them back to the guards who tortured them….

What kinds of changes do you want to see? We have to harmonize the AMA’s policies and the other medical associations’ policies with international law. That is, it’s no longer enough for the medical associations to say, “We oppose medical participation in torture.” The medical associations must say, “We stand by the Geneva Conventions, and, furthermore, we stand by the legal accountability of health professionals to the Geneva Conventions.” We can’t just say that these documents are moral aspirations. We have to insist that they are accountable, legal, and professional obligations….

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Taking on Torture

Steven Miles, photo by Mark Luinenburg

By Shelly Fling“Am I naïve in believing that medicine is still a noble profession, upholding the highest ethical principles? For the ill, doctors still stand for life. And for us all, hope.”

—Holocaust survivor Elie Wiesel, writing on prison medicine in Iraq in the New England Journal of Medicine in 2005.

“Early on, I would wake up in Abu Ghraib,” says Steven Miles (M.D. ’76), describing the toll his most recent research project took on him. “That was not a pleasant place to wake up in.” After seeing the leaked photographs of abused prisoners at the Abu Ghraib prison in Iraq in May 2004, Miles, a professor in the Medical School and the Center for Bioethics at the University of Minnesota and an attending physician at the University of Minnesota Medical Center, Fairview, wanted to know where the prison doctors were while these abuses were taking place. So he began to dig, reading through tens of thousands of pages of declassified government documents obtained by the American Civil Liberties Union (ACLU) and posted on its site.

“I’m not a professional historian,” Miles says. “I’m a doc, and so I have a special kind of expertise like, for example, the ability to read death certificates that a historian doesn’t have.” What he uncovered was extensive evidence that medical professionals in the prisons in Iraq and Afghanistan and at Guantanamo Bay were often participants in abusive interrogations, concealing and enabling torture and issuing fake death certificates. He read accounts of sodomy, pulpified legs, deaths by asphyxia and beatings, and doctors examining torture victims and then medically discharging them back to the guards who tortured them.

“This is easily the saddest and most disappointing academic project I’ve ever done,” Miles says. “Not just because docs were involved, but also because this is not a U.S. military that I recognize and it’s also not U.S. intelligence services that I recognize. I’ve had experience with both, and this is just outside of our history.”

Much of what Miles read—about the abuse of women prisoners and of children, the pouring and igniting of lighter fluid on the backs of prisoners’ hands, and other atrocities—he set aside if he didn’t find evidence of a medical professional involved. That material was not included in his article on medical complicity in torture, published in the British medical journal The Lancet in 2004, that received worldwide attention or in his subsequent book, Oath Betrayed: Torture, Medical Complicity, and the War on Terror, published by Random House in 2006. This past spring, with a grant from the University’s Office of Public Engagement, Miles organized, indexed, and cross-linked the material he used in his research—an estimated 60,000 pages of documents, including documents pertaining to the deaths of 160 prisoners—into an online archive on the Human Rights Library site at the University (it may be accessed through www.umn.edu/humanrts).

Miles says he’ll continue to add to the archive as documents are declassified, including approximately 500 recently released pages about the mental health of the guards at Abu Ghraib. But his job is otherwise complete, and he says he’s searching for his next project—something else around “the idea of engaging medical ethics in a broader social debate.” His past research has addressed—and often helped shape policy around—end-of-life care, reducing bed-rail accidents in nursing homes, universal health care, and the treatment of victims of AIDS in Africa and of refugees in camps.

Whether Miles’s work leads to new anti-torture policies and regulations by medical associations and licensing boards is yet to be seen. Meantime, he points to the lasting value of the sort of archive he has created—one that is a model for transparency and accountability in government.

What follows are Miles’s characteristically frank answers to questions about his research.

Are prisoners in U.S. custody being tortured right now? One of the problems is that we’re working with a telescope that goes out two light years; that’s how long it takes to declassify materials. I think that the situation in Guantanamo may be better from the standpoint of physical abuse, although there are still substantial abuses of due process at Guantanamo—habeas corpus, fair trials, arbitrary detention, and so forth. But I think that the question of physical abuse in Afghanistan and Iraq remain a huge issue, although it’s impossible to quantitate because of the way the Freedom of Information Act works [including that obtaining information from agencies close to national security, such as the CIA, can be impossible].

Is torture ever justified if it could save lives? Every time a nation has decided that torture can be justified, it’s wound up misusing it. They’ve taken a singular case and they’ve gone to a general practice. So I don’t think that the technology of torture works. It doesn’t produce reliable information. It can’t be targeted just to people who would pop that information. And we don’t have a way of using that information in real time. And so I’d answer the question no.

What do you hope for this archive—how it will be used, what it might forward? I know it’s currently being used by human rights groups and by major media. The ACLU deserves great credit for putting this stuff up, but it’s largely categorized by the date that they were able to post it. And so by organizing it, indexing this material, it made it more accessible for other people to do research. So, my hope is that this will be used to that end, and, in fact, the work so far has resulted in changes to the policies of the World Medical Association, the AMA [American Medical Association], the Royal College of Psychiatrists, the American Psychiatric Association, the American Psychological Association—and it’s changed at least three Defense Department policies. So it is having an impact, but I think we’re still at a relatively early stage in terms of getting the final impact from this whole episode of treatment of prisoners.

What kinds of changes do you want to see? We have to harmonize the AMA’s policies and the other medical associations’ policies with international law. That is, it’s no longer enough for the medical associations to say, “We oppose medical participation in torture.” The medical associations must say, “We stand by the Geneva Conventions, and, furthermore, we stand by the legal accountability of health professionals to the Geneva Conventions.” We can’t just say that these documents are moral aspirations. We have to insist that they are accountable, legal, and professional obligations.

What was the AMA’s reaction to the allegations of medical complicity in the torture? The AMA initially, right after the Abu Ghraib pictures came out, turned down an invitation by the British Medical Association to call for an independent investigation. The AMA did strengthen its anti-interrogational abuse policy a click, but they have not called for an independent investigation. They took an extremely low-profile position with regard to the McCain Amendment [of 2006, prohibiting the inhumane treatment of prisoners]. And although the JAMA [Journal of the American Medical Association] is separate from the AMA because of an editorial firewall between the two, JAMA [as of mid-June] has not editorialized on this issue at all. So, I think the AMA’s position has been one of silence.

You’ve spoken to some medical professionals in the prisons. Did they talk about the pressure they were under to participate in abusive interrogations? There was pressure. And some of the pressure can be seen in the documents as well. But what I don’t see in the documents or in their personal stories is the type of pressure that is brought to bear against health professionals who protest torture in countries like Chile or Uruguay or the Soviet Union or Turkey, and risk being disappeared or tortured or killed or having their family members killed for that resistance. The pressure that was brought to bear was peer pressure, in some cases the threat of a transfer. But when I look at my colleagues in other torturing countries, I see them taking absolutely heroic and in some cases suicidal risks to protest torture. So I don’t accept—I simply do not accept—the notion that the pressure was of a degree that should have caused them to be silent or complicit….Would you knowingly go to a doctor as your personal physician who’d been complicit in torture? I remember a wonderful teacher I once had who had been an S.S. officer. He teaches at a local college. His insights into how he wound up becoming an S.S. officer and the historical warnings that he gave his students, and, indeed, the academic community at large, were really important. So, I guess I wouldn’t want to go to a physician who practiced torture who didn’t take from it some kind of wisdom about why that was such a terrible idea and have a willingness to share about how to avoid taking that path.

Do you think that complicity by medical professionals makes torture worse? Yes, I do, in a couple respects. Jacobo Timmerman, who was a prisoner in the Argentine junta, described it this way: The doctor’s “presence was terrible because he was the symbol that a scientific instrument is with you when you are tortured by the beasts.” When you look at torture victims, around 60 percent say they’ve seen medical professionals supervising it, and that doesn’t include the ones who are buried with a fake death certificate. I think it makes it worse in terms of its demoralizing impact on the person undergoing torture, but also because it winds up roping in a larger medical community on behalf of a torturing society….
And, perhaps most relevant to myself and my colleagues who have been fighting to change American Psychological Association policies for quite a while:

How did you read the torture documents day after day without losing your sanity? I went down to the Dakota Jazz Club in Minneapolis a fair amount, which was a very good thing to do. I actually learned a lot about jazz during this project, which had a major saving effect. And I don’t think that’s entirely coincidental, because since so much jazz is related to the African American experience, which is an experience of torture, I think there is an interesting redemptive theme to jazz. But this material is toxic. Robert Jay Lifton, who wrote on the Nazi doctors, said the same thing when I was talking to him about this. It’s not something people should work with for a long period of time. It’s not just taboo material, it’s material that will transform you into a nonhealthy state. So part of putting up the archive was to turn the process over to others.

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