As the many layers of horror of the abuse and torture of Iraqi prisoners at Abu Ghraib are explored, one tier remains unexamined. Why were the prison's military physicians and medics silent as the prisoners they were treating were tortured?
The evil of torture can hardly be worsened. But we instinctively react with revulsion to physicians who are its accomplices in deed or in silence. The first Nuremberg trials were of physicians who tortured people at Nazi death camps. Japan's and Argentina's physicians supervised torture. Iraqi physicians who participated in torture under Saddam Hussein were a prominent and feared part of that gruesome regime.
A tortured prisoner is alone -- the betrayal by health professionals emphasizes his or her utter lack of protection.
The U.S. government admits that the Geneva Convention applies to prisons established and supervised by the U.S. military in Iraq. This convention bars physical or mental torture. Quibbles over whether the detainees were POWS, irregular combatants, insurgents or common criminals make no difference.
The United Nations' "Body of Principles for the Protection of All Persons under Any Form of Detention or Imprisonment" says that humane and dignified treatment is owed them all. In United States vs. Noriega, the U.S. Supreme Court said that U.S. prison officials "must keep in mind the importance to its own troops of faithful ... adherence to the mandate of Geneva."
"Regardless of how the government views this defendant as a person, the implications of a failure to adhere to the Convention are too great to justify departures."
Why were military physicians and medics silent as their patients were tortured? Silence was not an option.
The World Medical Association's Declaration of Tokyo and the U.N.'s Principles of Medical Ethics forbid physicians from condoning, participating in or appearing to support torture or inhuman or degrading treatment, in any situation including war. The mere presence of a military physician during any inhumane treatment of detainees is a violation of the physician's "service of humanity."
International agreements say that officials who have reason to believe that a torture "has occurred or is about to occur" must report the matter to their superior authorities and, where necessary, to "other appropriate authorities or organs vested with reviewing or remedial powers."
The World Medical Association and numerous other groups aggressively support physicians who report torture and protocols describing the medical evaluation and recording of torture-related injuries.
The U.S. Army's Taguba report shows that medics saw the degradation of prisoners at Abu Ghraib. It is widely reported that these same health professionals treated wounds and observed the bodies of those who died during interrogation.
The military command could not legally authorize torture. Even it did so or even if it allowed torture to flourish, the physicians at Abu Ghraib were morally obliged to serve their patients' welfare. The collapse of their independent moral action is another sign that the incidents at Abu Ghraib prison were more than the acts of a few bad apples. Military torture is rarely an incident. It is a culture where prisoners are dehumanized and isolated and where prison officials operate without administrative or moral accountability.
We must ensure that the U.S. military code of medical ethics and a more robust system of international law rise from this ruin.
Steven Miles is a professor of medicine and geriatrics at the University of Minnesota's Center for Bioethics.
© Copyright 2004 Star Tribune.
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