Perceptions on role of medical professionals in state-sanctioned torture

Sarah Kimball, MD

After seeing first-hand the clinical and psychological effects that torture and abuse can have on asylum seekers—individuals coming from a different country who have yet to be given a legal status—Sarah Kimball knew she had to find a way to educate other health professionals on reasons to oppose involvement in the mishandling of prisoners.

In an editorial published in The BMJ, Sarah Kimball, MD, who recently completed her Internal Medicine residency at BWH, and co-author Stephen Soldz, PhD, director of the Center for Research, Evaluation and Program Development at the Boston Graduate School of Psychoanalysis, discuss medical professionalism and abuse of detainees in the war on terror.

About the Report

Using data from a 2013 task force report from The Institute on Medicine as a Profession, “Ethics Abandoned, Medical Professionalism and Detainee Abuse in the War on Terror,” the co-authors explain why they believe it is wrong for medical professionals to participate in state-sanctioned torture. They argue that when physicians are involved, it is a violation of their professional code of ethics: doing no harm and putting the patient first.

Kimball and Soldz call on health professionals, international medical societies and licensing boards, specifically the American Psychological Association (APA), to strengthen their ethical stances when it comes to provider involvement in interrogations. According to the editorial, the APA allows involvement of members in interrogations as long as cruel treatment is avoided, while the American Medical Association and the British Medical Association (BMA) have come out with strong statements against involvement of physicians in interrogations.

The report also calls on professional associations to “strengthen ethical guidance, to investigate abuses and speak out publicly against them and to aggressively discipline members found to have participated.”

In addition, the report supports legislation that discourages physicians from becoming involved in unethical conduct towards prisoners.

“Medical societies and licensing boards need to move beyond statements condemning torture to proactively educating members and the public, while ensuring compliance with our ethical standards,” wrote Kimball and Soldz.

“The report discloses that, among other unethical roles, doctors in Abu Ghraib, Guantanamo [a United States military prison located within Guantanamo Bay Naval base in Cuba] and CIA secret prisons were monitoring oxygen saturations during water boarding, watching for edema in detainees forced to stand in stress positions, and helping increase psychological distress by sharing prisoners’ individual health information with interrogators. Despite criticism, the Department of Defense and the CIA have left in place many protocols that allow, even encourage, this degradation of professional ethics,” wrote Kimball and Soldz.

In an interview with BWH Clinical & Research News, Kimball shared her perceptions on the role of medical professionals on this topic and what needs to be done going forward.

How and why did you become interested in this topic?

Three years ago I joined Physicians for Human Rights, an independent organization that uses medicine and science to stop severe human rights violations against humans, and worked to perform asylum evaluations on people seeking refuge in the United States. I saw first-hand the clinical and psychological effects of torture and abuse on people who were trying to come to our country. My work with these asylum seekers showed me the effects that torture has on individuals and how devastating it can be. As I was learning about that, I was also learning about the role of our own government and, in particular, our medical profession in abusing detainees in Guantanamo.

Why, in your opinion, shouldn’t medical professionals participate in state-sanctioned torture?

I know that going into a profession where this is part of our professional legacy just feels wrong. There are many people who make the same argument that the APA makes that the involvement of medical professionals in state-sanctioned torture makes things safer, and I don’t think this is true. I feel that it’s a gross human rights violation and a gross misunderstanding for people to say that what is going on is not torture just because health professionals are involved. It’s also an abuse of the health care profession.

From the human rights perspective, I think there’s plenty of evidence that shows that enhanced interrogation and torture do not actually give us valuable information. While I haven’t worked with Guantanamo detainees before, I have worked with clients who have had health care professionals involved in their torture abroad and it creates incredible distrust of the health care system. It also makes it incredibly hard for these people to come to a new country and on top of that trust that any physician or psychologist is going to be working in his or her best interest.

Did you have any goals when writing the editorial?

What I hope people will take from the editorial is a more active belief and more vocal sense that this is not something our profession should support. I think it’s very easy to ignore it and wish it didn’t happen. But in reality, this is something that is being done in our country’s name and in this case our profession’s name. We need to figure out a way that we can work collaboratively to get people on board to realize how important this is.