It’s Not Torture If A Doctor Is In the House

The role John Yoo played in the DoJ’s embrace of torture is well known, though it didn’t do much to hurt Yoo’s landing a cushy job torturing law students at Cal Berkeley.  But the New England Journal of Medicine notes, with obvious disgust, the bad things that happen when physicians and lawyers work too well together.

In December 2014, the U.S. Senate Intelligence Committee’s report on torture was released to the public. The 600-page report (a redacted summary of the still-classified 6000-page report) documents in disturbing detail the use by the Central Intelligence Agency (CIA) of physicians, lawyers, and psychologists in its post-9/11 torture program at more than a dozen “black sites,” or secret prisons, around the world.

To begin to understand the torture, we believe it’s necessary to understand how physicians and lawyers collaborated to overcome their professional inhibitions.

See that?  Not to say that it’s undeserved, but it’s as if doctors’ mommies let their babies play with the bad boy lawyers, and look what happens.

Medical professionals, primarily private contractors, filled four basic roles at the black sites: clearing terrorist suspects as “medically fit” for torture; monitoring torture to prevent death and treat injuries; developing novel torture methods; and actually torturing prisoners. All these actions were taken only after CIA and U.S. Department of Justice attorneys assured the medical professionals that they had immunity from prosecution and would not be held legally responsible for violating U.S. and international law against torture as long as they used the techniques approved in legal memos (since withdrawn) written to justify their actions.

Not to hurt physicians’ feelings, but the fact that government lawyers said they could play the torture game at CIA black sites isn’t exactly the same as putting a gun to these doctors’ heads and forcing them to do so.  No one made them participate in torture. The lawyers, bad as it may be that they absolved the docs of legal culpability, couldn’t make physicians desire to be party to torture. They did that on their own.

Let’s be clear. That physicians came up with “novel torture methods” and engaged in “the actual torture of prisoners” can’t be attributed to legal absolution.  The stench of Josef Mengele wafts through this description, where doctors made their own personal choices to not merely be in the house, but to contribute to the actual torture inflicted on other human beings.

No lawyer made that happen.  Any doc who did so was a big boy, and did so of his own accord.

The use of unapproved torture methods illustrates, we think, the impossibility of confining torture to legally defined methods. For example, CIA agents threatened KSM’s children, a universally condemned method that was nonetheless later declared “legal” by the Counterterrorism Center, so long as the threats were “conditional,” whatever that means.

Sure, the CIA was out of control. But what of the physicians?

Another unapproved technique, described as “rectal feeding,” consisted of delivering food rectally to demonstrate dominance over the prisoner (though no nutrition can be delivered through the rectal mucosa). This torture technique was used, for example, on Majid Khan, who was on a hunger strike. CIA medical officers had “discussed rectal rehydration as a means of behavior control.”

There is, of course, no medical indication for rectal feeding, and the fact that it was done by or under the supervision of a physician cannot convert this torture technique into a medical procedure. Nonetheless, a medical justification was the cover story to legitimize its use when it became public. For example, responding to the Senate report, Vice President Dick Cheney said rectal feeding was not approved but that he believed “it was done for medical reasons.” It seems more accurate to describe rectal feeding as a technique of sexual assault. 

By having physicians in place, personally present and willingly involved, it created a cover to manufacture two particularly nefarious deceits. First, that it couldn’t be nearly as harmful as it might seem to those of us lacking medical training, as doctors were there overseeing the health and welfare of prisoners.  Certainly the doctors wouldn’t let any medical harm come to prisoners, because doctors.

Second, it allowed the government to perpetrate a lie, that engaging in such atrocities as “rectal feeding” was done for vague medical reasons, and not to sexually assault a prisoner to demonstrate physical dominance over him.  Or to be less sanitary, to torture him under the guise of medicine.

Without the help of physicians, there would have been no plausible deniability that we were torturing Majid Kahn by shoving stuff up his rectum as if there was any explanation for this horror short of torture. Instead, we’ve got Marcus Welby’s benign, grandfatherly face telling us that “Majid Khan’s `lunch tray,’ consisting of hummus, pasta with sauce, nuts, and raisins, was `pureed’ and rectally infused” for his own good.

This by no means absolves the lawyers of their responsibility for their role in torture, but the physicians who were only too happy to shove pureed nuts up a human being’s rectum are culpable for their own involvement. The docs can’t lay this off on the lawyers, and there is absolutely nothing the lawyer did or could do to compel medical personnel to tell the CIA, “sure guys, of course we want to be on your torture team and inflict pain and humiliation while tossing around cool medical words to make it seem like it isn’t nearly as disgusting and horrible as it truly is.”

While it’s commendable that the NEJM is willing to publicly address this shocking disgrace by its own kind, to diminish their role and shift blame off the individuals who personally engaged in torture, who came up with new and ever-more fun ways to torture, is inexcusable.

So much for “do no harm,” and let’s see what new ways we can find to create misery and pain.  That’s your docs, guys. Own it.  And remember the admonition of Luke 4:23: “physician, heal theyself.”  The lawyers involved are a disgrace to the legal profession. But the docs involved are a disgrace to medicine. And both are a disgrace to humanity.


30 thoughts on “It’s Not Torture If A Doctor Is In the House

  1. REvers

    Every time I see something about rectal feeding, I can’t help but wonder if they got the idea from that South Park episode.

  2. Dave

    In other words, just because a lawyer tells you something is legal, it doesn’t mean it is. Even if that lawyer is a prosecutor. It is up to you, the non lawyer, to independently ascertain if it is really something you should be doing. While when the question is one of byzantine accounting regulations, where understanding the law at all is difficult even for lawyers (deliberately so, I think), there could be some cover from a legal memo. But when it comes to torture and rape (and as you said, penetrating someone’s anus against their will for no medical purpose is rape, no doubt about it), there is no such cover for the doctor (or anyone else). Nor should there be.

    1. SHG Post author

      Either I’ve failed miserably to make myself clear, or you’ve completely missed the point. But no, that is not “in other words.” Please, never recharacterize what I’ve written again. You suck at it.

        1. SHG Post author

          Or I’m horribly incompetent at communicating what I’m trying to say. Not sure which.

          Wait, I see what you did there.

          1. Dave

            Well, perhaps I just understood part of your point, in that it appeared to me that “lawyerly advice that a sin is not a sin does not absolve you of your sins” is a pre-requisite for your point.

    2. Turk

      Even if that lawyer is a prosecutor. It is up to you, the non lawyer, to independently ascertain if it is really something you should be doing.

      The first rule of medicine is this: Do no harm.

        1. Turk

          So you didn’t see that in the post?

          It was directed at Dave, who apparently missed the point.

            1. Rick Horowitz

              That’s what you get for not calling me first. I actually do know sign language.

              And I am ever at your disposal.

              FWIW, I left this comment because it was the only thing I had to add – since I did get your point. (Although, I was disappointed by your substitution of shoving things up someone’s “rectum” for the more appropriate word. But it’s not my blog, right?)

            2. SHG Post author

              I was going to write “shoving things up someone’s ass,” but I was trying not to offend medical sensibilities. You know me, always moderating my language to avoid offense.

  3. scott morrell

    What a disturbing post (the content, not your writing). What is shocking to me, more-so than the legal justification and cover, is that these so-called doctors had a ‘choice’ to make.

    Legality, I always thought, was suppose to come from a moral code, at least in the U.S. Notwithstanding if it was legal or not, what about your inner self sense of right and wrong? Are these doctors really delusional enough to wipe out their core decency? My only logical answer is that these ‘doctors” violated their code because they probably entered the profession for some monetary reason alone.

    I do not know how it is even possible to go to bed at night, knowing what they were condoning, and feeling righteous about themselves the next day.

    And worse….There was presumably a patient in the waiting room ready to have care provided by them the next morning.

    1. SHG Post author

      Not sure why you assumed that “legality…was suppose to come from a moral code.” Criminality was, long ago, a reflection of moral culpability, but it has long since gone beyond that. Morality is a religious concept. Law, not so much.

      1. scott morrell

        Good point. There can be laws that have nothing to do with morality. I mixed up legality and criminality. Although morality does not necessarily need to come from a moral code as atheists can attest to.

        We assume doctors are moral because of their oath to “do no harm.” However, just like in a legal setting, how many people have lied in court or on depositions? People are people and are flawed. No matter what their professional position is, it does not mean that thy are ethical or moral. We tend to look past this too many times.

        1. SHG Post author

          That docs are people isn’t really in dispute, the god-thing notwithstanding. But whether medical profession tolerates its members being engaged in torture is very much an issue. Lawyers have ripped John Yoo a new one for having written the DoJ torture memo. What will physicians do about the torturers in their midst?

          1. Scott Morrell

            If it is legal, I would have those doctors de-certified by the states medical bar associations for life. Choice have consequences, even if it is not a legal consequence.

  4. Nigel Declan

    Have any medical associations or licencing bodies weighed in on the subject, as to whether doctors participating in torture (or, in a similar vein, executions) are acting within their authority as physicians? Have any of the doctors involved in this torture been sanctioned or had their licence revoked for such conduct?

    1. SHG Post author

      Not to my knowledge, though docs are licensed by state, and I frankly don’t know whether anybody can specifically identify the particular docs who did the dirty.

    2. Quinn Martindale

      The American Medical Association and American Psychiatric Association prohibited their members from assisting in any interrogations in 2006. No US medical professional has been sanctioned for torture arising from the war on terror, though cases were brought against psychologists in Ohio ( Larry James), Texas (James Mitchell). and New York (John Leso). The UK revoked a doctor’s (Derek Keilloh) license for lying about the death of a prisoner who had been beaten to death.

  5. David M.

    He who hath not crammed a deli platter up a grown man’s asshole for national security purposes, let him cast the first stone at these medical professionals.

  6. lawrence kaplan

    How pedestrian of the docs
    Just to give some electric shocks.
    But to shove food up some guy’s ass–
    Now that, I must say, shows real class!

  7. Marc R

    Please preface such a post with a trigger warning for those non-mouth eaters. Sometimes a Gatorade doesn’t cut it to quench your thirst after a day of Socratic dialogue in a black site outside lovely Krakow in the summer.

  8. Konrad

    I see nothing in the article that tries to shift the blame to lawyers. It bluntly condems doctors both for engaging in torture and for helping to conceal it. That’s what the ‘collaborating with lawyers’ phrase is about: They combined their their medical and legal credentials to legitimize torture under the guise of medical procedures.

    What stands out to me is that their emphasis on reminding their audience that torture doesn’t count as practicing medicine. As in, “the fact that it was done by or under the supervision of a physician cannot convert this torture technique into a medical procedure”. And again in the concluding sentence: “And in all contexts, physicians should act only in ways consistent with good and accepted medical practice, with the consent of their patients.”

      1. Konrad

        I suppose that in your line of work “collaborating with lawyers” isn’t necessarily a perjorative.

        1. SHG Post author

          In my line of work, the ability to comprehend the nuance of written language clearly and with unbiased detachment is a necessity. We understand that others may lack this ability, and can’t see what we do.

  9. Konrad

    I don’t doubt that you’re a nuance ninja while I’m known to lack that knack. Your response is so nuanced that I’m not sure what you’re trying to say, which just goes to prove your point.

    However, even a dunce like me knows that meaning depends on the context and the intended audience. The NEJM’s audience are people who hold a license to practice medicine in accordance with “accepted medical practice.” There’s nothing nuanced about using those three words. They don’t give out prizes for being acceptable.

    John Yoo doesn’t decide what’s an accepted medical practice. The docs have to decide that for themselves, and that’s what I see happening here.

    1. SHG Post author

      While this may be fascinating to you, it’s really not to me, and hasn’t been from the start. Yes, the docs are responsible for their own conduct. There is no question about that.

      As for your reading versus my reading, everyone who reads this will reach their own conclusions, and no one will give a shit what you see versus what I see. It’s what they see that matters. So, your persistence in harping on your “all about me” reading is a waste of time and bandwidth.

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