The Interrogation of Detainees: How Doctors' and Psychologists' Ethical
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ANALYSIS The interrogation of detainees: how doctors’ and psychologists’ ethical policies differ The treatment of detainees in prisons such as Guantanamo Bay is controversial. Kenneth Pope and Thomas Gutheil ask whether the different stances of doctors and psychologists are justified INTERNATIONAL AMNESTY The professions of medicine and psychology vening.4 The APA decided not to add detainees Detainee at Abu Ghraib prison, Baghdad, with a bag on share many ethical values, but their ethical poli- to the enforceable standards section of its code, his head and wires attached to his hands cies differ sharply. The contrasting responses which protects groups that are vulnerable or of physicians and psychologists in the United at risk and allows complaints to be made to Protecting non-US citizens at risk during conflict States to the interrogation of detainees provide the ethics committee. Groups designated in Despite many admirable humanitarian stances, a striking example and show the ethical chal- the code include persons “for whom testing the APA has sometimes been reluctant to take lenges that confront all healthcare professions. is mandated by law or governmental regula- formal steps to protect non-US citizens who The results of such decisions can affect the pub- tions,” “persons with a questionable capacity to are at risk during conflicts. For example, when lic interest, how a profession understands itself, consent,” research participants, “subordinates,” Jewish psychologists and their families were and countless individual lives. clients, students, supervisees, and employees. fleeing to safety from Nazi Germany in the In the years since the 11 September terrorist There is even an enforceable standard on the 1930s, an APA “Council proposal in 1933 attacks in the US, numerous articles have con- humane treatment of laboratory animals.5 to inquire into racial discrimination against sidered what forms of involvement, if any, are psychologists in Nazi Germany was tabled appropriate for physicians and psychologists Reasons for difference permanently [rejected] . When some of in detainee interrogations in settings like Abu Why did the APA take such a different approach the victims of this discrimination sought ref- Ghraib prison and Guantanamo Bay detain- from the AMA? Below we discuss some of the uge in the U.S., the APA waited until 1938 to ment camp.1 In this article we take a brief look factors that may explain the decision. acknowledge the problem of displaced foreign at the contrasting ethical policies adopted by psychologists by the appointment of a commit- physicians and psychologists in the United Age of the profession tee to ‘survey’ it.”9 States regarding this controversy and consider Psychology is a younger profession than medi- some of the reasons for the differences. cine. Without the centuries of teachings, tradi- Response to conflicts between ethics and tions, and shared identity as an independent governmental authority Contrasting ethics policies profession, a newer profession might more eas- US psychologists’ views about the relation Physicians limited their involvement in detainee ily comply with the demands of government. between ethics and the government’s author- interrogations to such a degree that they pro- ity seem to differ sharply from the views of hibited even monitoring an interrogation with View of ethics code their medical colleagues. After the 11 Septem- intent to intervene. Priscilla Ray, chair of the Founded in 1892, the APA functioned for 60 of ber attacks, the APA changed its ethics code’s American Medical Association (AMA) council its 117 years without an ethics code. Its decision enforceable standard about responsibilities on ethical and judicial affairs, stated: “Physi- to adopt a code was controversial.6 that conflict with governmental authority. cians must not conduct, directly participate in, Before 11 September 2001, the code acknowl- or monitor an interrogation with an intent to Attitude to prevailing medical and scientific consensus edged that ethics and the authority of the intervene, because this undermines the physi- Historically the APA has been willing to adopt state might conflict: “If psychologists’ ethical cian’s role as healer. Because it is justifiable for a stance at odds with the medical and scien- responsibilities conflict with law, regulations, physicians to serve in roles that serve the pub- tific consensus about issues affecting the public or other governing legal authority, psycholo- lic interest, AMA policy permits physicians to interest. For example, in the 1980s the APA gists make known their commitment to the develop general interrogation strategies that are bought Psychology Today to bring psychologi- Ethics Code and take steps to resolve the con- not coercive, but are humane and respect the cal science to the public.7 Although journals flict.”10 In 2002, however, the APA adopted a rights of individuals.”2 At a press conference belonging to medical associations refused to new enforceable standard allowing members she elaborated that the statement should not carry tobacco advertisements because of the to set aside any ethical responsibilities that be interpreted to mean that physicians could health effects of smoking, the APA board of were in irreconcilable conflict with govern- participate in developing rapport building or directors unanimously decided that Psychology mental authority: “If the conflict is unre- other strategies for individual detainees.3 Today would accept advertisements for ciga- solvable via such means, psychologists may In contrast, the American Psychological rettes (and alcohol). Its statement reflected the adhere to the requirements of the law, regula- Association (APA) in 2005 adopted a policy tobacco industry’s position that cigarettes are tions, or other governing legal authority.”5 An that allowed consultation and monitoring of but one of a number of “products considered attempt to limit the scope of this permission individual interrogations with the intent of inter- by some to be hazardous.”8 to apply only to ethical responsibilities not 1178 BMJ | 16 MAY 2009 | VOLUME 338 ANALYSIS involving human rights was relegated to the tems, desires, motivations, culture and religion Fair, Eban reported, “Psychologists weren’t non-enforceable section of the code. likely will be essential in assessing how best to merely complicit in America’s aggressive new The AMA and other physician organisa- form a connection and facilitate educing accu- interrogation regime. Psychologists, working tions have not allowed state authority to serve rate, reliable and actionable intelligence . in secrecy, had actually designed the tactics as a rationale for evading fundamental ethical Psychologists have valuable contributions to and trained interrogators in them.”16 A Sen- responsibilities. In 2003 the World Medical make toward . protecting our nation’s security ate investigation found that “Military psy- Association’s president stated: “At Nuremberg through interrogation processes.”13 chologists were enlisted to help develop more in 1947, accused physicians tried to defend aggressive interrogation methods, including themselves with the excuse that they were only Perceived difficulties of doing no harm snarling dogs, forced nudity and long peri- following the law and commands from their Differences in beliefs may also exist about the ods of standing, against terrorism suspects.”17 superiors . the court announced that a physi- challenges of doing no harm. “First, do no Mayer noted that a general “drafted military cian could not deviate from his ethical obliga- harm” is a constant reminder to physicians. psychologists to play direct roles in breaking tions even if legislation demands otherwise.”11 In 2006 the American Psychiatric Associa- detainees down. The psychologists were both tion voted overwhelmingly to discourage its treating the detainees clinically and advising Perceptions of professional competence and roles members from participating in devising strate- interrogators on how to manipulate them and Not surprisingly, different professions hold dif- gies to get information from detainees. When exploit their phobias.”18 ferent perceptions of their (and others’) com- the Pentagon announced it The Boston Globe sum- petence, training, and roles. Physicians do not would try to use only psy- “Military psychologists were marised a major theme of design interrogation plans for specific detain- chologists in this role, Stephen enlisted to help develop more a series of news articles: ees or observe interrogations with the intent to Behnke, director of ethics for aggressive interrogation “From the moment US intervene because “this undermines the physi- the American Psychological methods, including snarling military and civilian officials cian’s role as healer.” Association, said “psycholo- dogs, forced nudity and long began detaining and inter- Psychologists’ ethical policies, on the other gists knew not to participate in periods of standing, against rogating Guantanamo Bay hand, reflect a view that interrogation is a psy- activities that harmed detain- terrorism suspects” prisoners with methods that chological endeavour and that psychologists’ ees.”14 In 2007, the president the Red Cross has called competencies allow them to take a special role wrote: “The association’s position is rooted in tantamount to torture, they have had the assist- in detainee interrogations.12 The APA statement our belief that having psychologists consult with ance of psychologists.”19 Previously