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 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

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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 classified on psychology and interrogations submitted interrogation teams makes an important contri- US Justice Department documents released in to the US Senate Select Committee on Intel- bution toward keeping interrogations safe and April 2009 in response to freedom of informa- ligence maintained: “Conducting an interroga- ethical.”15 tion requests described the roles played by both tion is inherently a psychological endeavour. It seems worth examining these assurances “on-site psychologists” and “outside psycholo- . . . Psychology is central to this process because in light of increasingly detailed reports about gists” in justifying the use of waterboarding and an understanding of an individual’s belief sys- detainee interrogations. Writing in Vanity other techniques.20 /AP/PA y LYNNE SLADk LYNNE A detainee from Afghanistan en route to interrogation at Camp X-Ray, Guantanamo Bay, Cuba

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In April 2008 American Civil Liberties code of medical ethics. All the while they are Competing interests: None declared. Union released government documents that it in violation of the code of ethics.”25 Provenance and peer review: Not commissioned; externally peer reviewed. said confirmed “psychologists supported illegal We submit the following recommendations 1 Psychologists’ and physicians’ involvement in detainee interrogations in Iraq and Afghanistan.”21 The for consideration. Firstly, the Nuremberg interrogations. 2008. http://kspope.com/interrogation/ index.php. APA ethics director responded that the docu- ethic—that individuals cannot avoid personal 2 Ray P. New AMA ethical policy opposes direct physician ments actually showed how psychologists were accountability by just following orders, laws, or participation in interrogation. Press release, 12 June 2006. fighting abuse and thus validated APA’s ethical other forms of state authority—should be cen- www0.ama-assn.org/ama/pub/category/print/16446. html. policy. The union disagreed with the APA’s con- tral to all professions despite their differences. 3 Moran M. American Medical Association interrogation clusion and added, “We are deeply concerned There is great diversity of professional roles, policy similar to American Psychiatric Association’s position. Psychiatr News 2006;41(13):1-5. by the fact that, viewed in context, these docu- values, and activities not only between profes- 4 American Psychological Association. Report of the American ments warrant the opposite conclusion.”22 sional organisations but also within them. The Psychological Association presidential task force on psychological ethics and national security 2005. www.apa. Many psychologists are reported to be 54 divisions of the APA, for example, represent org/releases/PENSTaskForceReportFinal.pdf. unhappy about their colleagues’ role in inter- such divergent fields as consumer psychology, 5 American Psychological Association. Ethical principles 19 of psychologists and code of conduct. Am Psychol rogating detainees. In population and envi- 2002;57:1060-73. 2008, the APA took a We can see no reason why the APA ronmental psychology, 6 Pope KS, Vasquez MJ. Ethics in psychotherapy and vote of its membership offers protection to many vulnerable industrial and organisa- counseling. 3rd ed. San Francisco: Jossey-Bass/Wiley, 2007. on a resolution stating groups but refuses detainees even tional psychology, exper- 7 Salameh WA. Psychology Today: a malleable medium for that psychologists may imental psychology, the deciphering our discipline. APA Monitor 1984;15:4. the “humane treatment” accorded 8 Advertising policy adopted for magazine. APA Monitor not work in settings experimental laboratory animals psychology of aesthetics, 1983;14:2. where “persons are held creativity, and the arts, 9 Samelson F. APA between the world wars: 1918 to 1941. In: Evans, RB, Sexton VS, Cadwallader TC, eds. 100 years: outside of, or in violation of, either International and . Ethics codes may dif- the American Psychological Association: a historical Law (eg, the UN Convention Against Torture fer to reflect major differences of roles, but no perspective. Washington DC: American Psychological Association, 1992:119-24. and the Geneva Conventions) or the US Con- one should be able to escape personal ethical 10 American Psychological Association. Ethical principles stitution (where appropriate), unless they are accountability merely through following orders, of psychologists and code of conduct. Am Psychol 1992;47:1597-611. working directly for the persons being detained laws, and other forms of state authority. History 11 World Medical Association. Physicians under threat, warns or for an independent third party working to has shown what can result when professionals WMA president. Press release, 23 June 2003. www.wma. protect human rights.” It was approved by follow this kind of fallacious ethical reasoning. net/e/press/2003_9.htm. 12 Behnke S. Ethics and interrogations: comparing and 8792 members, with 6157 voting against (from Secondly, when special ethical considera- contrasting the American Psychological, American Medical a membership of over 148 000).23 However, tions are relevant to professionals’ work with and American Psychiatric Association positions. Monitor on Psychology 2006;37(7):66. this new policy is not enforceable or part of the a particular at risk group, those considerations 13 American Psychological Association. Statement of the ethics code. Responses to a series of questions should be explicitly included in an enforceable American Psychological Association on psychology and interrogations submitted to the United States Senate select about the resolution posted on the APA’s web- ethics code. We can see no reason why the APA committee on intelligence. 2007. www.apa.org/ethics/ site state: “The petition would not become part offers protection to many vulnerable groups but statement092107.html. 14 Lewis A. Psychologists preferred for detainees. New York of the APA Ethics Code nor be enforceable as refuses detainees even the “humane treatment” Times 2006 June 7. http://query.nytimes.com/gst/fullpage. are prohibitions set forth in the Ethics Code.”24 accorded experimental laboratory animals. html?res=9D05EFDF1531F934A35755C0A9609C8B63. The APA has released several admirable public Thirdly, professional organisations should 15 Brehm S. APA letter to Washington Monthly, 9 January 2007. www.apa.org/releases/washingtonmonthly.pdf statements against torture over the years, but make greater efforts to ensure that all members 16 Eban K. Rorschach and awe. Vanity Fair 2007 Jul 17. www. has included none in the enforceable section know the nature of their ethical responsibilities. vanityfair.com/politics/features/2007/07/torture200707? printable=true¤tPage=all. of its ethics code. Ideally, all AMA members would understand 17 Flaherty A. Probe: officials warned about harsh its policy on participation in executing prison- interrogations. USA Today 2008 Jun 17. www.usatoday. com/news/washington/2008-06-17-senate- Policy considerations ers and all APA members—rather than the rela- interrogation_N.htm. The interrogation of prisoners at places like Abu tively small percentage of the membership that 18 Mayer J. The dark side. New York: Doubleday, 2008. 19 Psychologists and torture [editorial]. Boston Globe 2008 Ghraib and Guantanamo Bay poses complex voted on the 2008 initiative—would believe that Aug 30. www.boston.com/bostonglobe/editorial_opinion/ ethical questions lacking easy answers. Similar the ethics of participation in the government’s editorials/articles/2008/08/30/psychologists_and_ questions arise in any custodial setting and in detainee interrogation programme was an issue torture/?page=full. 20 American Civil Liberties Union. Released: the Bush any setting in which governmental authority of sufficient importance to take part in a ballot administration’s secret legal memos. 16 April 2009. www. may stand in sharp contrast to a professional’s to determine that policy. aclu.org/safefree/general/olc_memos.html. 21 American Civil Liberties Union. Newly unredacted report basic ethical responsibilities. The controversy Kenneth S Pope independent licensed psychologist, PO Box 777, confirms psychologists supported illegal interrogations in around physicians’ participation in capital Norwalk, CT 06856-0777, USA Iraq and Afghanistan. Press release, 30 April 2008. http:// Thomas G Gutheil professor of , Beth Israel www.aclu.org/safefree/torture/35111prs20080430.html. punishment exemplifies the difficulties that can Deaconess Medical Center, Harvard Medical School, Brookline, 22 Romero AD. Letter from the American Civil Liberties occur in adopting and enforcing a clear ethical MA 02446, USA executive director to Stephen Behnke, director, ethics standard. The continuing misunderstandings Correspondence to: K Pope [email protected] office, American Psychological Association. 18 June 2008. Accepted: 23 December 2008 http://psychoanalystsopposewar.org/blog/wp-content/ and disagreements among AMA members uploads/2008/07/ACLU-LetterToBehnke06-18-08APA- Contributors and sources: This article grew out of the authors’ despite a clear prohibition for over three dec- Letter.pdf. research, writings, and professional involvement in ethics. KSP 23 American Psychological Association. APA members approve ades led Abraham Halpern, professor emeritus chaired the ethics committees of the American Psychological petition resolution on detainee settings. Press release, 17 of psychiatry at New York Medical College, to Association (APA) and American Board of Professional Psychology. Sep 2008. www.apa.org/releases/petition0908.html. TGG is cofounder of the programme in psychiatry and law, Beth 24 American Psychological Association. Petition on comment: “The vast majority of physicians do Israel Deaconess Department of Psychiatry, Harvard Medical School. psychologists’ work settings: questions and answers. 2008. not know what the AMA policy is on this, and A practising forensic psychiatrist, he was president of the American www.apa.org/governance/resolutions/qa-work-settings. Academy of Psychiatry and Law in 2000 and is president of the html. they think they are helping the authorities and International Academy of Law and Mental Health. He chaired the 25 Daly R. Participation in death penalty: where should line be making the death of these prisoners more com- ethics committee of the American Board of . Both drawn? Psychiatric News 2006;42:9. fortable or peaceful, [a goal that] supports the authors researched and wrote this article and stand as guarantors. Cite this as: BMJ 2009;338:b1653

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