"Physicians must neither conduct nor directly participate in an interrogation, because a role as physician-interrogator undermines the physician's role as healer and thereby erodes trust in the individual physician-interrogator and in the medical profession."
It further states that:
"physicians must not monitor interrogations with the intention of intervening in the process, because this constitutes direct participation in interrogation."
It does allow that:
"physicians may participate in developing effective interrogation strategies for general training purposes. These strategies must not threaten or cause physical injury or mental suffering and must be humane and respect the rights of individuals."
In the face of this text sounding strikingly different than anything coming from the American Psychological Association , Behnke states:
"the AMA report states that physicians may consult to interrogations by developing interrogation strategies that do 'not threaten or cause physical injury or mental suffering' and that are 'humane and respect the rights of individuals.' Substitute 'psychologist' for 'physician,' and the relevant passages in the AMA report could be inserted into the PENS report with no change in APA's position whatsoever-that 'It is consistent with the APA Ethics Code for psychologists to serve in consultative roles to interrogation and information-gathering processes for national-security related purposes' when acting in accordance with strict conditions. While one recommendation in the AMA report places physician consultation in a training context, numerous statements in the body of the report and in the report's 'Conclusion' convey a scope of involvement that extends well beyond training. As one example, the AMA report states explicitly that the presence of a psychiatrist at an interrogation may serve to benefit the individual under questioning by virtue of a trust that can facilitate the interrogation, i.e., information-eliciting process. The AMA report must be carefully read in its entirety to understand and appreciate the breadth of its position on the appropriate role for physicians in interrogations."
Thus, Behnke claims that the AMA policy recommendations do not mean what they appear to mean, or what they actually say. In both written and verbal statements, AMA officials claim otherwise. On August 22, the President of the AMA wrote a letter to the Executive Director of Physicians for Human Rights reiterating these differences. The letter states:
"I certainly believe that the recommendations pertaining to the ethical role of physicians are unambiguous.... In developing its recommendations, I know that the members of CEJA [the AMA's Council on Ethical and Judicial Affairs] deliberated the meaning of every word; I also know that the AMA Code of Medical Ethics does not use the words 'must not' lightly. The guidelines, therefore, leave no room for confusion. The AMA has adopted a strict prohibition on physician participation in the interrogation of an individual, and only permits that medical knowledge be used to develop strategies that can be presented in the context of general training. This was clearly reiterated in the statement the AMA released on June 12, 2006.
"The AMA is aware of the article published in the July/August issue of the Monitor on Psychology. We have found that the commentary analyzing the AMA and the American Psychological Association positions did not accurately represent our ethical guidelines. By arguing that the two positions are similar and by failing to point out critical differences, we believe the readers of the Monitor could be induced in serious error regarding the ethically acceptable role for physicians. For this reason, the chair of CEJA, Dr. Robert Sade, has submitted a letter to the editor of the Monitor to refute the proposition that the policies are similar. In his words: 'AMA and APA policy differ substantially in ethical acceptability of supporting interrogation.'"
In the letter by Sade referred to, he explicitly takes issue with Behnke's quote from the AMA which Behnke claims allows physician participation in interrogations:
"Behnke misrepresents the substance of the AMA guidelines when he says: '...the AMA report states explicitly that the presence of a psychiatrist at an interrogation may serve to benefit the individual under questioning by virtue of a trust that can facilitate the interrogation.' He has taken this statement out of its context in a discussion of potential roles of physicians, and has failed to observe that it is negated by the guidelines themselves."
Sade goes on to state:
"To clarify the crux of AMA's new ethical policy: Physicians must not conduct, monitor with an intent to intervene, or directly participate in any way in an interrogation, because each of these actions undermines the physician's role as healer. Because it is often justifiable for physicians to serve the public interest, AMA's policy permits physicians to develop general interrogation strategies that are not coercive, but are humane and respect the rights of individuals. In contrast, APA prohibits psychologists from participating in cruel, inhuman or degrading treatment but accepts that they can 'serve in the role of supporting an interrogation' and as a consultant. Thus, AMA and APA policy differ substantially in ethical acceptability of supporting interrogation."
(To be fair, it should be noted that Behnke, in his original article as well as in his response to Sade's letter, refers to the "body of the [AMA] report" and insists that this report must be read in its entirety. I have so far not been able to get access to the text of this full report. AMA officials state that the report is being prepared for publication in a medical journal. Most such journals have a strict policy against publishing papers that have already been reported in the popular press. Thus, they refuse to release the report prior to publication (a position I find understandable yet troubling in matters with significant public policy import).
I was told by the AMA officials, however, that the report has no official standing with the AMA. Only the Recommendations were adopted by vote, the report was not voted on but simply "filed." These officials stated that the Recommendations stand on their own. Only with the publication of this full report can we be certain, but, at this point, it certainly looks like the claim that the Association's and AMA's policies are virtually identical is yet another smokescreen thrown up to obscure the Association's long-standing practice of protecting psychologists' participating in the abuses at Guanta'namo and elsewhere.
A detailed article in Psychiatric News, a publication of the American Psychiatric Association (note for non-mental health professionals: psychiatrists are medical doctors specializing in mental health treatment, psychologists are not medical doctors), also tends to refute Behnke's interpretation of AMA policy and supports the interpretation that the AMA policy means what it appear to say: no participation in interrogations. For example, the article quotes Steven Sharfstein, the Psychiatric Association's immediate past President, as saying "I really think this is a very strong statement that closely corresponds to and reinforces the APA [American Psychiatric Association] position that physicians, including psychiatrists, should not be participating in any way in the interrogation of individual detainees." (emphasis added) This article also indicates that the wording of the AMA statement was changed the day before approval to strengthen the prohibition against physician participation:
"In a letter dated June 8, Appelbaum [chair of the Psychiatric Association's Council on Psychiatry and Law] wrote on behalf of APA to members of CEJA to address concerns about the wording of the passage as it stood at the time, just one day prior to the opening of the AMA meeting. It read: 'Physicians may participate in developing effective interrogation strategies that are not coercive but are humane and respect the rights of individuals.'"'This language appeared to allow physicians to consult on the planning of interrogations of particular detainees,' Appelbaum told Psychiatric News. 'In contrast, APA's statement explicitly rules out advising authorities on the use of specific techniques of interrogation with particular detainees.'
"The final wording in the CEJA report was changed to emphasize that the development of strategies be for 'general training purposes.'"
Why?
The pattern of behaviors going back at least to 2002 - documented here and in my previous article - by the American Psychological Association leadership supportive of psychologist involvement in national security interrogations strongly suggests that sections of the leadership are working, probably intentionally, to avoid the development of any position, guideline, or ethics code statement that would unambiguously forbid members from engaging in national security interrogation, even though these interrogations frequently involve the kinds of psychological torture documented as occurring at Guanta'namo and elsewhere by Physicians for Human Rights
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