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American Medical Association emphasizes interrogation policy differences with APA

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One of the defenses of the American Psychological Association (APA) to charges of being soft on psychologist involvement in torture has been to claim that the APA policy is really virtually identical to the apparently much stronger American Medical Association (AMA) policy adopted in June. The AMA policy stated [thanks to Bioethics Blog]:

For this report, we define interrogation as questioning related to law enforcement or to military and national security intelligence gathering, designed to prevent harm or danger to individuals, the public, or national
security. Interrogations are distinct from questioning used by physicians to assess the physical or mental condition of an individual. To be appropriate, interrogations must avoid the use of coercion-that is, threatening or causing harm through physical injury or mental suffering. We define a "detainee" as a criminal suspect, prisoner of war, or any other individual who is being held involuntarily by legitimate authorities.

Physicians who engage in any activity that relies on their medical knowledge and skills must continue to uphold ethical principles. Questions about the propriety of physician participation in interrogations and in the development of interrogation strategies may be addressed by balancing obligations to individuals with obligations to protect third parties and the public. The further removed the physician is from direct involvement with a detainee, the more justifiable is a role serving the public interest. Applying this general
approach, physician involvement with interrogations during law enforcement or intelligence gathering should be guided by the following:

(1) Physicians may perform physical and mental assessments of detainees to determine the need for and to provide medical care. When so doing, physicians must disclose to the detainee the extent to which others have access to information included in medical records. Treatment must never be conditional on a patient's participation in an interrogation.

(2) 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.

(3) Physicians must not monitor interrogations with the intention of intervening in the process, because this constitutes direct participation in interrogation.

(4) 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.

(5) When physicians have reason to believe that interrogations are coercive, they must report their observations to the appropriate authorities. If authorities are aware of coercive interrogations but have not intervened, physicians are ethically obligated to report the offenses to independent authorities that have the power to investigate or adjudicate such allegations.

In response to this apparently unequivocal policy against physician involvement in interrogation, Stephen Behnke, the APA's Ethic Director argued in an American Psychologist article that the policies are actually virtually identical. Thus, 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."

In response, the President of the AMA issued a letter on August 22 denying the similarity. It states [portions of this letter appeared in Benjamin Greenberg's "Hungry Blues blog earlier today]:

August 22, 2006

Leonard S. Rubenstein, JD
Executive Director
Physicians for Human Rights
1156 15th St. NW
Washington, DC 20005

Dear Mr. Rubenstein:

Thank you for your letter regarding the AMA's ethical guidelines regarding physician participation in interrogation. As you correctly state, the Council on Ethical and Judicial Affairs (CEJA) presented a report on this topic to the House of Delegate at its Annual Meeting in June 2006, and the report's recommendations were adopted. I certainly believe that the recommendations pertaining to the ethical role of physicians are unambiguous; in part, they state:

(2) 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.

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Stephen Soldz is psychoanalyst, psychologist, public health researcher, and faculty member at the Boston Graduate School of Psychoanalysis. He is co-founder of the Coalition for an Ethical Psychology and is President of Psychologists for Social Responsibility. He was a psychological consultant on two of (more...)
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