In Soviet Russia, psychiatrists sometimes collaborated with the repressive regime by locking up dissidents in mental hospitals and injecting them with powerful psychotropic drugs, "antipsychotics" designed to treat schizophrenia. The Soviet psychiatrists were rightly condemned for their misuse of medicine for the un-therapeutic purpose of social control.
American health personnel are not immune from cooperating with efforts to misuse psychiatric drugs for social control purposes having no connection with those drugs' intended uses. The U.S. Immigration and Customs Enforcement agency (ICE) has been systematically administering psychotropic drugs to immigrants in the process of being deported as the Washington Post reported this week. Deportees who in the past had resisted deportation were injected with drugs, often a three drug "cocktail," in order to keep them pliant during deportation. These drugs included the powerful antipsychotic drug Haldol, as well as the antianxiety drug Ativan, and Cogentin, a drug used to treat the often severe Parkinsons illness like side effects of Haldol.
These drugs were prescribed by psychiatrists and administered by specially selected nurse "medical escorts." The drugs were administered in extremely high doses, sometimes rendering the deportees unable to speak. It sometimes took deportees days or even weeks to get the drugs out of their system. Thus Michael Shango was injected with 32.5 milligrams (mg) of Haldol, as well as 8.5 mg of Ativan and some Cogentin over 11 hours. His initial Haldol dose was 10 mg. Compare this with a usual Haldol dose of 2 to 5 mg repeated in 4 to 6 hours for "control of the acutely agitated schizophrenic patient with moderately severe to very severe symptoms" and 2 to 6 mg of Ativan daily for patients whose bodies have already adapted to the medication; lower doses of these drugs are recommended for new patients as people need time to adjust to them.
These drugs, especially Haldol are extremely powerful and are almost never utilized in individuals not diagnosed as actively psychotic. They can be extremely uncomfortable, especially if first administered in high doses and can disorient an individual for days. When Shango was imprisoned upon his return to the Congo, he was so disoriented that he didn't know where he was fortunately, friends helped him escape. It was weeks before he fully recovered from the drugs.
This use of powerful medications to control detainees is likely illegal. In fact, the Clinton administration had concluded:
"Regarding detainees who are not mentally ill, involuntary medication of such persons for the sole purpose of subduing them during deportation, without a court order, is not supported by any legal authority and raises ethical issues as well." [emphasis in original]
Regardless of whether this use of drugs is legal, it violates the professional ethics of most health professions and constitutes a profound threat to the role of healer. Doctors, nurses, and other health professionals rely upon trust between healing professional and patient, trust that the interests of the patient are forefront in the doctors mind. We incorporate recognition of the importance of trust in the crucial importance given to patients' informed consent in medical decision-making. Except in the most extreme of circumstances, drugs and other medical interventions should be administered only with the consent of, and in the interests of, the person receiving the intervention.
The ethics of most medical professions do allow for involuntary intervention in extreme circumstances to protect the patient or public from imminent harm. Further, in order for a medical treatment to be used involuntarily, the treatment must be, as the Supreme Court stated in considering involuntary drugging of prisoners, "in the inmate's medical interest." Thus, the American Psychiatric Nurses Association, in a position statement on Mandatory Outpatient Treatment (MOT), endorses mandatory treatment, but insists that it is a last resort:
All patients have the right to make their own decisions and MOT should be used as a last resort. ... If MOT needs to be implemented, measures must be taken to ensure that each patient is treated with respect and dignity, and that full consideration is given to the patient's rights, civil liberties, and confidentiality issues.
The criterion of "use as a last resort" and treatment "with respect and dignity... and that full consideration is given to the patient's rights [and] civil liberties" is clearly not met in the ICE use of these powerful drugs. The psychiatrists and nurse escorts are serving only the interests of the ICE and are oblivious to the interests or the wishes of those receiving drugs, who, because they manifest no medical need, are not in any meaningful sense "patients." These drugs are being used to control the deportees as they attempt to assert their rights. These drugs thus are in fact often a way of destroying the deportees' ability to resist disturbing and often questionable deportations. What could be more disrespectful of a person's dignity than to chemically destroy his or her ability to resist?
The ICE has recently amended thepolicy that allowed involuntary drugging of deportees. Unfortunately, as Physicians for Human Rights pointed out in a January 28th 2008 letter to the ICE, the new rules are still inadequate and open to abuse:
The new policy, in fact, largely ratifies ICE's past practice, allowing court-ordered forced sedation "to effectuate removal" when a detainee's resistance is deemed "dangerous." The Amended Policy also requires evidence from a medical doctor that the drug or drugs to be forcibly administered are "medically appropriate."
While we welcome this recognition of medical concerns, the Amended Policy offers no criteria for the vague standard of "appropriateness," providing far too little guidance and presenting far too great a risk that ICE's sole interest in removal will subvert the physician's obligation to the patient's health.
The use of drugs by ICE is, unfortunately, part of a pattern by the Bush administration of the misuse of the health professions for non-therapeutic purposes. I and others have written extensively about the role of psychologists in aiding national security interrogations, interrogations that often cross the line into torture. Recently the Washington Post and CQ reported on likely involuntary drugging of detainees (see my commentary: Involuntary Drugging of US Detainees: A Crisis for the Health Professions). It is beginning to look as if there is a pattern of inappropriate use of psychopharmacological agents for overcoming resistances of various types.
So far Congress and the health professions have failed to systematically confront the abuses of these professions by the current administration. The failures, until recently, of Congress to stop or actively expose administration abuses are well known. While at times making strong statements against certain abuses, none of the health professions has taken active steps to investigate abuses or to expose or discipline members participating in abuses. All too often, good sounding words have been a substitute for action. Bioethicist Steven Miles, author of Oath Betrayed: Torture, Medical Complicity, and the War on Terror, said in response to these latest revelations:
Governments do not inject people with antipsychotics, medical personnel do.
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