Military doctors "breached the laws of war" by helping intelligence officers carry out coercive and potentially torturous interrogations at detention facilities in Iraq and Cuba, according to a report today in a leading medical journal.
The report says medical personnel collaborated with prison guards and military interrogators to devise "aggressive" interrogation plans in which detainees were deprived of sleep, given minimal bread and water and, among other things, exposed to extreme temperatures.
Military intelligence interrogators also were allegedly given access to detainees' medical records.
The report does not lay out definitive proof that any doctors were complicit in torture either at Abu Ghraib prison in Iraq or the detention facility at Guantanamo Bay, Cuba.
But Dr. M. Gregg Bloche, an author of the report who is co-director of the Georgetown-Johns Hopkins Joint Program in Law and Public Health, said physicians were an "integral part" of devising interrogation plans - some of which were "coercive, even abusive" and "rose to a level that breaches the Geneva Conventions."
The Third Geneva Convention forbids physical and mental torture - as well as other coercive methods - as a means of extracting information from prisoners of war.
The report, published today in the New England Journal of Medicine, is based on at least two dozen interviews, testimony from military officials and a range of documents, some of which have been made public under the Freedom of Information Act, according to the authors.
A spokesman for the military could not immediately be reached for comment.
The report references the testimony in February of Col. Thomas M. Pappas, chief of military intelligence at the Abu Ghraib prison, before a military panel investigating charges of abuse there.
Doctors had final say
Pappas said that a physician and a psychiatrist reviewed interrogation plans and had "the final say as to what was implemented," according to a copy of the testimony posted by the American Civil Liberties Union on its Web site.
The interrogation plans included "a sleep plan and medical standards." The "sleep plans" included instructions for inmates to be allowed an hour's sleep every four hours.
Psychiatrists were also assigned to observe detainees being questioned to determine "whether they were being medically and physically taken care of," according to the testimony. But Pappas said the system for making sure that those visits took place was not always in place, leaving periods of time when the detainees' welfare was not being monitored.
The New England Journal report, which is labeled "Perspective," calls interrogation tactics used at Abu Ghraib and Guantanamo "transparently coercive" and "threatening."
"The conclusion that doctors participated in torture is premature, but there is probable cause for suspecting it," wrote Bloche and his co-author, Jonathan H. Marks, a bioethics fellow at Georgetown University Law Center and the Johns Hopkins Bloomberg School of Public Health.
More investigation is needed, the authors said, to "determine whether they helped to craft and carry out the counter-resistance strategies ... that rise to the level of torture."
The report goes on to ask a fundamental question about the role of military doctors: Do they breach their medical ethics by developing and executing interrogation strategies?
One school of thought is that military physicians are combatants first and, therefore, have no doctor-patient relationship with detainees.
But Dr. Arthur Caplan, a medical ethicist at the University of Pennsylvania, said a military doctor's primary responsibility is to serve the interests of the weak.
"Doctors have to be doctors first," he said. "They are the moral ballast, the place you turn to witness, intervene and advocate for whoever is being victimized."
Caplan said it would be naive to expect that there would be no ethical "slippage" in the conduct of war - but not on the part of physicians and other medical personnel.
"The view that you're a soldier first and a doctor second isn't tenable," he said. "Doctors feel they have to protest [abuse], they have to report it. And I think that every soldier ... should understand that doctors should be blowing the whistle."