Pentagon Limits Medical Role in Questioning

The Pentagon on Tuesday placed new restrictions on how doctors can be involved in interrogations of detainees, but critics deplored any policy that gives medical professionals a role, saying it can lead questioners to use harsher tactics than they would without medical advice.

The military’s use of medical professionals in interrogations has drawn fire from human rights groups and medical ethicists. They have charged that doctors have been used unethically at the prison in Guantanamo Bay, Cuba, to force-feed detainees on hunger strikes and provide medical advice to help interrogators.

William Winkenwerder Jr., the assistant secretary of Defense for health affairs who approved the new policy, said it was written to ensure that healthcare professionals play an appropriate role. The policy attempts to draw a clear distinction between medical personnel who care for the health of detainees and mental health professionals, called “behavioral science consultants,” who assist interrogators.

Winkenwerder, in a conference call with reporters, said the “consultants” did not take part in interrogations. They make psychological assessments of prisoners, he said, but are not allowed to shape interrogations with their knowledge of a subject’s phobias or medical vulnerabilities.

Leonard S. Rubenstein, executive director of Physicians for Human Rights, said the military should prohibit psychologists or doctors from aiding in the questioning of detainees. “They are using their professional knowledge to hurt people,” he said. “The bottom line is health professionals should not be involved in interrogations.”

The guidelines are part of a policy directive for medical personnel that was originally due to be released with the Army Field Manual and another directive on the treatment of detainees.

But the Field Manual has been held up by objections from members of Congress, who are worried that it might not go far enough to ensure prisoners are treated humanely. The Times reported Monday that the Pentagon has decided to leave out a key part of the Geneva Convention that bans “humiliating and degrading treatment.”

Sen. John F. Kerry (D-Mass.) on Tuesday sent a letter to President Bush, saying such an omission would “make our troops and our country less safe.”

“Given the current situation in Afghanistan and Iraq,” he wrote, “it is an especially bad time to send a signal to the world that we no longer abide by internationally accepted norms for the treatment of prisoners.”

The medical directive released Tuesday also makes no mention of international law or treaties.

“It is outrageous that there is no reference to Geneva,” said M. Gregg Bloche, a Georgetown University law professor and one of the first to disclose the work of the behavioral consultants in an article in the New England Journal of Medicine.

The most controversial of the new rules for medical personnel are likely to be those governing the “behavioral science consultants,” psychologists or other experts who advise interrogators.

The American Psychiatric Assn.’s guidelines prohibit its members from taking part in interrogations. Professional guidelines for psychologists are less clear.

The new policy notes that physicians, such as psychiatrists, are not ordinarily used as behavioral consultants, “but may be so assigned” when qualified psychologists are unavailable.

Critics have said the consultants give interrogators information that helps them to increase the discomfort, stress or ill-treatment of detainees, giving tacit approval that allows harsher treatment.

Under the guidelines, the consultants are permitted to “make psychological assessments of the character, personality, social interactions, and other behavioral characteristics of detainees.” They can also train military personnel on “safe and effective interrogation methods” and advise them on the “potential effects of cultural and ethnic characteristics of subjects.”

The rules, however, bar them from “the use of physical or mental health information regarding any detainee in a manner that would result in inhumane treatment or not be in accordance with applicable law.”

“These words speak to humane behavior,” Winkenwerder said. “And if you have observed our personnel in action ... I can tell you they act humanely and they act with humane principle and they are ethical people.”

He said the new rules consolidated existing policies and added new details. “They reaffirm what has been a tradition that goes back decades and decades and decades,” he said.

Rubenstein, with Physicians for Human Rights, said anything short of a complete ban on the use of psychologists or physicians in interrogations would result in medical personnel helping interrogators use ever-tougher tactics.

“They have adopted the same policy and dressed it up in what purports to be safeguards,” he said. “Once you get sucked into interrogations, the likelihood of violating ethical obligations and hurting people is high.”

Many doctors and psychologists argue it is ethical to give classes on human behavior or other general instruction to interrogators. But giving advice on how to break an individual subject and make him or her talk crosses an ethical line, they say. The new rules allow such individualized advice, if the interrogators use lawful techniques.

Stephen Xenakis, a psychiatrist and former Army brigadier general in the medical corps, has criticized the use of doctors and psychologists in interrogations. He said he once supported the kind of wall the Pentagon is trying to create between caring for detainees and aiding in their interrogation.

But he now says such a distinction will be impossible. “You are always a healthcare provider,” Xenakis said. “You can’t be an interrogator in one job and a doctor in another.”

The new guidelines may also tighten the use of medical records. At Guantanamo Bay, there was for a time no restriction on interrogators looking at medical records. The new directive does not restrict access to records but mandates that such disclosures are recorded.

The new rules also offer guidance on force-feeding. They say that medical personnel may assist in force-feeding detainees on a hunger strike “without the consent of the detainee to prevent death or serious harm.” The directive says the treatment must be medically necessary.

The International Committee on the Red Cross prohibits force-feeding.

Xenakis argues that doctors should take steps, short of force-feeding, to try to keep patients alive, or persuade them to stop hunger strikes. But he said if patients were mentally competent, and rationally decide to starve themselves, medical personnel must let them do it.

“Patients have the right to exercise autonomy and starve themselves,” he said.

Winkenwerder said the new directive adhered to the policy of the Federal Bureau of Prisons: to keep anyone under detention alive.

He said healthcare was provided “with the consent of the detainees,” with the exception of those who are refusing nourishment. “We have a policy that is to preserve life,” he said. “That policy is an ethical policy,” he said.

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Times staff writer James Gerstenzang contributed to this report.