Doing harm

Rafael Campo, an internist and Harvard Medical School professor, is the author of "The Other Man Was Me" and "The Poetry of Healing: A Doctor's Education in Empathy, Identity, and Desire." His new book of poetry, "The Enemy," will be published in early 2007.

THE central image of my Roman Catholic faith is, on the most literal level, a tableau of torture. While viewing countless depictions of Christ's crucifixion during a recent trip to Italy, I was struck by the heinous inhumanity of such an act and, at the same time, by its symbolic meaning as God's sacrifice to save humankind. In his harrowing book "Oath Betrayed: Torture, Medical Complicity, and the War on Terror," physician Steven H. Miles shows how far from that symbolism our nation and its leaders have moved, concluding in his first chapter: "The United States is a torturing society."

In a writing style as dispassionate as it is unflinching, Miles cites death certificates, sworn statements, detainee abuse incident reports and news accounts, among a wealth of other materials, to present incontrovertible evidence of the torture inflicted by Americans upon prisoners held in Iraq, Afghanistan and the U.S. military base at Cuba's Guantanamo Bay, and of the complicity of U.S. medical personnel who failed to resist such abuses.

Miles cites the case of Abu Ghraib prisoner Ameen Said Sheikh, whose testimony last year helped convict Army Spc. Charles A. Graner Jr. of abusing detainees. In sworn statements, one medic told of trying to intervene to keep Sheikh, who had a dislocated shoulder due to a prior beating, from being suspended by his handcuffs. The medic was "recommended for disciplinary action for failing to stop or report the ongoing abuse" even though he said two officers witnessed his examination of Sheikh. In a later incident, a second medic said the on-call physician refused to treat Sheikh for a bleeding wound or admit him to the adjacent hospital. The medic told investigators that when she asked the doctor if he had heard of the Geneva Convention, he replied: "Fine, sergeant, you do what you have to do; I am going back to bed."

True to his training as a medical ethicist, Miles painstakingly examines what proves on one level to be a political debate about whether the barbaric acts perpetrated against Americans five years ago in the Sept. 11 terrorist attacks justify a response in kind, and whether medical professionals serving in the armed forces during a time of extraordinary conflict remain obligated by their Hippocratic oath to do no harm.

In the course of this unforgettable book, Miles provides a short history of torture, reminding us of its earliest recorded uses by the ancient Greeks and Romans, and its perfection as an interrogation technique by, ironically, the Roman Catholic Church during the Middle Ages. Perhaps most surprising is how few nations have avoided its use. Miles reports that as many as 130 countries, secular states as well as those founded upon the world's major religions, are known to have practiced torture, aided by physicians and nurses in many instances. In discussing the historic role physicians have played in advancing torture, Miles cites the infamous examples of Nazi Germany's Josef Mengele, who conducted sadistic experiments upon Jews, homosexuals and others deemed "diseased" according to the warped eugenics espoused by Adolf Hitler.

Most of the book, however, is devoted to abuses that have occurred during the current "global war on terror." In refusing to sensationalize the events he analyzes, Miles, a practicing physician and University of Minnesota professor, allows us to revisit Abu Ghraib and Guantanamo as thinking, nonjudgmental witnesses, thereby revealing the true horror of what happened there.

Invoking such guiding principles as the United Nation's 1948 Universal Declaration of Human Rights, the 1949 Geneva Convention and Hippocrates' ancient admonition -- and placing these texts alongside the declarations, executive orders and legal memos of Defense Secretary Donald H. Rumsfeld, former Atty. Gen. John Ashcroft and President Bush, among others -- he lets us reach our own conclusions about whether torture can ever be justified. The expedient policies of our leaders are contrasted with the collective wisdom of the many nations whose voices joined together in those earlier international declarations with shared disgust at the crimes against humanity perpetrated by Hitler and Josef Stalin. Because one of the main benefits of such agreements is the protection they afford our own soldiers and citizens against barbaric treatment, one is struck by the greatly heightened risk we have collectively incurred by casting them aside.

Miles doesn't indict the individual soldiers and health professionals who were agents of the abuses he so carefully researches and documents; to do so would make him as complicit as the government and military leaders who were happy to scapegoat those they portrayed as "a few bad apples." Instead, he considers what might lead any of us to behave inhumanely: Silence can be justified by such statements as "I didn't know what was going on." Active abuse is explained away by "I was following orders."

More sophisticated rationalizations, such as the claim that the urgency of obtaining information about imminent terrorist strikes to save innocent lives demands the use of torture, are debunked by well-known evidence that intelligence extracted from adversaries under duress is almost always false. The more troubling cry for vengeance is harder to invalidate, except to observe that such behavior makes us as evil as those we are bent on punishing.

This final concern reveals a deficiency in this otherwise impeccably reasoned work. Miles poses valuable questions but leaves us without an entirely persuasive ethical rejoinder to terrorist provocation. What alternatives do we have when confronted by a foe whose criminal acts are so unconscionably vile as to incite us to retribution? The high-minded language of international accords feels tragically insufficient to this egregiously uncivilized kind of challenge, one that even the actions of such latter-day despots as Cambodia's Pol Pot and Liberia's Charles Taylor could not have presaged.

Also incompletely explored is how today's dehumanizing medical education process might breed physicians like some working in U.S. military detention camps who, instead of ministering to prisoners, participated in torturing them. Miles correctly implicates conspicuously silent U.S. medical professional organizations in the ethical failures that contributed to Abu Ghraib. Medical schools and residency programs that view patients as little more than the abstract sums of their diagnoses, thus stripping them of their humanity, surely bear an even greater share of the responsibility.

In the end, Miles succeeds in connecting the distant abstraction of torture to the realm of individual values and personal responsibility. To think that my family escaped Cuba, a notorious torturing nation, to live free of religious and political persecution in the United States, only to witness torture abetted by members of the profession I was once so proud to join is to experience anguish of the deepest kind. What would my grandfather, whose gaunt neck was encircled by a simple gold chain from which a crucifix dangled, think of the crimes recounted in this haunting book? I think of that emblem of suffering now, just as when I toured the churches and monuments of Italy; I try to remember its message that in our pain we are all equally human, and that through such knowledge the possibility of redemption is revealed.

Perhaps torture will finally cease when each of us -- elected leaders and government functionaries, physicians and nurses and soldiers, and even our most hated enemies -- take to heart this indelible truth. *

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