Last week, M. Gregg Bloche, a doctor and professor of law at Georgetown, published a compelling op-ed in the Times. Drawing on recently declassified government documents, Bloche shows that US doctors employed by the CIA played an active role in the design and implementation of state torture after September 11, 2001. With the president-elect still unsure about his preferred approach to interrogation — the leading possibilities range from “bring[ing] back a hell of a lot worse than waterboarding” to giving detainees “a pack of cigarettes and a couple of beers” — the piece could hardly be more timely.
Sadly, the CIA’s torture doctors do not stand alone among medical professionals. We’ve known for years that psychologists on government contracts designed the torture program, and that doctors were present to regulate torture. Moreover, an American Psychological Association report released last year showed that individuals at the highest level of the profession (and the APA) worked to shield “enhanced interrogation” from criticism.
What is new in Bloche’s op-ed is the confirmation of doctors’ willingness to go above and beyond the practices ruled “legal” by the Bush Justice Department’s infamous torture memos. The premise is, on its face, absurd; international legal instruments from the Geneva Conventions to the Convention Against Torture leave no room for practices like simulated drowning and sleep deprivation. Yet the Justice Department did claim that these practices were allowed. Nonetheless, Bloche’s CIA doctors refused even this cellophane cover, pursuing waterboarding in such a way as to make it “more terrifying and dangerous than what government lawyers permitted.” (Indeed, these doctors turned the practice from a simulation of drowning into the real thing.)
Reading all of this left me frustrated and surprised, though not for the reasons one might expect. Yes, the Hippocratic Oath demands that doctors do no harm, but in each of the instances of systematic torture that I have studied, psychologists were critical to the development of “scientific” torture, and doctors helped to calibrate and respond to the deliberate infliction of pain in order to ensure maximal distress while keeping their victims alive. Likewise, US doctors may have exceeded the bounds of the officially approved torture program, but this too is a constitutive aspect of systematic torture. Indeed, any centrally planned apparatus of state repression presumes to operate within limits, yet in practice such “controls” never last long. Even the CIA has recognized as much. Its 1983 Human Resources Exploitation Training Manual, used across Latin America, included, along with instruction in “coercive interrogation,” this warning: “The routine use of torture lowers the moral caliber of the organization that uses it and corrupts those that rely on it.”
No, the real surprises in Bloche’s op-ed were altogether more depressing. The first isn’t news, but still worth underscoring: it is shocking that the Bush administration opted to bring so many outside experts, namely lawyers and psychologists, into its torture program. If the Justice Department and the APA hadn’t gotten involved, and CIA interrogators and doctors had been left to run it alone, I suspect we’d know as much about this latest round of “coercive interrogation” as we do about the prior half-century of US state torture. Whatever approach Trump ultimately alights on, I’m confident he won’t make this particular mistake.
The same cannot be said for the CIA’s doctors and other operatives, however. Since the first revelations, in the early 2000s, of US detainee treatment in Iraq, there has been no legal accountability for those implicated in the design and execution of torture. Indeed, few have even called for them to be tried. Violators of international law and the most elemental norms of decency, then, have suffered few adverse consequences beyond those imposed by their own consciences. This abandonment of accountability extends to Bloche’s op-ed as well, and in the process it demands a logical leap so large that it sails clear beyond the page. After spending sixteen paragraphs carefully outlining the horrific and (even under the loosest, torture-memo-iest interpretation of US law) illegal behavior of these doctors, Bloche concludes his piece with this call:
“An independent inquiry into what those physicians did and how they lost their ethical moorings is vital. So are clear lines between acceptable and improper use of medical expertise for national security purposes. The law of armed conflict sets standards for access to medical care for detainees, and clinical assessment is a potent tool for detecting abuse.
“Meanwhile, it’s urgent that American medicine sends a powerful, public message to President-elect Trump that there can be no place for medical participation in the engineering of cruelty, even in clandestine service to the nation. And it’s critical that C.I.A. and military doctors heed this message, even if they must defy orders to the contrary.”
Independent inquiries are all well and good, but how will we draw “clear lines” without acknowledging a cut-and-dry violation of the law? And how can we argue with a straight face that there “can be no place for medical participation in the engineering of cruelty,” when Bloche has just devoted 800 words to demonstrating the opposite?
In a remarkable twist of fate, the very day after reading Bloche’s piece in the Times, I came across this news clipping at Chile’s Museo de la Memoria y los Derechos Humanos:
It’s a special October 1986 issue of the Chilean newspaper La Hora, about torture in Uruguay. The headline reads, “The Complicity of Military Doctors in Torture was Systematic and Extensive.” It’s a translation of an article published earlier that year in the prestigious Journal of the American Medical Association by — wait for it — M. Gregg Bloche! After reviewing the evidence for medical participation in widespread state torture under Uruguay’s 1973-1985 dictatorship, Bloche 1986 concludes by reflecting on the individual responsibilities of physicians to denounce torture, and by endorsing efforts by Uruguay’s then-president and its medical community to cast those responsible out of the profession. It’s a far cry from full legal accountability, but it’s much more than Bloche 2016 is calling for here in the US, today.
Reading Bloche 1986 tempts me to invert one of Bloche 2016’s more striking phrases. If history teaches us anything hopeful about the relationship of medicine to torture, it is not that there can be no medical participation in the engineering of cruelty. Instead, it’s that there can be no engineering of cruelty without medical participation. So let’s revoke some medical licenses — or better still, let’s put some doctors in jail.