Tortured Logic

"The end excuses any evil."
--Sophocles, "Electra" (409 B.C.)

"No man is justified doing evil on the grounds of expediency."
--Theodore Roosevelt, "The Strenuous Life" (1900)

Last week, I was having dinner with a good friend who is an extremely bright and thoughtful person. I shared with him how shocking it is to me that our country is having a rational debate about whether or not it's permissible to torture people. "It's unfathomable to me that some people think it's morally defensible to torture people in the name of defending our freedoms," I said. "If we can't draw a bright moral line about torturing, then where can we? Torture is never the right thing to do."

"Oh, yes it is," he replied, causing me to choke on my sushi. "What if some guy abducted your beloved wife and son, had them locked up somewhere with a bomb that was rigged to explode in two hours, and the police captured him. Wouldn't you torture him to get the information you needed to save their lives?"

"I don't know what I would do," I replied, "but I'd like to believe that nothing ever justifies torture. Expediency is a slippery slope."

As the cartoon character Pogo once said, "We have met the enemy and he is us." Sometimes, people do the darkest acts in the name of helping protect their loved ones. Sweet and precocious young Anakin Skywalker goes to the Dark Side and becomes the evil Darth Vader in hopes of gaining enough powers to protect his beloved wife from dying in childbirth.

In this column, I want to focus on the morality and efficacy of torture more than the political and legal concerns. What does torturing people say about us as human beings, and how does it involve us as health professionals? And if doctors, nurses and psychologists torture people or participate in executions, how does that affect people's visceral perceptions and experiences of us as healers rather than as torturers? If we physicians are causing suffering rather than relieving it, and if we destroy lives rather than save them, what kind of corrosive effects does that create?

According to Leonard Rubenstein, executive director of Physicians for Human Rights, "Torture can also compromise the integrity of health professionals." As Harvard psychiatrist Robert J. Lifton wrote in The New England Journal of Medicine, "The participation of doctors [in torturing] can confer an aura of legitimacy."

There are important reasons why the most sacred medical oaths and doctrines, including the World Medical Association Declaration of Tokyo, prohibit doctors from participating in torture in any way. All physicians take the Hippocratic Oath, which states, "I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrongdoing."

In an op-ed column in the Washington Post, "The Stain of Torture," by Dr. Burton J. Lee II, former personal physician to President George H.W. Bush, the doctor wrote:

It's precisely because of my devotion to country, respect for our military and commitment to the ethics of the medical profession that I speak out against systematic, government-sanctioned torture and excessive abuse of prisoners during our war on terrorism. I am also deeply disturbed by the reported complicity in these abuses by military medical personnel. This extraordinary shift in policy and values is alien to my concept of modern-day America and of my government and profession. Military leaders have long been aware that torture inflicts lasting damage on both the victim and the torturer. The systematic infliction of torture engenders deep hatred and hostility that transcends generations. And it perverts the role of medical personnel from healers to instruments of abuse.

But according to Dr. David Tornberg, deputy assistant secretary of Defense for health affairs, (as quoted in the New England Journal of Medicine) a medical degree is not a "sacramental vow"--it is only a certification of skill. When a doctor participates in interrogation, "he's not functioning as a physician," so the Hippocratic Oath no longer applies. This makes no sense at all, since it is precisely because of the physicians' skills and training that they are asked to participate in torture. Worse, it debases and degrades the humanity of our profession and the sacred vows and oaths that we take. By speaking out against torture in all its forms, we can reclaim our role as healers.

For those who defend the need to torture in certain circumstances, there is a presumption that it works. Yes, it's bad, they may say, but if it's the lesser of two evils and necessary to protect our loved ones, then it can sometimes be justified. However, a recent report by the National Intelligence University states that there is no evidence that torture works in providing useful information. Worse, it often leads subjects to provide misinformation.

Douglas Johnson is executive director of the Center for Victims of Torture in Minneapolis. He says, "We care for people who the rest of the community would consider innocent victims of torture, but all of those survivors would tell you that they would have said anything--anything at all that was wanted of them--to get the torture to stop. And so, they'll confess, they'll give the information that's fed to them, because the person who most needs a confession is the torturer. Without that confession, the torturer has no justification for what they've done. And the only way that torture states manage the morale and the minds of their torturers is that a confession emerges. And that's one of the key reasons why truth doesn't emerge from torture. Anything could emerge. Sometimes it's a danger."

According to Dr. Steven Miles, a professor of medicine and author of the book "Oath Betrayed: Torture, Medical Complicity, and the War on Terror," "One of the fascinating things about the ticking-time-bomb scenario is that it has elicited bad information, which has sent our troops on dangerous and fatal missions. The sole source for the information that bioweapons were being developed jointly by Saddam Hussein and Al Qaeda came from a guy that we kidnapped in Sweden, took to Egypt and tortured, and that made it to the U.N. and was part of the authorization to go to war."

His views were echoed by Sen. Joseph Biden last month at a Democratic debate at Dartmouth College: "I met up here in New Hampshire with 17 three- and four-star generals, who said, 'Will you make a commitment you will never use torture?' It does not work, and it's part of the reason why we got the faulty information on Iraq in the first place, because it was engaged in by one person who gave whatever answer they thought there were going to give in order to stop being tortured. It doesn't work. It should be no part of our policy ever. Ever."

Earlier this month, according to the Washington Post, there was a reunion of about two dozen World War II veterans in Washington who participated in the interrogation of Nazi prisoners of war. "Many of the proud men lamented the chasm between the way they conducted interrogations during the war and the harsh measures used today in questioning terrorism suspects," the paper reported." Henry Kolm, an MIT physicist whose interrogation of Hitler's deputy, Rudolf Hess, occurred over a chessboard, said, "We got more information out of a German general with a game of chess or ping-pong than they do today, with their torture."

Alberto Mora is the former Navy general counsel who opposed the administration's policy on torture. In 2006, while accepting the JFK Profiles in Courage Award, he said: "We need to be clear. Cruelty disfigures our national character. It is incompatible with our constitutional order, with our laws, and with our most prized values. Cruelty can be as effective as torture in destroying human dignity, and there is no moral distinction between one and the other. To adopt and apply a policy of cruelty anywhere within this world is to say that our forefathers were wrong about their belief in the rights of man, because there is no more fundamental right than to be safe from cruel and inhumane treatment. Where cruelty exists, law does not."

"Torture" is defined in the Military Commissions Act of 2006 as "an act specifically intended to inflict severe physical or mental pain or suffering upon another person within his custody or physical control for the purpose of obtaining information or a confession, punishment, intimidation, coercion, or any reason based on discrimination of any kind." According to The Washington Post, methods of torture that have been used by the CIA include waterboarding (mock drowning), exposure to extreme cold (including induced hypothermia), stress positions, extreme sensory deprivation and sensory overload, violent shaking, striking, sexual humiliation, prolonged isolation, prolonged sleep deprivation, threats of harm to individuals and to their family and friends, among others.

The Third Geneva Convention states, "No physical or mental torture, nor any other form of coercion, may be inflicted on prisoners of war to secure from them information of any kind whatever. Prisoners of war who refuse to answer may not be threatened, insulted, or exposed to any unpleasant or disadvantageous treatment of any kind." The issue of dual loyalty--the need for military doctors to follow orders and also to be bound by principles of medical ethics--was clearly dealt with in this and other international treaties, including the Nuremberg tribunals in which "orders are orders" was not a valid defense by military personnel against war crimes.

According to several sources, including a recent report, "Leave No Marks," by Physicians for Human Rights and Human Rights First, increasing evidence indicates that physicians and other health professionals, including psychologists, have been involved in torturing detainees in Guantánamo Bay, Iraq and Afghanistan. These activities range from participating in torture, watching it behind one-way mirrors, patching wounds, treating collapsed prisoners, turning over medical records to interrogators, and covering up and even falsifying deaths due to torture so they appeared to be from natural causes. Dr. David Auch, commander of the medical unit that staffed Abu Ghraib during the time of the abuses made notorious by soldiers' photographs, said military intelligence personnel told his medics and physician assistants not to discuss deaths that occurred in detention.

Psychologists may advise interrogators on how best to exploit fears and weaknesses in those that they are torturing. I was disappointed that the American Psychological Association (APA) did not pass a proposed moratorium earlier this year banning psychologists from being involved in coercive interrogations. According to Dr. Miles, "[The APA] very specifically stated that physicians or psychologists could work in secret prisons with an option of leaving if they wanted, but not with an obligation to call attention to the abuses within secret prisons."

As Douglas Johnson said during a recent interview, "I think it's important to understand that in today's world there are more health-care professionals involved in the design and structuring of torture than there are those who are involved in providing care for survivors of torture around the world."

If we're not careful, we become that which we most fear. When we torture people, even if we win the battle, we've already lost the war for hearts and minds. Especially our own.

This piece was originally published in Newsweek. A link to the article is here.

Comments

[jbulette]

this is a very thoughtful, academic essay. it would be more convincing to those uncertain about whether torture is ever justified if the scope of motivations and history of our use of torture was included. torture has been a covert element of u.s. policy following wwii, if not before. operation phoenix was a systematic program of torture, intimidation and assasination widely used in viet nam. the intent of those who advocate torture is not limited to obtaining vital information but also to let the target population know what they can expect. when our leaders talked about winning the hearts and minds of the vietnamese, operation phoenix was a major component of that effort. abu ghreib was similarly intended and was initiated at the very top , and is a very clear indication of the moral decay there.john bulette m.d.

[IMPRISONBUSH]

BUSH IS RIGHT IN ONE THING :
..." AMERICANS DON'T TORTURE "

WE SEND PRESONERS TO OTHER COUNTRYS TO DO THE TORTURE.

IF BUSH...., CHENEY AND OTHERS EVER TAKE A TRAPE OUT SIDE AMERICA, THEY COULD BE PICKED UP BY THE " WORLD COURT " AND BE " CHARGED WITH TORTURE ".
FOR THE PAST SIX YEARS WHAT A WAY FOR A COWARD TO MEET HI PUNISMENT ?.

[darker]

So WHAT ARE YOU GOING TO DO ABOUT THIS??

All we hear from celebrities, congress people, media guys is a BUNCH OF BLATHER and no action.

[Mack20]

Here is a quote you missed: “The gentlest gamester is the soonest winner”. Henry V, William Shakespeare.

This torture thing has gotten way out of hand. We have seen pictures from Abu Grab with prisoners wearing underwear on their heads, dogs used to threaten inmates, and annoying non-stop music blaring to result in sleep deprivation. I know there are lots more situations that arouse you people, but why do you leftists constantly focus on what our side may or may not be doing? There is never a critical word about beheadings, disembowelments, and other evil actions by our enemy. Not to mention our enemy killing innocents to further some crazy, sick agenda and fuel a civil war.

Remember we are at war! If you truly support the troops, then anything within reason to protect and save lives should be embraced.

Dr. Dean, your answer “I don’t know what I would do” tells me everything I need to know about you and your commitment to this war and those lives in the balance. This question needs to be posed to every one running for president next year. Remember that similar question posed to Mike Dukakis in 1998 by Bernard Shaw? His non-answer spelled the end of his presidential campaign as well as his political career. No?

This issue and that question will be asked about a year from now by another moderator in a debate possibly between Hillary and Rudy. Hillary has 11 or 12 months to position herself on the right side of the issue through lots of polling and focus group meetings. Rudy will answer then as he believes now. American lives are more valuable than our enemy’s lives and since we are at war, the president is bound by the constitution to protect America at all costs. Hillary will probably say the same thing but most of us know she really doesn’t mean it. The majority of voters know she will say anything and everything popular to be elected. It is no wonder many of you dems can’t stand her. Your only hope is Gore.

[INQUIRER]

More brainless blabber by another Republican fanatic.

[wmbear]

THE ABOVE THOUGHTE LED ME TO A FURTHER REALIZATION...

Since torture is basically an irrational interrogation technique, its primary purpose cannot be to facilitate the extraction of information. No. I believe that the primary (and covert) reason for torturing prisoners is actually as a form of PUNISHMENT. Yes, using torture in interrogations is really just a covert means of exacting "cruel and unusual punishment" on one's enemies under the guise of an interrogation technique. If this fact were realized more generally, perhaps the debate would begin to lead somewhere other than the current vicious circle (so to speak).

[wmbear]

"Last week, I was having dinner with a good friend who is an extremely bright and thoughtful person. I shared with him how shocking it is to me that our country is having a rational debate about whether or not it's permissible to torture people."

DEBATE, YES...

Rational, no. I am not a moral absolutist, so I don't "believe in" statements such as, "Torture is never the right thing to do." Not that I believe that torture IS ever the right thing to do, just that I realize that such absolutizing invites counter-examples, such as that of Dr. Ornish's dinner partner.

My response (after not generating a moral absolute in the first place) would have been to point out that this kind of case is 1) a hypothetical, and 2) unrealistic, in that this is not the typical case where a decision "to torture or not to torture needs to be made." I would simply counter with a realistic counter-counter example drawn from the many documented cases where innocent prisoners have been tortured into confessing to non-existent crimes.

Thus the two fundamental reasons for not employing torture as an instrument of policy are these:

1) Torture is inhumane and, if nothing else is both a violation of international law and sets a horrible example.

2) Even from a pragmatic standpoint, it's been shown time and again that torture simply doesn't WORK as an interrogation technique -- the information extracted is likely to be false, made-up, and of the I'll-say-whatever-you-want-me-to-say variety.

Why people can't see this remains a complete mystery to me and many others.

[GH]

But first, you'll have to change the mind of Nobel Peace prize winner - Mr. Al.

RICHARD CLARKE - Snatches, or more properly "extraordinary renditions," were operations to apprehend terrorists abroad, usually without the knowledge of and almost always without public acknowledgement of the host government. . . The first time I proposed a snatch, in 1993, the White House Counsel, Lloyd Cutler, demanded a meeting with the President to explain how it violated international law. Clinton had seemed to be siding with Cutler until Al Gore belatedly joined the meeting, having just flown overnight from South Africa. Clinton recapped the arguments on both sides for Gore:.. Gore laughed and said, "That's a no-brainer. Of course it's a violation of international law, that's why it's a covert action. The guy is a terrorist. Go grab his ass."

That was all, an excerpt. Gore supported extroadinary rendition and torture, as well. Currently all we hear is lip partisan service. Put him back in, and the power will go right back to his head.

"The common denominator seems to be based on an instinct to intimidate and control."

And look at how well it's continued to work.

[JimReed]

"We got more information out of a German general with a game of chess or ping-pong than they do today, with their torture."

The Germans knew they were doing wrong, just following orders. This weakness made it easier to get information from them by friendly means. Today's "terrorists" know they are fighting against the evil, not for it. They are willing to endure great pain and even die for the cause. Wouldn't we expect Americans to do the same if we were ever under attack form some power threatening to take over our country?

[DrDeanOrnish]

Thank you for your kind words, which I deeply appreciate.

[anotherbozo]

You are preaching to the choir here, Dr. Ornish. Go say that on Fox News, CNN, in Murdoch's papers...

[mommadona]

Waaaay too late with this type of "I'm shocked! Shocked!" mullings.

The horse is out of that barn and the door is locked.

If you think ANY from this day forward are going to work TO RETURN OUR RIGHTS as we once knew them about 5 years ago, has got a BIG paradigm switch to deal with. It is NOT your country any longer.

[jdm58]

If we stopped, for a moment, and examined the actions of our government from the viewpoint of the "other" we are so afraid of, we would have a glimpse of understanding of why we are so deeply villified. Our government no longer walks the walk of freedom. It no longer offers a road others want to follow. When will we wake up to the consequences of our actions? We are one of the only countries left in the world to practice in the death penalty or torture as solutions. Is this the power of the Democracy we are promoting? No wonder they're not lining up to join us.

[drricklippin]

Dr. Ornish;

Glad that physicians like you are writing pieces that go beyond what you (they) are most known for- In your case nutrition science.

Its nice when physicians demonstrate they can offer eudite opinions and writings on non-medical topics.

It demonstrates to me that expertise in one are may actually exhance expertise in another.

So yes- I belive in the reniassance person concept. Where are the REAL answers? Hands down-the poets.

Dr. Rick Lippin
http://medicalcrises.blogspot.com

[Ilvfredum]

I love how a lawyer who has never done an honest days work gets elected to Congress and suddenly becomes an expert on everything from Farm-subcidies to Healthcare.

[drricklippin]

llvfredum-

20 years ago I proposed an organization called ABA= "Anything But a Lawyer" to be elected to ANY political office

I proposed it as a joke but people started to send me $. I never developed it.

Politics= by lawyers-for lawyers.

We sure do need a better mix.

Thanks

Dr.Rick Lippin

[rabun666]

I applaud the Bush maladministration use of torture despite the fact that it was torture that created the Iraq fiasco. However, their is not more expedient way for this nation to successfully rush headlong into the dung heap of the despicable and vile countries that have preceded us, like Nazi Germany or Stalin's USSR, just to mention a few. If torture does produce misinformation that creates atrocities by the torturers, the responsibility can be deflected to the tortured for giving misinformation thereby absolving the torturer,Bush, of any responsibility. I mean it was god that told Bush to invade Iraq, relieving Bush of the responsibility. And was Bush or god the tortured or the torturer? Hmmmmm

[Canukistani]

Wonderful article! You make a clear and obvious case for anyone who wants to listen. It should also be noted that torture and even inhumane treatment is clearly against the Universal Declaration of Human Rights. There is just no defending it on any rational grounds.