Doctors and Interrogation
http://www.100md.com
《新英格兰医药杂志》
To the Editor: I am disappointed with the Journal for publishing articles by Bloche and Marks (January 6 and July 7 issues)1,2 that are critical of U.S. military health professionals without devoting equal space to opposing views. To do so is akin to trying a defendant without permitting testimony solicited by the defense team.
The use of torture during times of war has been around as long as war itself, and no treaty can change this. If the use of a health care professional can make the procurement of useful information more efficient and humane (and there is no evidence to suggest otherwise), how can someone with no personal stake in the matter so vehemently criticize it? One's perspective in life is a function of one's experiences. Whoever first said that the end cannot justify the means probably never witnessed genocide or treated dying soldiers.
Whether or not we are honest enough to admit it, our criminal justice system is predicated on the use of punishment and enticements. Prisoners are routinely deprived of sleep, dignity, privacy, and the ability to communicate freely. When our judicial system wants to extract useful information from inmates, it offers them more freedom and less squalid living conditions.
Sometimes the commitments and responsibilities of one's various stations in life are inconsonant. Three years before graduating from medical school, I took the oath of an Army officer, swearing to defend my country and obey all lawful orders given by superior officers in my chain of command. Before becoming an officer, I was a U.S. citizen. But first and foremost, I was a member of the human race. I do not know the personal histories of the physicians who took part in interrogations of prisoners, but I am sure that they, too, have conflicting allegiances. I consider myself to be a compassionate doctor, yet I must confess that my responsibilities as a human being and an American citizen take precedence over any doctrine, professional or otherwise, that I did not create and never agreed to uphold.3 I believe that terrorism is an axiomatic evil, and that the preservation of life is a moral imperative. If I could use my medical knowledge to prevent another human tragedy such as September 11 or the Holocaust, I would do so without blinking an eye. Isn't this why we entered medicine in the first place?
Steven P. Cohen, M.D.
Johns Hopkins School of Medicine
Baltimore, MD 21209
scohen40@jhmi.edu
References
Bloche MG, Marks JH. When doctors go to war. N Engl J Med 2005;352:3-6.
Bloche MG, Marks JH. Doctors and interrogators at Guantanamo Bay. N Engl J Med 2005;353:6-8.
Principles of medical ethics relevant to the role of health personnel, particularly physicians, in the protection of prisoners and detainees against torture and other cruel, inhuman, or degrading treatment or punishment: adopted by U.N. General Assembly resolution 37/194 of 18 December 1982. (Accessed September 14, 2005, at http://www.unhchr.ch/html/menu3/b/h_comp40.htm.)
Dr. Bloche and Mr. Marks reply: Dr. Cohen misreads our discussion of Pentagon policies as criticism of U.S. military health professionals. Many military physicians disagree with these policies, which have included the use of personal health information to craft interrogation strategies and the detailing of psychiatrists to interrogation units. Military health professionals have performed with great effectiveness, even heroism, in myriad clinical roles since the September 11 attacks.1
In our July 7 article, we did not categorically object to physicians' advising interrogators (though we have concerns2). Others do: the Army's second-highest-ranking medical officer recently recommended that psychiatrists stop serving as consultants to interrogators.3 His advice was rejected by higher-ranking officials. We do hold that health professionals should not abet interrogations that violate international human-rights law or the laws of war.
In becoming a physician, Dr. Cohen accepted his profession's ethical obligations. And in pledging to defend the nation, he agreed to abide by the laws of armed conflict, which recognize the unique responsibilities of physicians in time of war. Most military physicians with whom we have spoken take these commitments seriously — and think and act with care when tensions arise among them.
M. Gregg Bloche, M.D., J.D.
Jonathan H. Marks, M.A., B.C.L.
Georgetown University Law Center
Washington, DC 20001
References
Gawande A. Casualties of war - military care for the wounded from Iraq and Afghanistan. N Engl J Med 2004;351:2471-2475.
Marks JH. Doctors of interrogation. Hastings Cent Rep 2005;35:17-22.
Office of the Surgeon General. Army — final report: assessment of detainee medical operations for OEF, GTMO, & OIF. (Accessed September 22, 2005, at http://www.globalsecurity.org/military/library/report/2005/detmedopsrpt_13apr2005.pdf.)
The use of torture during times of war has been around as long as war itself, and no treaty can change this. If the use of a health care professional can make the procurement of useful information more efficient and humane (and there is no evidence to suggest otherwise), how can someone with no personal stake in the matter so vehemently criticize it? One's perspective in life is a function of one's experiences. Whoever first said that the end cannot justify the means probably never witnessed genocide or treated dying soldiers.
Whether or not we are honest enough to admit it, our criminal justice system is predicated on the use of punishment and enticements. Prisoners are routinely deprived of sleep, dignity, privacy, and the ability to communicate freely. When our judicial system wants to extract useful information from inmates, it offers them more freedom and less squalid living conditions.
Sometimes the commitments and responsibilities of one's various stations in life are inconsonant. Three years before graduating from medical school, I took the oath of an Army officer, swearing to defend my country and obey all lawful orders given by superior officers in my chain of command. Before becoming an officer, I was a U.S. citizen. But first and foremost, I was a member of the human race. I do not know the personal histories of the physicians who took part in interrogations of prisoners, but I am sure that they, too, have conflicting allegiances. I consider myself to be a compassionate doctor, yet I must confess that my responsibilities as a human being and an American citizen take precedence over any doctrine, professional or otherwise, that I did not create and never agreed to uphold.3 I believe that terrorism is an axiomatic evil, and that the preservation of life is a moral imperative. If I could use my medical knowledge to prevent another human tragedy such as September 11 or the Holocaust, I would do so without blinking an eye. Isn't this why we entered medicine in the first place?
Steven P. Cohen, M.D.
Johns Hopkins School of Medicine
Baltimore, MD 21209
scohen40@jhmi.edu
References
Bloche MG, Marks JH. When doctors go to war. N Engl J Med 2005;352:3-6.
Bloche MG, Marks JH. Doctors and interrogators at Guantanamo Bay. N Engl J Med 2005;353:6-8.
Principles of medical ethics relevant to the role of health personnel, particularly physicians, in the protection of prisoners and detainees against torture and other cruel, inhuman, or degrading treatment or punishment: adopted by U.N. General Assembly resolution 37/194 of 18 December 1982. (Accessed September 14, 2005, at http://www.unhchr.ch/html/menu3/b/h_comp40.htm.)
Dr. Bloche and Mr. Marks reply: Dr. Cohen misreads our discussion of Pentagon policies as criticism of U.S. military health professionals. Many military physicians disagree with these policies, which have included the use of personal health information to craft interrogation strategies and the detailing of psychiatrists to interrogation units. Military health professionals have performed with great effectiveness, even heroism, in myriad clinical roles since the September 11 attacks.1
In our July 7 article, we did not categorically object to physicians' advising interrogators (though we have concerns2). Others do: the Army's second-highest-ranking medical officer recently recommended that psychiatrists stop serving as consultants to interrogators.3 His advice was rejected by higher-ranking officials. We do hold that health professionals should not abet interrogations that violate international human-rights law or the laws of war.
In becoming a physician, Dr. Cohen accepted his profession's ethical obligations. And in pledging to defend the nation, he agreed to abide by the laws of armed conflict, which recognize the unique responsibilities of physicians in time of war. Most military physicians with whom we have spoken take these commitments seriously — and think and act with care when tensions arise among them.
M. Gregg Bloche, M.D., J.D.
Jonathan H. Marks, M.A., B.C.L.
Georgetown University Law Center
Washington, DC 20001
References
Gawande A. Casualties of war - military care for the wounded from Iraq and Afghanistan. N Engl J Med 2004;351:2471-2475.
Marks JH. Doctors of interrogation. Hastings Cent Rep 2005;35:17-22.
Office of the Surgeon General. Army — final report: assessment of detainee medical operations for OEF, GTMO, & OIF. (Accessed September 22, 2005, at http://www.globalsecurity.org/military/library/report/2005/detmedopsrpt_13apr2005.pdf.)