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编号:11342743
Oath Betrayed: Torture, Medical Complicity, and the War on Terror
http://www.100md.com 《新英格兰医药杂志》
     A 2004 posting of the "Interrogation Rules of Engagement" at the Abu Ghraib military prison stated that the following techniques required the approval of the commanding general: dietary and environmental manipulation, "sleep adjustment, isolation for longer than 30 days, presence of military working dogs . . . sensory deprivation, stress positions." A central strategy of human rights work is to expose and document violations of human dignity. Steven Miles, the author of Oath Betrayed, is a physician, bioethicist, and human rights activist who has worked against torture in Turkey, the former Soviet Union, South Africa, Cuba, and the United States. He begins his discussion by asking, "Where were the doctors and nurses at Abu Ghraib?" The audience for the book is not confined to medical professionals, however. The book grew from an article on the same subject published in the August 21, 2004, issue of the Lancet, which drew a large response from the international media. According to Miles, the book is based on approximately 35,000 pages of official documents, most of them posted on the Internet. Miles writes that although medical personnel in other countries have a history of participating in acts of torture, "such actions departed from the United States' tradition of medical care for prisoners of war." It is a shocking story, even for readers who think they have learned all they need to know from the media about torture in U.S. military prisons.

    (Figure)

    A Detainee at the Abu Ghraib Prison in Baghdad, Iraq, Receiving Medical Attention.

    From the AP/Wide World Photos.

    Miles describes in detail the involvement of U.S. military physicians, nurses, and medics in the neglect, abuse, and torture of prisoners in Afghanistan, Iraq, and Guantánamo Bay. He describes specifically the active, nontherapeutic role U.S. military physicians played in advising interrogation teams, examining prisoners before and after interrogation, and condoning the use of stress positions, sleep deprivation, isolation, and threats. Even more disturbing, Miles documents the deaths of prisoners under torture and physician involvement in falsified death certificates. He concludes that at least some U.S. military physicians, whom he names whenever the available records permit, violated basic tenets of medical ethics by allowing three grave breaches of the Geneva conventions: assisting in harsh and coercive interrogations; failing to ensure that findings pertaining to the cause of death were "reliably, truthfully, and promptly communicated"; and failing to "forcefully advocate for minimally adequate resources to meet prisoners' basic need for mental health care, sanitation, tuberculosis treatment, shelter from weapon fire, and in some cases medical care."

    Miles calls for new policies, more transparency, and more accountability for military medical personnel and rightly asks the medical profession to take the lead. Physicians can and should clearly articulate and support medical ethics standards, but physicians cannot reform government policy and practices on their own. In the same week that the book was published, the U.S. Supreme Court, in Hamdan v. Rumsfeld, firmly repudiated Bush administration policy and ruled that common article 3 of the Geneva conventions (which prohibits not only "cruel treatment and torture" but also "humiliating and degrading treatment") applies to all prisoners in U.S. military custody, regardless of their status.

    Documentation should, of course, lead to action, and the next steps should include an independent investigation to determine how and why these abuses occurred, the establishment of a system to improve accountability, and the development of a plan to prevent such abuses from recurring. Of course, prisoners should be protected from abuse, and as Miles notes, "clinicians are frontline monitors for human rights abuses in prisons." But military physicians must also be confident that they always have the legal authority to place the medical interests of their patients first. In this regard, the primary responsibility for the corruption of military medical ethics rests in civilian hands, especially those of lawyers in both the White House and the Department of Defense who wrote memos and instructions that conflict with medical ethics, U.S. and international law, and the advice of the Judge Advocate General.

    Oath Betrayed is a stellar example of human rights work, but it could have been even better. The book needs an index (a publisher's note does refer readers of this first printing to an online index and promises inclusion of an index in future printings), and the author should have documented all Internet sources, an important consideration in a book whose power comes from the distillation of original government documents. The explanation that some of the documents may no longer be available on the Web exactly where the author found them is insufficient, and the author's assurance that he has kept hard copies that "are available for a copying fee to interested researchers" is one that few readers will find useful. The publisher should have insisted on posting all of the book's unpublished sources on an accessible — and indexed — Web site.

    Michael A. Grodin, M.D.

    George J. Annas, J.D., M.P.H.

    Boston University School of Public Health

    Boston, MA 02118

    grodin@bu.edu(By Steven H. Miles. 220 p)