Physician involvement in hostile interrogations

Cambridge Quarterly of Healthcare Ethics

Volumn 15, Issue 4, 2006, Pages 392-402

  Allhoff, Fritz ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; DOCTOR PATIENT RELATION; ETHICS; HUMAN; MEDICAL ETHICS; PHYSICIAN ATTITUDE; TORTURE;

ETHICS, MEDICAL; HUMANS; PHYSICIAN'S ROLE; PHYSICIAN-PATIENT RELATIONS; TORTURE;

EID: 33749326421     PISSN: 09631801     EISSN: 14692147     Source Type: Journal    
DOI: 10.1017/S0963180106060506     Document Type: Article

References (41)

1. See, for example, Priest D, Gellman B. U.S. decries abuse but defends interrogations: "Stress and duress" tactics used on terrorism suspects held in secret overseas facilities. Washington Post 2002 Dec 26:A14,A15;
2. Lewis NA. Iraqi prisoner abuse reported after Abu Ghraib disclosures. New York Times 2004 Dec 1.2:A12;
3. Lewis NA. Fresh details emerge on harsh methods at Guantanamo. New York Times 2005 Jan 1:A3,11;
4. th Military Intelligence Brigade (The Fay Report). Available at: http://news.findlaw.com/hdocs/docs/dod/fay82504rpt.pdf (accessed April 1.3, 2005);
5. Miles SH. Abu Ghraib: Its legacy for military medicine. The Lancet 2004;364:725-8;
6. Bloche MG, Marks JH. When doctors go to war. New England Journal of Medicine 2005;352:3-6;
7. Stephens J. Army doctors implicated in abuse: Medical workers helped tailor interrogations of detainees, article says. Washington Post 2005 Jan 6:A8.
8. Other authors have chosen other modifiers for such interrogations. For example, Jonathan Marks prefers "aggressive interrogations" and Matthew Wynia has used "harsh interrogations." I think that "hostile interrogations" is superior to these locutions for various reasons. First, some of the tactics employed are withholdings or deprivations which, by definition, are not aggressive because they are omissions rather than commissions. I think that "harsh" is less problematic, though it carries a range of definitions that range from "unpleasant" to "severe or cruel." Although the former is clearly appropriate, the latter is debatable (i.e., it begs important questions), so this usage is not without its perils. "Hostile" can mean "characteristic of an enemy," "demonstrative of ill will," or "unfavorable to health or well-being"; any of these definitions would, I think, be appropriate.
9. This does not, of course, necessarily follow: Sometimes we might be morally required to participate in immoral practices in order to minimize overall harm or wrongness. However, given the structure of this debate and the positions put forth by its commentators, I will assume that if hostile interrogations are impermissible then physician involvement is, a fortiori, impermissible.
10. See Allhoff F. Terrorism and torture. International Journal of Applied Philosophy 2003;17:105-18.
11. Reprinted in Understanding Terrorism: Philosophical Issues, Shanahan T, ed. LaSalle, IL: Open Court Press; 2005:243-59;
12. see also Allhoff F. A defense of torture: Separation of cases, ticking time-bombs, and moral justification. International Journal of Applied Philosophy 2005;19:243-64.
13. For a discussion of some of these other issues, see Gross M. Bioethics and armed conflict: Mapping the moral dimensions of medicine and war. Hastings Center Report 2004;34:22-30;
14. a reply to Gross by Rubenstein LS. Medicine and war. Hastings Center Report 2004;34;
15. Howe EG. Dilemmas in military medical ethics since 9/11. Kennedy Institute of Ethics Journal 2003;13:175-88.
16. Lewis NA. Red Cross finds detainee abuse in Guantanamo. New York Times 2004 Nov 30:A1.
17. See note 6, Lewis 2004.
18. See note 1, Bloche, Marks 2005:3.
19. See, for example, The Hippocratic Oath. In: Ancient Medicine: Selected Papers of Ludwig Edelstein. Temkin O, Temkin CL, eds. Baltimore, Md.: Johns Hopkins Press; 1967:6;
20. American Medical Association. Code of Medical Ethics: Current Opinions with Annotations, 2004-2005 edition. Chicago: AMA Press; 2004:xiv, 295-6;
21. Jonsen A. A Short History of Medical Ethics. Oxford: Oxford University Press; 2000.
22. See note 9, American Medical Association 2004:24-5 (emphasis added). This statement continues that "Physicians should . . . strive to change situations in which torture is practiced or the potential for torture is great." I object to this claim on the grounds that the American Medical Association has neither the authority nor license to make political (or nonmedical moral) statements; its magisterium is medicine (including medical ethics) and its remarks should be therein confined.
23. Of course the death would also have been preventable if the torture had not occurred, but this is irrelevant to the current question, which is whether, given the occurrence of torture, physicians are obligated to prevent preventable deaths.
24. See note 1, Bloche, Marks 2005:3.
25. See note 1, Bloche, Marks 2005:4.
26. See note 1, Bloche, Marks 2005:4-5.
27. For more discussion of these issues, see Physicians for Human Rights. Dual loyalties & Human Rights. Boston, Mass.: Physicians for Human Rights; 2002;
28. see also note 5, Gross 2004.
29. It should be acknowledged that some people find this claim controversial. For example, some philosophers ascribe to some form of Michael Walzer's spheres of justice doctrine, which holds that, for example, only medical considerations are relevant to medical decisions. On this model, other considerations, such as national security, could not countervail medical considerations because the former are impotent against the latter.
30. See note 9, American Medical Association 2004:226.
31. See note 9, American Medical Association 2004:305.
32. Of course, it is an empirical question how these interrogators actually view their relationship with the interrogatees. Certainly there will be some interrogators that do view interrogatees as patients, and, in these cases, there might be plausible arguments as to why a patient-physician relationship would be therein constituted. But this is irrelevant for present purposes as we are assuming that the interrogator does not have this attitude. The moral project needs merely to show that hostile interrogations by medically trained interrogators are morally permissible given some plausible affective state of the interrogator (whether actual or counterfactual). My assumption here seems weak enough to at least be afforded this plausibility.
33. See note 1, Bloche, Marks 2005:4. This is a position that is hastily dismissed by Bloche and Marks, who argue that such a position is "self-contradictory" because a "military physician's contributions to interrogation - to its effectiveness, lawfulness, and social acceptance in a rights-respecting society - arise from his or her psychological insight, clinical knowledge, and perceived humanistic commitment (p. 5)."
34. The principle is generally credited to David Hume; see his A Treatise of Human Nature, 2nd ed. Nidditch PH, ed. Oxford: Oxford University Press; 1978:III.I.i.
35. A contemporary discussion is in Hudson WD. The Is/Ought Question: A Collection of Papers on the Central Problems in Moral Philosophy. London: Macmillan; 1969.
36. Although this formalization might appear as though all duties require positive acts, this need not be the case, as φ could be an omission instead of a commission.
37. In this claim, I am denying that medicine is "inherently normative" as well as any account of the professions that would derive from such a presupposition. Such views have been defended by, for example, Edmund Pellegrino; see his The Virtuous Physician and the Ethics of Medicine. In: Virtue and Medicine: Explorations in the Character of Medicine. Shelp EE, ed. Dordrecht: D. Reidel Publishing Company; 1985:248-53. My opposition to these accounts, which I will not defend here, centers on their unattractive metaphysical commitments as well as the fact that such commitments are morally superfluous insofar as general moral theory is sufficient to ground the duties of physicians - though note that these appeals to general moral theory could (and in fact will) provide different moral requirements than Pellegrino-like accounts when medical duties are in conflict with or countervailed by nonmedical duties. For an alternative to Pelligrino's account (although not one that I completely endorse),
38. see Applbaum A. Doctor, schmoctor: Practice positivism and its complications. In: The American Medical Ethics Revolution. Baker RB, Caplan AL, Emanuel LL, Latham SR, eds. Baltimore: The Johns Hopkins University Press; 1999:144-58.
39. This is just a consequence of propositional logic: If P is sufficient for Q and if Q is sufficient for R, then P is sufficient for R.
40. These criticisms have been made especially by Dirk Baltzly, Jeannette Kennett, and Thomas Pogge.
41. Note that, if there is any sort of worry that traditional medical education requires some sort of presumption of professional training (as, e.g., we might expect given the requirements for courses on professionalism), medically trained interrogators could, in theory, receive their medical training at institutions (perhaps ones to be created) that lack such presumptions.