APA Addresses Ethics Concerns In Detainee Interrogation
Several months ago the media reported on charges that during interrogations of prisoners held at the U.S. naval base at Guantanamo Bay, Cuba, and in Iraq and Afghanistan, psychiatrists and psychologists participated in abusive practices.
At that time APA had no official position on the ethical and professional issues attendant to such participation. Recognizing the need to provide guidance to psychiatrists on this controversial issue, the APA Board of Trustees approved a position statement at its October meeting in San Diego.
The statement was developed by the Council on Psychiatry and Law and its Committee on Judicial Action in collaboration with the Committee on Ethics and Committee on Misuse and Abuse of Psychiatry. Input was also provided by APA members in the military.
Paul Appelbaum, M.D., chair of the Council on Psychiatry and Law and a former APA president, pointed out at the Board meeting that the U.S. Army was waiting for a statement from APA so it could add the Association's guidelines to a statement it is developing on this issue. It already cites the more permissive statement from the American Psychological Association (Psychiatric News, August 19).
The APA statement makes it clear that “psychiatrists should not participate in the interrogation of persons held in custody by military or civilian investigative or law-enforcement authorities, whether in the United States or elsewhere.” It also indicates that psychiatrists should not provide information to those same authorities about the “consequences of specific techniques of interrogation” as they may be applied to a particular individual.
In addition, the statement reiterates APA's position that psychiatrists“ should not participate in, or otherwise assist or facilitate, the commission of torture,” and psychiatrists who learn of such activity are obligated to report it to someone “in a position to take corrective action.”
Psychiatrists providing medical care to detainees, the statement points out, should put the well-being of the patient they are treating before requests to assist military or civilian authorities in interrogation-related activities. Psychiatrists should also refrain from disclosing information from detainees' medical records to anyone involved in interrogating those individuals.
The Assembly will review the statement at its November meeting; position statements require both Board and Assembly approval.
The Board also approved the distribution of $300,000 in grants to 22 APA district branches. The grants, which were made through APA's competitive-grant program, ranged from $5,000 to $30,000 and will be used for projects targeted at member recruitment, programs for members-in-training and early career psychiatrists, public affairs, linkages with primary care, access-to-care issues, and minority issues, among others. Grant requests were received from 47 of the 76 district branches and state associations and were evaluated by the Council on Member and DB/SA Relations.
On other issues the Board voted to
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defeat a proposal to add level-of-care criteria to existing and future guidelines in APA's practice guideline series. The Board acted on a negative recommendation from the Steering Committee on Practice Guidelines, to which the proposal had been referred. That committee said that each guideline“ already provides a nuanced discussion of the multiple factors that influence choice of treatment setting for an individual patient” and noted that there is a lack of data on which to base recommendations for level-of-care determinations.
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back a related proposal that will have the Council on Healthcare Systems and Financing and Council on Quality Care explore whether APA should set up an ad hoc committee that would develop a consensus document that would include level-of-care recommendations. It would also review level-of-care standards developed by other organizations.
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appoint an ad hoc work group to review issues raised by an Assembly-endorsed proposal to allow the Assembly to override actions by the Board of Trustees (Psychiatric News, June 17). The work group is to discuss a possible process for “implementing a compromise” when the Assembly objects to a Board vote on an issue on which the Assembly has acted. In May a majority of the Assembly asked the Board to establish such a process, which would increase the Assembly's influence in policy-making decisions that do not involve the Board's fiduciary responsibilities to APA. Many in the Assembly maintain that the balance of power tilts too far in favor of the Board.
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establish an emergency fund of $200,000 to help psychiatry residents who lost educational materials, books, and related supplies as a result of the recent hurricanes that hit the Gulf Coast.
The Trustees also were told of two actions regarding amicus curiae briefs taken by the Board's Executive Committee.
In one, the committee voted “in principle” to have APA sign on to a brief in a Maryland case in which former APA President Harold Eist, M.D., is challenging the validity of a reprimand and fine issued by the state's Board of Physicians (see story below). The committee also approved a $5,000 contribution to the cost of Eist's litigation.
In the second case, the Executive Committee agreed “in principle” to have APA sign on to an amicus brief in an abortion-related case, Ayotte v. Planned Parenthood of Northern New England, which is before the U.S. Supreme Court. The brief is being submitted by the American College of Obstetricians and Gynecologists and concerns parental notification laws when a minor wants to have an abortion and a young woman's health, but not life, is threatened by continuing the pregnancy.
A draft summary of all the Board actions taken at its October meeting will be posted soon in the Members' Corner area of APA's Web site,<www.psych.org>.▪
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Published online: 4 November 2005
Published in print: November 4, 2005
Notes
Among the wide-ranging actions on the Board of Trustees' agenda last month were endorsement of an official APA position statement on psychiatric participation in detainee interrogations and approval of $300,000 in grants to district branches.
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