Interrogation at Guantanamo

Allegations of the use of psychiatrists (and psychologists) to assist in the interrogation of prisoners at Guantanamo has raised the gravest of ethical concerns for our profession.

If these allegations are true, these clinicians would be violating medical ethics in two ways. First, if they used medical records for nonclinical purposes, it would constitute a violation of privileged communication, namely, that which the patients told the clinicians. Second, if they used their professional training to engage in nonclinical actions that were clearly detrimental to the patients' well-being (for example, using information about a person's fear of the dark), it would constitute a misuse of one's professional role. In these instances, the clinicians would be using information gained in their professional role to traumatize (that is, torture) the inmates.

Unfortunately, the article in the August 19 issue titled“ Terrorist-Suspect Questioning Prompts APA Ethics Review” shows APA equivocating at best. APA past President Paul Appelbaum, M.D., is quoted as questioning “whether it is legitimate for a psychiatrist to be involved in the investigative process and, if so, in what ways.”

Let's not forget our ethical roots as physicians. These standards of medical ethics go back to the Greek physician Hippocrates. In the first instance, his oath states that “whatever I may see or hear in treatment, or even without treatment, in the life of human beings—things that should not ever be blurted out outside—I will remain silent, holding such things to be unutterable [sacred, not to be divulged].” In the second instance, it states, “And I will use regiments for the benefit of the ill. .but from [what is] to their harm or injustice I will keep [them].”

Even though Psychiatric News posed the question as to “when `psychological pressure' crosses the line into torture,” there is no question that the use of clinicians to assist in the interrogation of detainees is wrong. When others obfuscate, APA needs to draw the line and condemn the use of their psychiatric skills for anything but the treatment of the ill.