Disciplines' Roots Led to Different View of Role in Interrogations

Differing policies espoused by psychological and medical organizations regarding participation in interrogations arose out of differing organizational and professional histories, according to a psychologist and a psychiatrist writing in the BMJ (British Medical Journal).

APA, the AMA, and the American Psychological Association all have ethics policies opposing torture and prohibiting members from engaging in that practice. APA and the AMA have also said that participation by psychiatrists and other physicians in interrogation of prisoners or detainees in current conflicts violates their ethical standards because they contravene the physician's role as a healer.

“In contrast, the American Psychological Association in 2005 adopted a policy that allowed consultation and monitoring of individual interrogations with the intent of intervening,” wrote Connecticut psychologist Kenneth Pope, Ph.D., and forensic psychiatrist Thomas Gutheil, M.D., in an article published online April 30. “The [American Psychological Association] decided not to add detainees to the enforceable standards section of its code, which protects groups that are vulnerable or at risk and allows complaints to be made to the ethics committee.”

(The preamble and general principles in the American Psychological Association's ethics document, titled the Ethical Principles of Psychologists and Code of Conduct, are not considered“ enforceable” but “should be considered by psychologists in arriving at an ethical course of action.” The ethics standards, however, are all enforceable.)

Pope is an independent licensed psychologist in Norwalk, Conn. Gutheil is a professor of psychiatry in the Beth Israel Deaconess Medical Center Department of Psychiatry at Harvard Medical School and a former president of the American Academy of Psychiatry and the Law.

APA's position prohibiting direct participation by psychiatrists in interrogations was developed prior to the AMA's statement and served as a model for the position later adopted by the AMA, said Paul Appelbaum, M.D., a former APA president, in an interview. Appelbaum is the Elizabeth K. Dollard Professor of Psychiatry, Medicine, and Law and director of the Division of Psychiatry, Law, and Ethics in the Department of Psychiatry at Columbia University College of Physicians and Surgeons.

Supporters of the psychologists' position have argued that interrogation is a psychological process and that participating psychologists would contribute to “keeping interrogations safe and ethical,” according to statements quoted by Pope and Gutheil. The U.S. interrogation policies, such as those used at Guantanamo Bay and Abu Ghraib prison in Iraq, were designed with the help of psychologists, they said.

Until 2002 the American Psychological Association's ethics code stated that when professional ethics conflicted with law or “governing legal authority,” psychologists should “take steps to resolve the conflict.” However, in 2002 the organization's ethics code was updated to state that if such conflicts couldn't be resolved, psychologists “may adhere to the requirements of the law, regulations, or other governing legal authority.”

That amounts to an “inverse Nuremberg principle,” said M. Gregg Bloche, M.D., J.D., a professor of law at Georgetown University and a psychiatrist, in an interview. The Nuremberg principles grew out of the Nazi war crimes trials after World War II and state that individuals cannot avoid personal responsibility when carrying out actions ordered by governments.

In a “Rapid Response” posted on May 15 on the BMJ Web site focusing on the issue of torture rather than the broader issue of psychologists' role in interrogation, Rhea Farberman, executive director of public communications for the American Psychological Association, commented,“ [I]t is critical to emphasize that the APA ethics code prohibits torture and that when the current version of Ethical Standard 1.02 (which addresses conflicts between ethics and law) was drafted in the fall of 2000, the language was in no way intended or foreseen to provide a defense to engaging in torture based on 'following orders.' In light of the Bush administration interrogation policies, the [American Psychological Association] Ethics Committee views it as crucial to clarify that 'following orders' can never be a defense to torture under the APA Ethics Code. APA's governing body, the Council of Representatives, will be reviewing this ethical standard with association-wide input at its upcoming meeting at the [association's] convention in August.

“[The American Psychological Association's] most recent policy action has restricted the scope of the earlier PENS Task Force [the 2005 Presidential Task Force on Psychological Ethics and National Security] recommendations related to the involvement of psychologists in national security investigations by prohibiting psychologists from working in detention settings that are in violation of international law and the U.S. Constitution, except in very narrowly defined roles. Immediately after a membership vote in 2008, APA informed key Bush administration officials and members of Congress of this new policy. APA is ensuring that officials in the Obama administration are likewise informed of APA's position.”

Pope responded to Farberman in a “Rapid Response” on May 17,“ [The American Psychological Association] highlights its 'most recent policy action' in this area, a 2008 ballot initiative. However, APA previously clarified that this ballot initiative would not be enforceable under its ethics code. Similarly, APA's numerous policies, public statements, etc., addressing torture have never been added to the enforceable section of its ethics code. Human rights require more than calls for voluntary compliance.”

Pope and Gutheil's article highlights the differences between the ethics of medicine and of psychology, which arose from very different sources.

“Medicine evolved as a clinical discipline and traditionally has avoided activities that would contradict or impair the clinical role,” said Appelbaum. “Psychology, in contrast, developed as an academic discipline, and when it left the laboratory, some of the discipline's earliest applied activities involved consultation, in [places like] schools or the workplace. Many psychologists, therefore, have a 'client' orientation that makes it difficult for psychology to set limits on involvement that a client requests. When the client is law enforcement, intelligence, or the military, those requests have included participation in interrogation, and psychology—distinct from medicine—has struggled to find a principled basis on which to say 'no.'”

In April, after the Obama administration released memos written by White House legal staff permitting harsher interrogation techniques during the Bush administration, the New York Times published a letter on May 5 by then APA President Nada Stotland, M.D., in which she reiterated that APA“ oppose[s] the participation of psychiatrists in interrogations—situations in which a person is being questioned involuntarily. As medical doctors, mental health professionals, and citizens, we are dedicated to the relief of human suffering by preventing and treating mental disorders.”

In their article, Pope and Gutheil suggested that professional organizations' ethics codes should demand personal accountability in the face of unethical laws or orders, offer protection to all vulnerable groups (including detainees), and ensure that all members clearly understand their ethical obligations.

The American Psychological Association “wholeheartedly supports the authors' recommendations in the article,” said Stephen Behnke, Ph.D., J.D., director of the Ethics Office of the American Psychological Association, in an e-mail interview. “In fact, the recommendations are highly consistent with [the association's] current positions....

“The APA ethics code applies to all psychologists. APA has explicitly rejected the argument that the ethics code does not apply to psychologists in nonhealth care-related roles. The ethics code always applies.”

“Contrasting Ethical Policies of Physicians and Psychologists Concerning Interrogation of Detainees” and the “Rapid Responses” can be accessed at<www.bmj.com/cgi/content/full/338/apr30_2/b1653>. The American Psychological Association's ethics code is posted at<www.apa.org/ethics/code2002.html>, and its 2007 resolution against torture participation is posted at<www.apa.org/governance/resolutions/councilres0807.html>.▪