AMA adopts policy on interrogations

The guidance says it's unethical for doctors to directly participate, but new guidelines from the Pentagon don't rule out asking psychiatrists to monitor questioning.

By — Posted July 3, 2006

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The AMA has joined the American Psychiatric Assn. in declaring that physicians should not conduct, monitor or directly participate in the interrogation of prisoners or detainees.

At its Annual Meeting last month, the House of Delegates adopted a Council on Ethical and Judicial Affairs opinion providing that and other ethical guidance on physician participation in interrogation.

The new AMA policy, like the one adopted by the APA in May, says physicians may help develop general interrogation techniques so long as they are humane and refrain from threatening or causing physical or mental harm.

The CEJA opinion also says physicians have a duty to disclose how much access interrogators have to prisoners' medical information and to report any coercive interrogations to authorities. If action isn't taken after they raise awareness, the opinion says, doctors are ethically obligated to report the offenses to independent authorities empowered to investigate.

David Fassler, MD, an American Academy of Adolescent and Child Psychiatry delegate who proposed a resolution on interrogation at the 2005 Interim Meeting, applauded the CEJA report. "Physicians should not design, participate in or monitor the interrogation of prisoners or detainees," he said. "Such activities are incompatible with our primary obligation to do no harm. ... I'm glad to see that organized medicine will now be able to speak with one voice on this issue."

Air Force Surgeon General George P. Taylor Jr., MD, said the CEJA opinion -- adopted without debate -- "provides valuable ethical guidance and is consistent with our commitment as military physicians to practice medicine and contribute to the defense of our great nation." Dr. Taylor, a member of the Section Council on Federal and Military Medicine, said he was impressed by the CEJA's "genuine desire to understand our current policies."

The opinions of Dr. Taylor and other military surgeons general are critical because they are the ones who will interpret Pentagon guidelines issued last month on the medical treatment of detainees, said retired Brig. Gen. Stephen N. Xenakis, MD, an advisor to Physicians for Human Rights who also spoke in support of the policy.

Setting operating procedures

The surgeons general will reference the Dept. of Defense's new policy guidance as well as the AMA and APA policies in developing their standard operating procedures, which entail "what exactly are going to be the instructions to physicians and clinicians," Dr. Xenakis said.

The Pentagon's guidance says that while physicians are not ordinarily assigned to participate directly in interrogations as behavioral science consultants they may be so assigned "in circumstances when qualified psychologists are unable or unavailable to meet critical mission needs."

In spite of that difference, Assistant Secretary of Defense for Health Affairs William Winkenwerder Jr., MD, said via e-mail that the AMA's policy is consistent with the new Pentagon guidance because it "reaffirms a fundamental principle that health care personnel have the duty in all matters affecting the physical and mental health of detainees to perform, encourage and support, directly and indirectly, actions to uphold their humane treatment."

The new Pentagon guidance also upholds its practice of force-feeding hunger-striking detainees in cases where it's been determined to be medically necessary to save the detainee's life. Previously, the AMA endorsed the World Medical Assn.'s Declaration of Tokyo which states that when mentally competent prisoners refuse to eat they mustn't be involuntarily fed. The AMA also has policy opposing torture and physician participation in torture or any cruel, inhuman or degrading treatment of prisoners.

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