Letters

Ethics and interrogations

The July/August Monitor article ("Ethics and interrogations: Comparing and contrasting the American Psychological, American Medical, and American Psychiatric Association positions") on the ethics of medical professionals' participation in interrogation did your readers a disservice by failing to point out some critical differences between the American Medical Association (AMA) and APA policies.

Stephen Behnke concluded that the policies were similar, when, in fact, a thorough reading would have made clear that the AMA report outlines many of the issues regarding physician participation in interrogation, and then concludes that physicians must not directly participate in an interrogation. For example, Behnke misrepresents the substance of the AMA guidelines when he says: "...the AMA report states explicitly that the presence of a psychiatrist at an interrogation may serve to benefit the individual under questioning by virtue of a trust that can facilitate the interrogation." He has taken this statement out of its context in a discussion of potential roles of physicians, and has failed to observe that it is negated by the guidelines themselves.

To clarify the crux of AMA's new ethical policy: Physicians must not conduct, monitor with an intent to intervene, or directly participate in any way in an interrogation, because each of these actions undermines the physician's role as healer. Because it is often justifiable for physicians to serve the public interest, AMA's policy permits physicians to develop general interrogation strategies that are not coercive, but are humane and respect the rights of individuals. In contrast, APA prohibits psychologists from participating in cruel, inhuman or degrading treatment but accepts that they can "serve in the role of supporting an interrogation" and as a consultant. Thus, AMA and APA policy differ substantially in ethical acceptability of supporting interrogation. In contrast, the American Psychiatric Association's policy on interrogation, like the AMA's, disallows direct physician participation in interrogation. Development of ethics policy benefits from vigorous discussion and debate, and much careful thought, deliberation and consultation with outside groups and individuals led to adoption of AMA's new ethics policy on physician participation in interrogation.

ROBERT M. SADE, MD
American Medical Association

STEPHEN BEHNKE RESPONDS:

I agree completely with Dr. Sade that a "thorough reading" of the AMA report is necessary. I am hopeful AMA will soon release its full report, as APA and the American Psychiatric Association have done, so Monitorreaders may determine for themselves how similar the two positions are: Psychologists and physicians do not directly participate in interrogations, do not monitor interrogations with the intent of intervening, never advise on coercive interrogations, never mix the role of health-care provider with that of consultant to an interrogation, never use information from a medical record to construct a strategy for eliciting information, and always report abusive or harmful behavior. Given how the AMA report defines "direct" and "coercive," my column may indeed have erred, but in the opposite direction Dr. Sade suggests, by over- rather than under-emphasizing the differences between APA and AMA. Two critical features distinguish APA and AMA from the American Psychiatric Association. The psychiatrists have described their position as not "an ethical rule," in stark contrast to APA and AMA. Second, the APA and AMA positions are explicitly based on twin duties: to the individual and to society; the Psychiatric Association disallows participation even in interrogations that may prevent future terrorist acts. While their announced position statements differ substantially, APA and the Psychiatric Association agree that military psychologists and psychiatrists following orders, keeping entirely separate the roles of health-care provider and consultant to an interrogation, reporting abusive acts, and avoiding any behavior that would constitute torture or cruel, inhuman or degrading treatment, will not be subject to discipline from their professional association. This clarification is important insofar as the military continues to train both psychiatrists and psychologists in this role, as both associations are fully aware.

For further discussion following release of the full AMA report, go to APA Ethics.

I joined apa in 1947, about A year after my discharge from the U.S. Army. I could not have conceived of supporting unethical actions against enemy prisoners in order to hasten [my return home]. I was not altruistic; the conventions on prisoner treatment protected my buddies and me as much as the enemy. Our nation had leadership of different caliber then. President Roosevelt and his attorney general didn't call for violation of the conventions on prisoner treatment.

APA should shield its members. Psychologists who participate in the American judicial system don't jeopardize their careers by strict ethical behavior. Under an administration that brooks no deviation by nonmilitary officials from its policies and practices, are we so naive as to believe that deviation by psychologists in the military will go unpunished? Let us protect those psychologists by declaring participation in interrogations out of bounds. Psychologists in South Africa and Australia are judging those among them who employed bogus psychological theories to support racist policies. The president, Board of Directors and Council of Representatives of APA, which in some of its great moments has taken courageous stands against war, poverty and social injustice, will be judged some years hence by the standards they employ in interpreting ethical practice during this war.

MILTON SCHWEBEL, PHD
Rutgers Graduate School of Applied and Professional
Psychology

Dr. Koocher attempts to defend the participation of psychologists in prisoner interrogations ("Varied and valued roles," July/August Monitor) by pointing out the ethically appropriate role of our colleagues who interview people "who may feel more or less coerced," giving as examples competence to stand trial evaluations, sanity evaluations and psychological evaluations for disability insurers. In any one of these situations the individual is told the nature of the assessment, the fact that it is not confidential, and that they are free to be a willing subject or not. I think we can all agree that the detainees in military custody do not have this option.

Dr. Koocher goes on to say that aversive interrogation techniques (sleep deprivation etc.) "...did not originate as the ideas of psychologists." Is this supposed to provide a moral defense of such practices? Finally, Dr. Koocher wrote that "We must also respect the legitimate roles of psychologists who participate in interrogations legally and appropriately in an effort to assure our safety." This of course begs the question. Those of us concerned about our colleagues utilizing their professional training to participate in interrogations causing mental, emotional and physical pain are aware that what they are doing may be "legal." However, we do not consider such activity to be legitimate nor appropriate, and we are not persuaded that their efforts do anything to "assure our safety." When the archetype of psychologist-as-healer becomes rationalized in this way, our professional integrity, and our role in assuaging human suffering is tragically compromised.

JULES BURSTEIN, PHD
Berkeley, Calif.

GERALD P. KOOCHER RESPONDS:

Dr. Burstein seems to have misunderstood some of my points. First, people undergoing forensic evaluations, independent psychological evaluations for disability insurers, or employee screening for sensitive positions, do indeed have information about the uses of and access to the data, and the ability to refuse. Certainly this does not constitute torture, but the consequences of such refusal remain highly coercive in emotional and economic terms (e.g., loss of child custody or withdrawal of job offer).

Second, I did not and do not defend the use of "sleep deprivation, social isolation, extreme temperature changes or degrading and embarrassing interventions." APA has clearly and forcefully stated that torture and degrading treatment violate our ethics code. Neither do I argue that national security assertions trump professional values. Rather, I pointed out the inappropriate assumption by many people that psychologists invented such strategies or somehow direct their use at Guantanamo or elsewhere. Members who have evidence of such abuses should contact our ethics committee.

Finally, I have never argued in favor of "our colleagues utilizing their professional training to participate in interrogations causing mental, emotional and physical pain" in the interest of national security. Rather, I gave several examples of appropriate uses of psychological practices that fall well within broadly accepted legal and psychological standards. Dr. Burstein's comments focus on an "archetype of psychologist-as-healer," failing to acknowledge that many psychologists perform legitimate work in law enforcement or national security unrelated to healing roles.

Given the recent ruling of the Supreme Court on the rights of detainees to be afforded the guarantees of the Geneva Convention, I am wondering if it might now be possible for the president of APA to address the question of psychologists' participation in interrogations in a more rational and considered manner than in his recent column. That such an accounting of [interrogation] activities (he was referring to "sleep deprivation, social isolation or degrading and embarrassing interventions") constitutes the APA president's considered understanding of ethical practice really must be unacceptable to the membership of APA. Dr. Koocher spins a rather bizarre example of psychologists in the military. We are provided with the height and weight of the woman policemen involved, and the prisoner is portrayed as a less than human, violent "other."

This is rhetoric not reason. It is likely that a reasoned and ethically informed discussion of the role of psychologists in interrogation will need to take both a historical perspective and a clear-eyed look at the present. For those of us arguing for dialog and clarity in our public policy on the conduct of psychologists at Guantanamo, much is at stake: the integrity of our profession and human rights which must be extended to even our most demonized enemies.

ADRIENNE HARRIS, PHD
New York, NY

GERALD P. KOOCHER RESPONDS:

The anecdotes provided to illustrate the points in my column came from first-hand accounts of a psychologist sent to help clean up the abusive culture that existed at Abu Ghraib in 2003 and earlier. I stand by the descriptions I reported, as a means to illustrate the youth, inexperience, and threat levels faced by inadequately trained, inexperienced and pressured military personnel at that time and place. The illustrations make it easy to understand how adding a psychologist to the environment can begin to bring about positive changes. I invite readers to check reports of the Army surgeon general's comments to APA's Council of Representatives and council's actions in next month's Monitor devoted to coverage of APA's 2006 Annual Convention in New Orleans.