Physicians for Human Rights, Nuremberg betrayed: Human experimentation and the CIA torture program, June 2017, pp 78. Available from: http://physiciansforhumanrights.org/assets/multimedia/phr_humanexperimentation_report.pdf

Background

The report Nuremberg betrayed: Human experimentation and the CIA torture program by the Physicians for Human Rights (PHR) describes the enhanced interrogation conducted by the Central Investigation Agency (CIA) of the United States of America on detainees, following the 9/11 attacks. The CIA’s programme of “enhanced interrogation” was derived from the US Military’s programme “Survival, Evasion, Resistance and Escape” (SERE) which is taught to military personnel to be able to resist interrogation and torture if they became detainees, and to increase their resilience. The techniques included milder forms of torture on subjects who were “volunteers” from the US military, who could stop the torture any time they wished. The risk of harm was significant; but precautions were in place.

The CIA aimed to demonstrate “efficacy” and “safety” of torture and to “improvise” torture techniques for the collection of intelligence. The actual intervention included systematic, multiple, harsh torture techniques of increasing severity and longer duration, repeatedly inflicting uncontrollable suffering. This would break the subjects psychologically, disrupt their resilience, induce learned helplessness and result in compliance to interrogation. The CIA received permissions from the Department of Justice and the Office of Legal Counsel (OLC) to conduct enhanced and abusive interrogation in breach of international agreements to protect prisoners of war.

The PHR is a non-governmental organisation; a global watchdog against human rights violations. The PHR report condemns the CIA’s state-sponsored torture as violative of humanitarianism, research and medical ethics; even if it be euphemistically garbed in phrases like “enhanced interrogation techniques”. The authors claim that the whole picture is still not clear, as many more documents are inaccessible.

Violation of human rights

Torture or “inflicting pain for gain” amounts to violation of human rights and dignity. However, varying degrees of torture are practised by states under the justification that they are obliged to protect their sovereignty and the welfare of citizens. Is it not justifiable according to the utilitarian theory of ensuring the good of the many at the cost of the rights and dignity of a few? Should human beings not lose their claim to human rights, after having committed or abetted an act of terror leading to harm or loss of life of many? Yes, in such situations, torture may seem essential; but are the CIA’s extreme techniques of torture justifiable? After a terror attack like 9/11, many may feel it is; but on deeper reflection, from a humanitarian angle, such arguments may seem devious.

Violation of research ethics

“Torture” as a counter terrorism measure needs to be contrasted with “torture” as a research intervention. Although based on SERE, the CIA’s improvisation of torture methods was devised by psychologists to prove a hypothesis using specific methodologies for interventions on human subjects; the response was measured and analysed for dissemination. Does this not qualify as research? If so, then serious reflection is crucial: Was the CIA’s hypothesis that torture leads to collection of accurate intelligence appropriate and scientific? Was the purpose and methodology legitimate? Was the protocol approved by an independent ethics committee? Were guidelines of research to protect participants from harm followed? Were the researchers trained in conducting such research and minimising harms? Was there an informed consent process? Were the detainees not “vulnerable” non-consenting subjects? Was it driven by the pressures of politics? Was there not a conflict of interest among the psychologists who received significant financial gains? Was the state and legal machinery supporting an unscientific unethical research in the name of national security? Was the research transparent and available for scrutiny? In the post-Nuremberg period, such programmes are far from being justified.

Violation of medical ethics

The fundamental principle of “First-do-no-harm” was violated. The CIA directed medical personnel to conduct, monitor and calibrate pain. They carried out the flagrantly unethical duty of indemnifying torture and making it “safe”. Doing so or even being present during such harmful interventions is totally against the ethics of medicine and is a blatant transgression of all international agreements; and flies in the face of the Nuremberg code and the Belmont report.

Lessons to learn

The CIA’s programme creates a sense of déjà vu. Are Nazi experiments being reincarnated? What does one learn from the behaviour of the US government, legal and healthcare systems? Many documents are inaccessible for study. Nevertheless, from whatever has emerged, the US government seems to have crossed the boundary of humanitarianism, and irrevocably stepped far out on a “slippery slope”.

Healthcare professionals need to urgently ensure strategies against recurrences in the future or at the least demand the provision of an opting out system from being party to unethical research, without prejudice to their rights and freedom.

Subsequently, many of the detainees were released as “innocent” under changed laws and policies; which means that the research on torture techniques were actually conducted on the “innocent”; the harm caused cannot be undone. The echo of the Blackstone ratio, – “Better that ten guilty persons escape than that one innocent suffer” reverberates.

Note:

¹ This statement is ascribed to the British jurist Michael Blackstone, but various legal authorities have changed the ratio.