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Sunday, March 11, 2007

Medicalizing Torture & Torturing Medicine

Medicalizing Torture & Torturing Medicine
Image © Austin Cline
Original Poster: National Archives
Click for full-sized Image

Revelations about the government's mismanagement of Walter Reed have been increasing in their seriousness. The public has learned not only that the problems extend far beyond that one facility, but also that many of those in charge knew about these problems years ago without having done anything to correct them. Even some Republican leaders knew about it, but refused to go public in order to save the military from embarrassment. All the suffering of wounded troops has occurred not because of a simple error or lack of information, but because our leaders haven't cared enough to treat wounded troops with the dignity and seriousness they deserve.

The most common framing of this story, at least by those who have the gall to criticize this administration, is that the failures in the military's medical care represent appalling mismanagement and/or a failure by the administration to "support the troops" in a manner that might match its rhetoric. Although these explanations are all appealing and all have perhaps some validity to them, I wish to take a bit of a detour and explore another, more fundamental, and perhaps more sinister connection.

This isn't the first scandal involving medical personnel of America's armed forces and the Iraq War. Now lost in the continuous rotation of fresh scandals were reports about the involvement of medical professionals in the torture of prisoners. Pretty much wherever torture occurs, medical personnel are complicit — their specialized knowledge of human biology and how to keep humans alive can be vital. Doctors and nurses are, for example, expected to treat injuries sustained during torture so that the victim can be made well enough to go through more sessions.

No competently run installation could have gone without medical personnel who at least knew and covered up for the soldiers, let alone those who might have actively helped. International law, not to mention basic standards of decency, require medical professionals to report mistreatment and torture. They are certainly prohibited from participating in any substantive manner, even if just to make it easier for torture and abuse to continue by patching up prisoners and sending them back to the meat grinder.

In 2004, CNN reported:

In one case, a medic inserted a catheter into the body of a prisoner who died under torture "to create evidence that he was alive at the hospital," Miles writes. And he writes about the family of an Iraqi man taken into custody by U.S. troops who was found months later in a hospital. "He was comatose, had three skull fractures, a severe thumb fracture and burns on the bottoms of his feet." But the man's U.S. medical report made no mention of the injuries, saying only that heat stroke had caused him to suffer a heart attack, which resulted in the coma, Miles said.

That same year, the BBC reported:

Writing in the medical journal The Lancet, Professor Steven Miles of the University of Minnesota says some collaborated with abusive guards. ..."Confirmed or reliably reported abuses of detainees in Iraq and Afghanistan include beatings, burns, shocks, bodily suspensions, asphyxia, threats against detainees and their relatives, sexual humiliation, isolation, prolonged hooding and shackling, and exposure to heat, cold and loud noise," said Professor Miles.

He said there was evidence that some medics had played a part. "Government documents show that the US military medical system failed to protect detainees' human rights, sometimes collaborated with interrogators or abusive guards, and failed to properly report injuries or deaths caused by beatings," he said. "In one example, soldiers tied a beaten detainee at the top of his cell door and gagged him. The death certificate indicated that he died of 'natural causes...during his sleep'. After news media coverage, the Pentagon revised the certificate to say that the death was a 'homicide'.

"Although the US Armed Forces's medical services are mainly staffed by humane and skilled personnel, the described offences do not merely fall short of medical ideals; some constitute grave breaches of international or US law," he said. In an accompanying editorial, The Lancet called on US army medics to come clean. "Guidelines and codes of practice state that doctors, even in military forces, must first and foremost be concerned about their patients and bound by principles of medical ethics," it said. "Health care workers should now break their silence. Those who were involved in or witnessed ill-treatment need to give a full and accurate account of events at Abu Ghraib and Guantanamo Bay."

The doctors, medics, and nurses who stood by silently while prisoners were being tortured were guilty of violating the most basic and fundamental medical ethics. Would you trust such people with the care of yourself, your spouse, or your children? I wouldn’t. People like this don’t even deserve to retain their medical licenses, much less to stay in the military.

What does any of this have to do with the Walter Reed scandal? There are two connections which I think should be made. First, the abuse of prisoners by the military was not a morally isolated incident. Torture is dehumanization — both of the victim and of the torturer. When an organization begins to use torture, it can only do so at the price of devaluing human beings at their most basic level. Such dehumanization cannot be limited to merely the enemy, though, and must inevitably extend to one's own allies and supporters.

Once the American government and military authorized torture and abuse of the "enemy," the basis was laid for acts of dehumanization and the devaluation of members of the military themselves. Once the Iraqis became disposable, so did America's own military personnel. We should thus not be surprised to see wounded veterans kept in shabby conditions. Already in 2003 the Bush administration cared so little for military personnel and their families that "imminent danger pay" and "family separation allowance" were deemed "wasteful and unnecessary." How much more of a step was it to treat basic medical and psychological care as "wasteful and unnecessary"?

The second connection lies with the institution of medicine itself. I focus above on the use of medical professionals in the process of torture because medicine is supposed to be a profession focused entirely on the needs of other human beings. Although dehumanization is compatible with many organizations and professions, it undermines the very purpose and existence of medicine itself. If, however, medical professionals can be enlisted in dehumanization of "enemies," then it's even less of a step to allow medical institutions to treat our own veterans as disposable or to treat basic medical care as "unnecessary."

The scandal at Walter Reed can thus be connected to a deeper rot that runs to the very core of the Bush administration. It's not a "rot" of incompetence, though, but a moral rot that derives from the gross immorality of the people in charge. They claim to be led and supported by God, but of course it's easier to justify morally monstrous behavior if you think that God is on your side — if God sanctions it, then it must be OK. Bush doesn't care if everyone else stops supporting him because he knows God is on his side; how can that be the case without also concluding that every other human being is ultimately disposable?

This was originally a World War II poster which said "Keep Pitching with Both Hands, Brother."

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