M.G. Bloche and J.H. Marks (New Engl. J. Med. 2005 353:6): The International Committee of the Red Cross and others agencies charge that the aggressive ‘counter-resistance measures of US military interrogators at Guantanamo constitute cruel and inhuman treatment and torture. A number of studies are starting to explore the complicity of medical perssonnel with such abuses. One aspect of the violations of detainee rights has been the sharing with interrogators of the confidential data on prisoners’ health status (gathered by healthcare workers either in the course of healthcare of the prisoners or explicitly for intelligence purposes) to shape interrogation techniques. Sleep deprivation, prolonged isolation, sexual provocation and humiliation, displays of contempt for Islamic symbols, beatings, and feigning (or real!) efforts to kill the detainee are among the approaches which might be chosen or shaped by health and mental health data on the particular prisoner.
Although denied by the Pentagon, evidence exists that interrogators did in fact use detainees’ health data to design their interventions. An inquiry by the inspector general of the US Navy found that access was supposedly carefully controlled at Guantanamo but interrogators sometimes had easy access to health data of their prisoners in Afghanistan and Iraq. But Bloche and Marks’ study found that the claim that medical confidentiality of Guantanamo detainees was shielded is sharply at odds with the facts. A policy statement from the military command with jurisdiction over GTMO instructed health care providers that communications from enemy detainees were not protected by medical doctor-patient privilege, and that providers had an obligation to convey any information germane to US ‘national security objectives’ obtained in the course of their work to security personnel. Behavioral science consultants had ready access to health records and also helped shape and implement interrogation techniques, in effect acting as a bridge between privileged health data and intelligence agendas. I have also heard from a different source that, to evade the stringent standards of physician-patient privilege, other non-MD health professionals with less explicit codes of ethics were used in their place or alongside the doctors ministering to these prisoners. Interrogators themselves have in fact had access to health data on their prisoners, and psychiatrists and psychologists participate in designing and implementing interrogation strategies with resistant prisoners involving extreme stress.
