Medical and legal experts are now questioning whether military doctors violated professional ethics while monitoring harsh interrogation techniques described in the C.I.A. inspector general's report released yesterday by the Obama administration.
The report, written in 2004 by Inspector General John L. Helgerson, outlines brutal interrogation techniques, such as choking, shackling and waterboarding, used against terror suspects in secret overseas prisons. It includes an appendix on medical and psychological support, noting that medics were responsible for monitoring the health of the detainees subjected to enhanced interrogation techniques.
The Hippocratic Oath states that doctors should consider first the health of the patient and never do physical harm.
Given that at least a dozen prisoners -- and likely more -- have died by homicide in military prisons this decade, many have wondered how often doctors monitored torturous interrogations without intervening, as was mandated by designers of the interrogation program.
"What we've learned is that high-value prisoners were subjected to a program designed to break them down psychologically and that medical professionals assessed and monitored them while they were being abused," said Steven H. Miles, whose book, Oath Betrayed: America's Torture Doctors, describes widespread medical abuses and cover-ups in U.S. military prisons.
A report written by the International Committee of the Red Cross in 2006 revealed that doctors in some instances physically participated in interrogations at C.I.A. black sites. That report, obtained and released by journalist Mark Danner earlier this year, describes an episode during which a doctor used a pulse oxymeter (a medical device that is placed on a patient's finger) to monitor the blood-oxygen level of a detainee being waterboarded for an hour.
"This is a technology that was developed for therapeutic purposes, and instead it's being employed basically to monitor torture to make sure we don't kill the person," said Greg Bloche, a doctor and law professor at Georgetown University. "That's a pretty egregious misuse of medical technology."
During a waterboard session, a prisoner is strapped to a bench while water is poured onto a cloth draped over his face, in order to simulate drowning, giving a prisoner a sense of imminent death.
According to the Red Cross report, doctors measured the swelling around the shackled ankles of detainees in order to detect signs of low-blood circulation. "The doctors weren't minimizing pain, they were helping calibrate pain," said Scott Allen, a Rhode Island doctor and adviser to the advocacy group Physicians for Human Rights.
The interrogation methods have been widely condemned as torture and abandoned by the Obama administration. The American Medical Association and the American Psychiatric Association have also denounced them. United States Attorney General Eric H. Holder Jr. has recruited John H. Durham, a veteran federal prosecutor, to investigate the abuse of prisoners.
Doctors stationed at the secret prisons intervened when interrogation methods grew too rough on more than one occasion, according to the Red Cross report. But many familiar with the report suggest that doctors failed to intervene on other occasions.
"You have examples where someone's getting their arm dislocated, and an unidentified medical professional pops the arm back in and says, 'continue,' " said Nathaniel Raymond, a spokesman for Physicians for Human Rights.
Some argue that military doctors are complicit in torture and should face trials or sanctions. As precedent, they point to the Nuremberg hearings following World War II. After top Nazi military commanders were tried, the next in line to face charges were doctors stationed at the death camps.
Health officials affiliated with the military from 2002 to 2004 -- when the harshest interrogations were taking place -- have disappeared from the debate. "This is not something that's daily supper-table conversation among me or my peers," said Michael Cowen, the surgeon general of the Navy during that time period.
William Winkenwerder, the assistant secretary of defense for health affairs during the Bush administration, who served as the principal medical adviser to Secretary of Defense Donald Rumsfeld, said in an e-mail, "Matters relating to the subject of interrogations are the subject of ongoing litigation. It would not be appropriate for me to comment outside the context of litigation."
Some former military doctors defended the interrogation methods, claiming that physicians stationed at military prisons are, in effect, combatants, and the Hippocratic Oath needn't apply.
"War is not a sanitary operation," said Stephen Cunnion, a retired captain in the U.S. Navy Medical Corps and now a senior fellow at the Potomac Institute for Policy Studies. He said the interrogation methods kept Americans safe. "Once the enemy finds your weaknesses, they use them. They'll just laugh this off and won't tell us anything."
Kelly Faucette, a retired colonel and Army doctor, who saved the life of a terrorist while he was in Iraq, disagreed, saying the methods violate a doctor's mission.
"They're completely against any ethical principles that go with medicine," he said. "We have a right to help people and to treat their illnesses ... (not to) evaluate whether a person was medically able to tolerate being abused or tortured."
The numbers of interrogated detainees and participating doctors are not known. Miles said the number of detainees exposed to harsh interrogations reached the hundreds, and likely the thousands.
In the C.I.A. report, designers of the program stated that the interrogation methods do not cause severe mental pain or suffering. Critics, however, point to the Red Cross report, which describes a claim by prisoner Abu Zabaydah that he lost control of his urine while being waterboarded in 2002 and continued to lose control of his urine during stressful situations. Zabaydah was waterboarded at least 83 times in August that year.
It's possible that medical complicity went beyond torture. Many experts, including Miles and Bloche, said that some military doctors altered death certificates of detainees to cover up homicides. Others claim that doctors violated confidentiality codes by handing over to interrogators the medical records of detainees, which were then used to create individually tailored interrogation regimes.