The Failure to Police Medical Professionals

Dec 17, 2014

IPFW Associate Professor and medical ethicist Abraham Schwab.
Credit Courtesy / Abraham Schwab

The method that caught my eye immediately was “rectal feeding."

I’d never heard this term before, but I thought I could guess what it involved. In one instance it involved pureeing hummus, pasta with sauce, nuts and raisins that were then rectally infused into a detainee. Just one of many techniques, this procedure makes clear the role that professional medical practitioners played in enabling this sexual assault of persons suspected of terrorist activity.

Former Vice-President Dick Cheney defended the “Enhanced Interrogation Techniques” (EITs) in general, but even he refused to defend rectal feeding as an interrogation technique, saying it was used for medical reasons. This justification was also used by former CIA Director Michael Hayden.

CIA Director John Brennan’s defense of the EITs was more guarded in his defense of the interrogation techniques, suggesting that the interrogations may not have produced actionable intelligence. He also noted that the use of such techniques by the CIA was “uncharted territory.”

It’s unsurprising then, that the CIA hired an outside firm to design and oversee the EIT program. Co-owned and run by medical professionals, the firm identified in the report became a facilitation tool in the program. As Atul Gawande put it: “The torture could not proceed [without] medical supervision.” In fact, one psychologist has admitted to participating in waterboarding detainees.

The involvement of medical professionals made the program’s techniques justifiable, and they gave Cheney the opportunity to say that rectal feeding was used for medical reasons.

But is the claim that rectal feeding is used for medical purposes plausible? No

It will have health effects, but its primary purpose is behavior control—there are other ways to ensure adequate nutrition and hydration, but rectal feeding will be a more effective method for causing discomfort and humiliation. Moreover, as noted above, it’s a kind of sexual assault.

While we cannot undo the harms done to individuals by this technique, the possibility of accountability remains. What will become of the architects and executors of this program? I fear not much.

"While many, many physicians are well-meaning and well-trained, some are not. And Medical Licensing Boards commonly hand down relatively light sentences on physicians who have clearly violated the profession's obligations."

For seven years, Dr. John Leso was investigated by the American Psychological Association (APA) for his involvement in the alleged torture of a Guantanamo detainee. The APA determined that there was no reason to discipline him in any way. This is surprising because of the APA stance on torture: direct or indirect involvement is prohibited.

And the APA is not alone here. Indeed, their decision not to discipline psychologists in the past matches a broader difficulty faced by medical practice. Who will police them? While many, many physicians are well-meaning and well-trained, some are not. And Medical Licensing Boards commonly hand down relatively light sentences on physicians who have clearly violated the profession’s obligations. From a neurosurgeon in Texas who killed two and maimed four to the Wisconsin doctor whose mistake killed a patient to the pain management physician in Indiana whose license was recently suspended (but has not yet been revoked), licensing boards are too slow to hold physicians accountable, or seem too light in their discipline.

For example, the Indiana physician first came to the attention of the licensing board in December 2012. His license was finally suspended as part of an investigation into 8 deaths from January 2013 to July 2014, after he was brought to the licensing board’s attention. 

I won’t be surprised if the architects and executioners of the EIT program are not held accountable by other members of the medical professions. It’s not clear to me that medical professionals are taking seriously enough their responsibility to hold each other accountable in public.

 

Abraham Schwab is an associate professor of philosophy and a medical ethicist at IPFW.

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