MONTREAL — The American Psychiatric Association is close to approving a policy outlining the role that psychiatrists should play—if any—in military or police interrogations.
The consensus within the specialty is that psychiatrists should not take part in torture, Jeffrey L. Metzner, M.D., said at the annual meeting of the American Academy of Psychiatry and the Law (AAPL). But agreement on other related issues has proven more difficult.
For instance, Dr. Metzner asked, “What about indirect participation” such as consulting with torturers? Can a psychiatrist tell them, “You can do this, and it won't kill them,” or “You should approach it this way—it's more likely to get participation”? Or if the torture involves solitary confinement with sensory deprivation, for example, is it OK to see how that person is doing?
The first part of the APA's draft policy statement—developed by the organization's council on psychiatry and the law—says that psychiatrists should not participate in torture, and points out that if they should become aware that torture is taking place, they should take appropriate steps to have it stopped, said Dr. Metzner, clinical professor of psychiatry at the University of Colorado Health Sciences Center, Denver, and a member of the APA council.
The next part asserts that military and civilian prisoners have a right to adequate medical care, and psychiatrists should be allowed to provide care to them. And, during such care, the usual bounds of confidentiality apply so the psychiatrist does not share with authorities any information revealed during medical treatment.
The third—and most controversial—part of the proposed statement says that “psychiatrists should not participate in interrogation of persons held in custody by military, civilian investigative, or law enforcement authorities, whether in the United States or elsewhere, nor should they provide information or advice to military, civilian investigative, or law enforcement authorities regarding the likely consequences of specific techniques of interrogation that is in any way particularized in its application to an individual detainee.”
That provision “does not include interactions with judges or attorneys in connection with adjudication or preparation for adjudication, interviews, or other interactions with a detainee authorized by a court.”
Executive committee member Jeffrey Janofsky, M.D., who was in the audience, said that the committee had “a divergence of view” about the third part of the statement.
Dr. Metzner noted that the APA's proposed statement is quite different from the position of the American Psychological Association. In June, the American Psychological Association's presidential task force on psychological ethics and national security released a report that included statements on psychologists' ethical obligations in national security-related work. The statements allow room for psychologists to participate in interrogations but with several precautions.
For instance, one statement says that psychologists have an ethical responsibility to report acts of torture or other cruel, inhuman, or degrading treatment to the appropriate authorities. It says that psychologists “do not engage in, direct, support, facilitate, or offer training in torture or other cruel, inhuman, or degrading treatment” and that “psychologists who serve in the role of supporting an interrogation do not use health care-related information from an individual's medical record to the detriment of the individual's safety and well-being.”
For the American Psychiatric Association, “the underlying principle coming from the council is first, do no harm,” said Dr. Metzner, a former AAPL president. “We don't want people to be concerned about bad things occurring because of interactions with physicians.”
APA President Steven S. Sharfstein, M.D., had a closer look at some of the problems with prisoners during an October trip to Guantanamo Bay, Cuba. Dr. Sharfstein and his counterpart at the American Psychological Association toured the facility, and met with top officials at the base as well as medical staff members and psychologists who were involved in consulting with interrogators. Dr. Sharfstein and his counterpart did not speak privately with any detainees, said Dr. Sharfstein, who had requested the trip.
Officials at Guantanamo were very open and receptive to feedback, but Dr. Sharfstein said the trip did not change his mind about the correct position for the APA to take regarding participation in interrogations.
“The ethical issue is, is it right or wrong to do this; I think it's wrong,” he said, adding that if ethics were not a question, psychiatrists would not be much help anyway.
“Do psychiatrists or psychologists have something special to offer the interrogation process? I don't believe that for 1 minute,” he said. “I don't think our training entitles us to be any better than experienced intelligence officers at getting information from people who are trying to withhold it.”
At its November interim meeting, the American Medical Association voted to ask its Committee on Ethical and Judicial Affairs to prepare a report that would “delineate clearly for physicians the boundaries of ethical practice with respect to participation in the interrogation of prisoners and detainees.”
The AMA action is backed by several medical organizations, including the American Academy of Child and Adolescent Psychiatry and the APA.
Meanwhile, at another November meeting, the APA's scientific assembly rejected the paragraph of the proposed policy statement dealing with interrogations, instead opting for a less restrictive paragraph.
That paragraph states that psychiatrists “should not participate in or assist any coercive interrogation of persons held in custody by military or civilian authorities, whether in the United States or elsewhere. Nor should they provide information or advice to military or civilian investigative or law enforcement authorities regarding the likely medical consequences of specific coercive methods.”
Paul S. Appelbaum, M.D., chair of the APA's council on psychiatry and law, explained that the council had originally drafted the position statement the way it was approved by the board of trustees, but also offered an alternative paragraph on interrogations—the paragraph that was approved by the assembly.
“Right now, the APA doesn't have a position on participating in interrogations, because the two entities have selected different options,” said Dr. Appelbaum, who is also chair of the department of psychiatry at the University of Massachusetts Medical School, in Worcester.
“Everybody agrees on not participating in coercive interrogations; what needs to be resolved is if psychiatrists should participate in any interrogations,” he pointed out.
The board is scheduled to meet this month. If it approves the statement voted for by the assembly, the statement will become official APA policy. Otherwise, any revisions would have to be taken back to the assembly, which meets again in May, Dr. Appelbaum said.
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