It was profoundly distressing to hear Donald Trump on the campaign trail vowing a return to abusing prisoners with “a hell of a lot worse than waterboarding.” Those thoughts threaten to reverse the work that I and others have done over the last decade to end torture as an official US government policy and to prevent health professionals’ participation in detainee abuse.

As a psychologist, I know the extreme damage that torture — the systematic infliction of severe pain and degradation — does to its victims and to its perpetrators. My colleagues and I helped transform the American Psychological Association’s policies, establishing a firm barrier between psychological practice and national security interrogations and forbidding psychologist involvement in detainee care at detention sites, like the Guantánamo Bay detention camp in Cuba, which violates international law. As a result, a year ago the New York Times reported that Gen. John Kelly had ordered the removal of psychologists from all involvement with detainees at Guantánamo.

Since Trump’s election, signals on torture have been mixed. His national security advisor, Mike Flynn, has at times endorsed the used of torturous “enhanced interrogation” techniques. His new CIA director, Mike Pompeo, has not ruled out changing US laws to allow waterboarding and other torture.

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Despite President Obama’s efforts to close Guantánamo, it remains open. The new administration is even considering expanding its population of detainees. And Wednesday the New York Times reports that the Trump administration is preparing an executive order that would make it possible for the CIA to operate so-called black site prisons overseas. The CIA had used such prisons to detain and torture terrorism suspects before they were shut down by former President Barack Obama.

During the George W. Bush administration, the US adopted interrogation techniques that our State Department had traditionally denounced as torture when used by others. The most famous of these was waterboarding, in which drowning is induced and then interrupted, inducing panic and terror. While waterboarding got the most attention, many of the other techniques, including excruciating stress positions, exposure to extreme hot and cold, and prolonged sleep deprivation in painful positions for up to 180 hours, were also deemed torture and had been denounced by the State Department.

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Torture is so repugnant that virtually every country, even those that surreptitiously practice it, feel a need to disclaim it. The United Nations’s Convention Against Torture has been signed by 160 countries. For hundreds of years, opposition to the use of torture has been an important measure of a country’s evolution toward civilized values. The return to torture in the Bush administration set back that progress, not only in our country but also around the world, as other nations took it as a green light for barbarous practices.

While ISIS would no doubt engage in barbarities regardless of US torture policy, it is no accident that the prisoners they execute in gruesome videos are cloaked in orange jumpsuits.

The US is again in danger of becoming a country where torturous barbarity is publicly endorsed as official policy. To prevent this, it is vital that every institution of civil society speak out.

Among these institutions, the health professions have great leverage. They must use it, and their constituencies must demand they use it. Wherever there is systematic torture, there are often health professionals, vetting prisoners for further abuse and treating them afterward to keep them alive, at least until the torturers are done with them.

In the Bush era torture program, psychologists played special roles. In the CIA program, psychologists devised and administered the abuses, apparently even being present during waterboarding. At Guantánamo, which is run by the military, interrogators consulted with psychologists, reportedly using information in prisoners’ medical files to identify vulnerabilities that could be used to “break” them.

This involvement of psychologists and other health professionals was intentional. In the Bush administration’s “torture memos,” the presence of health professionals during torture served as a legal “get out of jail free card” for the abusers. If a health professional assured interrogators that their techniques would not cause severe long-lasting harm — the Bush administration’s defining characteristic of torture — the interrogator was protected from legal responsibility for any harm that occurred.

The Trump administration will also likely need health professionals as participants and as legal cover for any return to torture. We must deny them that protection.

Over the last decade, professional organizations representing physicians, psychologists, and nurses have issued formal statements opposing their members’ participation in torture. Physicians and psychologists have gone further, stating that any participation by their members in national security interrogations violates the professions’ central ethical injunction to “do no harm.” However, despite credible complaints against specific health professionals, no professional associations or state licensing boards have launched investigations, much less taken disciplinary action.

Given the threat that the new administration may expand Guantánamo and return to torture, health professional and behavioral science organizations should reiterate their ethical opposition and maintain the bright line separating their professionals from national security interrogations. Other professions should follow psychologists in forbidding their members from involvement in detention facilities that violate international law.

But they must also go further. Professional organizations need to make it crystal clear that any credible complaint that a member has participated in detainee abuses or at detention sites deemed illegal under international law will be thoroughly investigated, and that discipline will be imposed if the complaint is substantiated. Not to act in the current climate would constitute a failure of the health professions carrying out their compact with society to protect and improve the health and welfare of all individuals, regardless of their legal status.

At this dangerous time, society needs the voices of health professionals, and our actions, to halt the use of torture.

Stephen Soldz, a clinical psychologist, is professor of psychology at the Boston Graduate School of Psychoanalysis and director of its Social Justice and Human Rights Program. He is a former president of Psychologists for Social Responsibility, a cofounder of the Coalition for an Ethical Psychology, and an anti-torture advisor to Physicians for Human Rights.