Withthe release of a previously top secret document – made public thanks to a legal victoryby the ACLU – disclosing the role of the Office of MedicalServices (OMS) in the CIA’s torture program, Physicians forHuman Rights (PHR) reminds health professionals that torture, in all its forms, isone of the most serious human rights violations and is absolutely prohibitedunder U.S. and international law, and that any collusion in its implementation – from planning through monitoring – is a gross violation of professionalethics.

The 90-page document provides a chilling account of how CIA health professionals willingly participated in torture. The “Summary and Reflections” of an unnamed chief of CIA Medical Services narrates the decision-making process that led to health professionals signing off on, and participating in, interrogation and detention practices that clearly constituted torture. The document provides a cascade of self-justification and minimization of the risks and harm to detainees.

“Whilemuch of the information in this document was already known, the step-by-step internalprocess it details shows how health professionals continually acceded to thedemands of those running the interrogation regime, relied on flawed legalinterpretations of torture definitions, and failed to live up to their duty to ‘do noharm,’” said Scott Allen, MD,FACP, professor emeritus at University ofCalifornia Riverside School of Medicine and PHR medical advisor.

The document further describes how certain techniques, such as confinement in a coffin-sized box, forced nakedness, near-hypothermia, prolonged sleep deprivation, and waterboarding were not considered to be torture because they were deemed not to cause “prolonged (mental) harm lasting months or years.” It is now clear that these determinations were based on the Office of Legal Counsel’s faulty interpretation of torture that elevated physical and mental pain thresholds and the condition of specific intent to cause such pain.

“The document makes the claim that OMS personnel served to protect detainees and ensure safe, legal, and effective interrogations, but provides no evidence that detainees were evaluated appropriately. In fact, it states that psychological assessments did not include the possibility of post-traumatic stress disorder, the most common psychological condition following torture. The document also fails to mention the OMS practice of forced rectal feeding, for which there is no medical indication and which represents a form of sexual assault” said PHR Senior Medical Advisor Vincent Iacopino, MD, PhD.

In addition, the document’s conclusion that the interrogation techniques did not cause long-lasting harm has been proven wrong. Some detainees subjected to these torture techniques who are still held in the Guantánamo Bay detention facility remain severely traumatized, according to PHR medical experts who have examined them. Detainees who have been evaluated after their release from Guantánamo, and elsewhere, also continue to show long-lasting harm, as described in reports such as PHR’s Broken Laws, Broken Lives.

The document refers to OMS practices being in compliance with American Psychological Association (APA) policies, but fails to acknowledge collusion between the APA, the CIA, and the Department of Defense in establishing those policies. These policies have since been abandoned. The document also attempts to defend against criticism of breaches of medical ethics by indicating that OMS participation was voluntary, that its practices were considered “legal” by the U.S. Department of Justice at the time, and that actionable intelligence was obtained and lives were saved. The author of the document rejects international medical ethical principles of “do no harm” as well as legal prohibitions against participation in torture by asserting that “saving lives” takes priority over respect for human dignity. We have learned since, from a 2014 Senate Select Committee on Intelligence report, that no actionable intelligence was ever obtained using “enhanced interrogation” techniques that could not otherwise have been gathered.

This document is a revealing self-indictment of U.S. torture practices and the critical role of CIA OMS personnel in participating in and concealing torture. It shows health professionals’ disregard for core ethical principles, including the World Medical Association’s Declaration of Tokyo, requiring that they remove themselves from all forms of participation in torture or ill-treatment.

“This document shows that within the CIA OMS culture in the post-9/11 years, there was a lack of understanding of the moral and ethical issues involved in the presence and cooperation of health professionals in interrogations and their willingness to preside over the deliberate infliction of pain on detainees,” Iacopino said. “The author of the document expresses continual concern for the physical safety of detainees, but he shows no qualms about OMS personnel participating in the interrogations that caused great pain and suffering to the detainees. This was an improper role for health professionals and OMS shows that it was blind or indifferent to ethical concerns raised by their participation,” he added.

Based on the new details in this document, PHR renews its call on the U.S. government, especially all CIA medical professionals, to take immediate action to make structural and procedural reforms to ensure that such human rights abuses – including the collusion and cover up of health professionals, in violation of their professional ethics – never happen again. As an organization of health professionals, PHR looks forward to those in positions of authority recognizing the important role played by doctors, psychologists, therapists, and others who practice medicine to ensure that torture tactics are never enabled by professionals whose primary obligation is to their patients, and that all agency operations respect the right to dignity and care for the individual.

Torture is absolutely prohibited under U.S. and international law at all times, and preventing the torture of those in custody is integral to the ethical duties and culture of health professionals. Torture violates everything that health professionals stand for and PHR will continue to advocate to ensure the U.S. government never engages in torture again.

Physicians for Human Rights (PHR) is a New York-based advocacy organization that uses science and medicine to prevent mass atrocities and severe human rights violations. Learn more here.