AMA Interrogation Policy Similar to APA's Position

Physicians cannot ethically conduct or directly participate in the interrogation of individual detainees, according to an AMA report that closely mirrors an APA position statement on the issue approved in May.

A report by the AMA's Council on Ethical and Judicial Affairs (CEJA), which was laboriously crafted and recrafted until just days before its approval by the AMA House of Delegates last month, states that physicians must not participate in interrogations; to do so “undermines the physician's role as healer and thereby erodes trust in the individual physician-interrogator and in the medical profession.”

The vote took place at the annual meeting of the AMA House of Delegates in Chicago.

The wording of the CEJA report varies somewhat from APA's statement, which says that “no psychiatrist should participate directly in the interrogation of persons held in custody by military or civilian investigative or law enforcement authorities, whether in the United States or elsewhere” (Psychiatric News, June 16).

The APA statement goes on to delineate specifi c activities that constitute“ direct participation” and are thus precluded. But in the AMA report, for instance, one of the fi ve concluding recommendations reads:“ Physicians may participate in developing effective interrogation strategies for general training purposes. These strategies must not threaten or cause physical injury or mental suffering and must be humane and respect the rights of individuals” (see box on Original article: page 4).

“Because it is justifi able for physicians to serve in roles that serve the public interest, the AMA policy permits physicians to develop general interrogation strategies that are not coercive, but are humane and respect the rights of individuals,” said psychiatrist Priscilla Ray, M.D., who is chair of CEJA, at a press conference after the AMA meeting.

She said an example of such strategies might include “rapport building” between interrogator and detainee. When asked if the language could be interpreted to mean that physicians could participate in developing rapport building or other strategies for specifi c individual detainees—as is prohibited by the APA statement—Ray said it should not be. And she reiterated that the CEJA report was closely in line with APA's position statement.

The report went through numerous iterations and was ultimately endorsed by APA, the American Academy of Psychiatry and the Law, and the American Academy of Child and Adolescent Psychiatry (AACAP). It was also supported by military physicians who spoke at the meeting.

“I really think this is a very strong statement that closely corresponds to and reinforces the APA position that physicians, including psychiatrists, should not be participating in any way in the interrogation of individual detainees,” said APA immediate past President Steven Sharfstein, M.D. He visited Guantanamo Bay in October 2005 to urge U.S. military and defense officials to exclude psychiatrists from participating in any way in the interrogation of detainees.

Paul Appelbaum, M.D., chair of APA's Council on Psychiatry and Law, agreed.“ Although there are small differences between the APA position statement and the AMA's position, there is agreement about the most important issues,” he told Psychiatric News. “Physicians do not belong in the interrogation room, and they ought not to be involved in planning the interrogations of particular suspects.”

`Unity of Medicine' Stressed

Both John McIntyre, M.D., chair of the Section Council on Psychiatry, and David Fassler, M.D., AACAP's delegate and author of the original resolution calling for the CEJA report, emphasized the unity of medicine around the issue of physician participation in interrogation.

“I'm glad to see that organized medicine will now be able to speak with one voice on this issue,” Fassler said.

Previous iterations of the AMA report—especially the passage regarding the development of interrogation strategies—were much less proscriptive than the final version, and it was largely the counsel of APA leaders that was instrumental in moving the AMA's position to one that was more in line with APA's.

In a letter dated June 8, Appelbaum wrote on behalf of APA to members of CEJA to address concerns about the wording of the passage as it stood at the time, just one day prior to the opening of the AMA meeting. It read:“ Physicians may participate in developing effective interrogation strategies that are not coercive but are humane and respect the rights of individuals.”

“This language appeared to allow physicians to consult on the planning of interrogations of particular detainees,” Appelbaum told Psychiatric News. “In contrast, APA's statement explicitly rules out advising authorities on the use of specific techniques of interrogation with particular detainees.”

The final wording in the CEJA report was changed to emphasize that the development of strategies be for “general training purposes.”

“Although not quite as explicit as APA's statement, the new language appears to clarify that legitimate involvement is limited to general training, such as teaching police how to deal with persons with mental disorders, as opposed to helping to plan a particular detainee's interrogation,” Appelbaum said.

“This conforms to APA's statement that psychiatrists may provide training to military or civilian investigative or law enforcement personnel on recognizing and responding to persons with mental illnesses, on the possible medical and psychological effects of particular techniques and conditions of interrogation, and on other areas within their professional expertise,” he said. “Thus, both statements now appear to concur that physicians should not be involved in the interrogation of particular detainees in either a direct or advisory role.”

Subject Engages Ethics, National Security

The careful wording and substantial revisions that the report underwent before being accepted appears to reflect the diversity and passionate nature of opinions on a subject that engages issues not only of professional and medical ethics, but also of national security and the radical measures that some believe may be needed to confront modern terrorism.

“This is a totally new area of medical ethics,” said Sharfstein.

Even the final version of CEJA's report fell short for some—at least at first glance—a reflection of the varying ways in which the council's carefully chosen words might be read.

During reference committee hearings (where opinions about reports and resolutions are aired before coming to the floor of the House of Delegates) Brig. Gen. (Ret.) Stephen N. Xenakis, M.C., delivered a strident speech calling for a more unambiguous prohibition on physician participation than the CEJA report provided. Xenakis is an advisor to the group Physicians for Human Rights and director of child and adolescent psychiatry at the Psychiatric Institute of Washington in Washington, D.C.

Later, Xenakis told Psychiatric News that after consulting with CEJA members about the intent of the wording, he came around to endorse the report. “They said that in their eyes they were crafting language that was intended to have the same meaning as the statement by APA,” he said.

Following the House of Delegates meeting, Physicians for Human Rights issued a statement in support of the AMA.

“The AMA acted today to defend the basic principles of medical ethics and to protect the men and women bravely serving our country as military health personnel,” Xenakis was quoted in the statement as saying.“ Since 2001, the civilian leadership at the Pentagon has been engaged in a full frontal assault on the basic standards of medical and military ethics, from the Hippocratic Oath to the Geneva Conventions. All the major medical associations are now standing together to demand that this administration respect the core values of both the health professional and the soldier.”

McIntyre noted that as a “big tent,” the AMA has to accommodate a range of opinions and interests, including those of physicians in the military, to craft a document that is widely acceptable on so difficult a topic requires the ability to thread words through the eyes of some tiny needles.

“There are people on the other side of this issue,” he told Psychiatric News. “To get a product out of the AMA that is also acceptable to APA is good work. That only occurred because we were active participants. If we didn't participate, I am certain the product would not have been something APA would favor.”

A press release on the AMA's new policy to oppose direct physician participation in interrogation is posted at<www.ama-assn.org/ama/pub/category/16446.html>.▪