The Inter-relationship of Prison and Medical Records

Okay, first here are the 'facts' as reported by the media earlier this week, based on a new report in the New England Journal of Medicine:

• Medical records for prisoners at the U.S. detention camp at Guantanamo Bay are being tapped to design more effective interrogation techniques
• Doctors, nurses and medics caring for prisoners there are required to provide health information to military and CIA interrogators
• Since 2003, psychiatrists and psychologists (at Guantanamo) have been part of a strategy that employs extreme stress, combined with behaviour-shaping rewards, to extract intelligence from resistant captives; that contradicts Pentagon statements that there is a separation between intelligence-gathering and patient care -- William Winkenwerder, U.S. assistant secretary of defence for health affairs, said in a memo made public in May that Guantanamo prisoners' medical records are considered private — as are American citizens'
• Such tactics are considered torture by authorities
• U.S. military medical personnel have been told to volunteer to interrogators information they believe may be valuable
• The report's authors are Dr. Gregg Bloche, a physician and a law professor at Georgetown University in Washington, and Jonathan Marks, a London lawyer who is currently a fellow in bioethics at Georgetown's law centre
• Guantanamo veterans are ordered not to discuss what goes on there, making it difficult to know how military intelligence personnel have used medical information for interrogation
• A previously unreported U.S. Southern Command policy statement dated Aug. 6, 2002, instructs health-care providers that communications from "enemy persons under U.S. control" at Guantanamo "are not confidential and are not subject to the assertion of privileges" by detainees. It also tells medical personnel they should "convey any information concerning ... the accomplishment of a military or national security mission ... obtained from detainees in the course of treatment to non-medical military or other U.S. personnel who have an apparent need to know the information."
• The only limit on the policy is that caregivers cannot themselves act as interrogators
  

Secondly, here's some reaction:

• Peter Singer, director of the University of Toronto's Joint Centre for Bioethics says this crosses an ethical line; "Physicians are there for the benefit of patients and if they are seen to be there for some other purpose, it really blurs what they're doing."
• Amnesty International Canada said the report gives serious pause to anyone who is following what happens at Guantanamo, reinforcing the call for a full, independent commission of inquiry into the detentions" including a determination of any rules being violated.
• On Tuesday, the Bush administration rejected a proposal to create an independent commission to investigate abuses of detainees at Guantanamo Bay since already 10 major investigations into allegations of abuse found the system was working well.
• Canadian Centre for Victims of Torture in Toronto, wasn't surprised by the journal report, saying that "A superpower that is considered a leader in many ways is losing its moral authority now, completely."
• The New England Journal of Medicine is the second respected journal to criticize U.S. interrogation techniques, after the British medical journal.
  

Finally some Observations and Implications:

• I believe there are times when prison officials should know the critical medical conditions of their charges, not to better interrogate or torture them with, but to make sure that any form of discipline or penalty will not further worsen their acute or critical medical condition. One can only take this perspective of course if one chooses to be humane with respect to prisoners and life in general.
• The Bush administration repeatedly rejects calls for an independent commission of inquiry to investigate the matter. One could argue he has done his bit and does not want more money and resources spent on this. Others could argue he is afraid of what the commission would find.
• There seems to be a disconnect between what the Pentagon says and what the report believes is the case. There seems to also be a disconnect between what the U.S. Southern Command and the Pentagon have said on this topic historically.
• In today's world such inconsistencies should not exist and each difference of perspective should be fully explainable. When this is not the case, either we have a situation where one of the perspectives is wrong or a situation where one of the proponents of a particular view is being dishonest. The telling of lies is normally a practice employed to cover up wrong-doing.
• It wasn't too many decades ago that the ordinary citizen could trust perhaps his minister or priest, his doctor, his lawyer to act in his best interests, his teacher, and his representative in government. It seems now each and every one of those, and in some cases, even his family, have fallen by the wayside and cannot be trusted. We are, as common men and women, almost alone.
• Distrust is alive and well.

As we see this growth of distrust about us in our communities, our towns, cities, nations, we have two choices. We can either do what we have often seen others do in this regard -- "if you can't beat them (or change them), join them" -- or we can make a firm decision to be different. We can decide to be totally honest. We can decide to be men and women of our word. We can decide that we don't need a dozen lawyers to protect us in every agreement that we make. We can decide to let a handshake be all the covenant required between the parties that we need.

Yes, sometimes we will get burned and there will be consequences. But, for the most part, we will gain benefits beyond our expectations. Just read, Jon M. Huntsman's Winners Never Cheat, Wharton School Publishing. Better still, read the manual from the one that created man in the first place. In the Bible (Matthew 5:37), He clearly recommends that we let our yes mean yes and our no mean no. That's not too hard, is it? And it just may be the modelling our next generation needs.

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