- Email: [email protected]
Commentary: Military medical support for detainee operations
Commentary: Military medical support for detainee operations Eric B. Schoomaker, MD, PhD
The very point that the author makes concerning the risk of abuse in similar situations5 is one of the main reasons it is critical to have a medical professional’s presence in these situations. The official Department of the Army’s Inspector General’s Detainee Operations Inspection has discussed the importance of Dr. Zimbardo’s work in at least one report.6 The processes Zimbardo described resulted in the abuse at Abu Ghraib, and a better understanding of these processes was key in helping the DoD develop strategies to prevent future abuse.1 We are in complete agreement with the author on the absolute prohibition of medical professionals supporting or condoning abusive treatment of detainees in any manner. However, a military medical professional actually has an affirmative duty that goes well beyond simply not being allowed to participate in any such treatment. Any DoD medical professional has a legal responsibility to stop, prevent, and report any such abuse. If he or she is unsuccessful in any such situation, the individual must continue to report it up the military chain of command. If the medical professional neglects this duty, he/she is criminally liable under the Uniform Code of Military Justice. This is another concrete reason why it increases the safety of detainees if medical professionals are present and available in detention setting. DoD policies have always prohibited detainee abuse and never sanctioned torture, and they have been updated regularly to provide healthcare personnel guidance in their responsibilities toward detainees to ensure that they are treated humanely, that they receive appropriate medical care, and that they are not subjected to cruel, inhumane, or degrading treatment.7 DoD detention operations policy, doctrine, and training have all recently been revised to provide more detailed guidance for the operational environment. In the few instances where abuse has occurred or was observed and not reported, the personnel responsible were investigated and held accountable. Some of the key revisions of our policies include clear delineation of roles and responsibilities for detainee care, custody, and interrogations, and very specific guidance of all personnel to identify, report, and investigate detainee abuse of any kind. New Army policy also mandates that our forces receive additional Law of War and Cultural Awareness Training. The Army, which provides training for all service members deploying in support of detainee operations, has enhanced its training for soldiers, units, and civilians, not
S
ince 2001, Department of Defense (DoD) medical professionals have worked hard to ensure that detainees in US custody are provided quality medical care, independent of their combatant status. There is no evidence of DoD medical professionals engaging in or supporting torture. On the contrary, there is an abundance of evidence that they worked diligently to prevent the abuse of detainees.1,2 For example, a DoD psychologist was one of the first to object to the mistreatment of detainees at Guantanamo, referenced in the SASC report, Committee on Armed Services, United States Senate, 2008.3 In regards to the action of nurses related to detainees at Guantanamo, the only involvement of nurses with detainees was and is in the role of caregiver. Nurses are now, and have always been, a critical element to ensuring high-quality medical care to all we treat. This has never been compromised. Some of the statements made in the commentary ‘‘Fork in the road: Accessories to cruelty or courage,’’ by Mohr in this issue, need to be addressed. At least one of the references4 used in the article to support the belief that nurses were involved in the abuse of detainees does not support that conclusion. In fact, the word nurse is never used in the document, and the allegations of abuse were not substantiated. Of much more critical importance, however, is that the abuse discussed in this report occurred before an Army psychologist was assigned.1 In this conflict, as in all others, Army, Navy, and Air Force nurses have been strong and consistent advocates for detainee health care. As one small example, nurses initiated the first detainee case management program in 2008 to better manage care for detainees with hypertension and diabetes. The program included detainee classes, in Arabic, on nutrition and skin care, as well as nutritional planning for special meals. Overall, the program significantly improved the detainees’ measures of diabetic and hypertensive control. Eric B. Schoomaker, MD, PhD, is a Lieutenant General, US Army and the Surgeon General/Commander, US Army Medical Command. Corresponding author: Cynthia Vaughan, Chief, Public Affairs, OTSG/MEDcom. E-mail: [email protected] Nurs Outlook 2009;57:292-293. 0029-6554/09/$–see front matter Published by Elsevier Inc. doi:10.1016/j.outlook.2009.08.005
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only as an annual requirement, but also institutionally and during predeployment. Our medical personnel continue to demonstrate the highest levels of professionalism in service to detained personnel. The DoD continues to clearly communicate its commitment to ensuring all service members live up to our values and the law of war, regardless of the circumstances, and that any service member found responsible for detainee abuse is held accountable. We strongly agree that the nursing profession is committed to ethical actions in support of social goals. It is already a violation of law for a military member to give or follow an illegal order. It is already illegal for any military member to take part in, condone, or simply fail to report, the abuse of any person, particularly a detainee. We strongly support the motivation of any medical professional to report at any time an ethical issue that they have or observe. Within the military medical system, there are already multiple avenues of consultation available, but we certainly support a dialog on improving these means. Finally, we strongly support an open discussion on the topics raised by the author. Open discussion about
S
these topics is essential to not only our military nurses and other medical professionals, but to our country as well. We look forward to continuing an informed, thoughtful dialog. REFERENCES 1. James LC. Fixing hell. New York: Grand Central Publishing; 2008. 2. Martinez-Lopez L. Assessment of detainee medical operations for OEF, GTMO, and OIF. Washington, DC: US Army, Office of The Surgeon General; 2005. 3. Committee on Armed Services. Inquiry into the treatment of detainees in U.S. Custody. US Senate: 110th Congress; 2008. 4. Third Military Police Group, 78th Military Police Detachment. CID Report of Investigation-Final C/SSI – 0124-04-CID25980199-/5C1Q2/5Y2E. DODDOACID 004821-33. 2004. 5. Zimbardo P. The Lucifer effect: Understanding how good people turn evil. New York: Random House; 2007. 6. Department of the Army, The Inspector General. Detainee operations inspection. Washington, DC: Department of the Army; 2004. 7. DoDI 2310.08E. Medical program support for detainee operations. June 6, 2006.
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The very point that the author makes concerning the risk of abuse in similar situations5 is one of the main reasons it is critical to have a medical professional’s presence in these situations. The official Department of the Army’s Inspector General’s Detainee Operations Inspection has discussed the importance of Dr. Zimbardo’s work in at least one report.6 The processes Zimbardo described resulted in the abuse at Abu Ghraib, and a better understanding of these processes was key in helping the DoD develop strategies to prevent future abuse.1 We are in complete agreement with the author on the absolute prohibition of medical professionals supporting or condoning abusive treatment of detainees in any manner. However, a military medical professional actually has an affirmative duty that goes well beyond simply not being allowed to participate in any such treatment. Any DoD medical professional has a legal responsibility to stop, prevent, and report any such abuse. If he or she is unsuccessful in any such situation, the individual must continue to report it up the military chain of command. If the medical professional neglects this duty, he/she is criminally liable under the Uniform Code of Military Justice. This is another concrete reason why it increases the safety of detainees if medical professionals are present and available in detention setting. DoD policies have always prohibited detainee abuse and never sanctioned torture, and they have been updated regularly to provide healthcare personnel guidance in their responsibilities toward detainees to ensure that they are treated humanely, that they receive appropriate medical care, and that they are not subjected to cruel, inhumane, or degrading treatment.7 DoD detention operations policy, doctrine, and training have all recently been revised to provide more detailed guidance for the operational environment. In the few instances where abuse has occurred or was observed and not reported, the personnel responsible were investigated and held accountable. Some of the key revisions of our policies include clear delineation of roles and responsibilities for detainee care, custody, and interrogations, and very specific guidance of all personnel to identify, report, and investigate detainee abuse of any kind. New Army policy also mandates that our forces receive additional Law of War and Cultural Awareness Training. The Army, which provides training for all service members deploying in support of detainee operations, has enhanced its training for soldiers, units, and civilians, not
S
ince 2001, Department of Defense (DoD) medical professionals have worked hard to ensure that detainees in US custody are provided quality medical care, independent of their combatant status. There is no evidence of DoD medical professionals engaging in or supporting torture. On the contrary, there is an abundance of evidence that they worked diligently to prevent the abuse of detainees.1,2 For example, a DoD psychologist was one of the first to object to the mistreatment of detainees at Guantanamo, referenced in the SASC report, Committee on Armed Services, United States Senate, 2008.3 In regards to the action of nurses related to detainees at Guantanamo, the only involvement of nurses with detainees was and is in the role of caregiver. Nurses are now, and have always been, a critical element to ensuring high-quality medical care to all we treat. This has never been compromised. Some of the statements made in the commentary ‘‘Fork in the road: Accessories to cruelty or courage,’’ by Mohr in this issue, need to be addressed. At least one of the references4 used in the article to support the belief that nurses were involved in the abuse of detainees does not support that conclusion. In fact, the word nurse is never used in the document, and the allegations of abuse were not substantiated. Of much more critical importance, however, is that the abuse discussed in this report occurred before an Army psychologist was assigned.1 In this conflict, as in all others, Army, Navy, and Air Force nurses have been strong and consistent advocates for detainee health care. As one small example, nurses initiated the first detainee case management program in 2008 to better manage care for detainees with hypertension and diabetes. The program included detainee classes, in Arabic, on nutrition and skin care, as well as nutritional planning for special meals. Overall, the program significantly improved the detainees’ measures of diabetic and hypertensive control. Eric B. Schoomaker, MD, PhD, is a Lieutenant General, US Army and the Surgeon General/Commander, US Army Medical Command. Corresponding author: Cynthia Vaughan, Chief, Public Affairs, OTSG/MEDcom. E-mail: [email protected] Nurs Outlook 2009;57:292-293. 0029-6554/09/$–see front matter Published by Elsevier Inc. doi:10.1016/j.outlook.2009.08.005
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Military medical support for detainee operations
Schoomaker
only as an annual requirement, but also institutionally and during predeployment. Our medical personnel continue to demonstrate the highest levels of professionalism in service to detained personnel. The DoD continues to clearly communicate its commitment to ensuring all service members live up to our values and the law of war, regardless of the circumstances, and that any service member found responsible for detainee abuse is held accountable. We strongly agree that the nursing profession is committed to ethical actions in support of social goals. It is already a violation of law for a military member to give or follow an illegal order. It is already illegal for any military member to take part in, condone, or simply fail to report, the abuse of any person, particularly a detainee. We strongly support the motivation of any medical professional to report at any time an ethical issue that they have or observe. Within the military medical system, there are already multiple avenues of consultation available, but we certainly support a dialog on improving these means. Finally, we strongly support an open discussion on the topics raised by the author. Open discussion about
S
these topics is essential to not only our military nurses and other medical professionals, but to our country as well. We look forward to continuing an informed, thoughtful dialog. REFERENCES 1. James LC. Fixing hell. New York: Grand Central Publishing; 2008. 2. Martinez-Lopez L. Assessment of detainee medical operations for OEF, GTMO, and OIF. Washington, DC: US Army, Office of The Surgeon General; 2005. 3. Committee on Armed Services. Inquiry into the treatment of detainees in U.S. Custody. US Senate: 110th Congress; 2008. 4. Third Military Police Group, 78th Military Police Detachment. CID Report of Investigation-Final C/SSI – 0124-04-CID25980199-/5C1Q2/5Y2E. DODDOACID 004821-33. 2004. 5. Zimbardo P. The Lucifer effect: Understanding how good people turn evil. New York: Random House; 2007. 6. Department of the Army, The Inspector General. Detainee operations inspection. Washington, DC: Department of the Army; 2004. 7. DoDI 2310.08E. Medical program support for detainee operations. June 6, 2006.
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