Ethics, Interrogation, and the American Psychiatric Association

Recently, it has been alleged that the American Psychological Association colludedwith the GeorgeW. Bush administration to allowpsychologist participation in enhanced interrogations of detainees in the war on terror. James Risen writing in The New York Times (1) asserted that a recent review of emails suggests that the American Psychological Association policy that supported this interrogation was adopted with the direct involvement of psychologists whoworked in the U.S. national securityapparatusandstructuredtoovercomeobjections from the Office of Legal Counsel in the Department of Justice over the continuation of the enhanced interrogation program. The American Psychological Association Board of Directors in late 2014 announced an independent legal review of these allegations tobeoverseenbyaspecial committeeof theirboard(2). These reports ledus to review thehistory of the adoption in 2006 of the formal position of the American Psychiatric Association that states categorically that psychiatrists should not participate in such enhanced interrogations (3). Sharfstein served as President of the American Psychiatric Association in 2005–2006 when the position statement was written and adopted; Summergrad served as President in 2014–15 when these new allegations regarding the American Psychological Association arose, and worked to make the American Psychiatric Association’s long-standing opposition to psychiatrist involvement in interrogations clear to the general public (4). Looking back on the 2005–2006 period, the question of whether physicians, especially psychiatrists, were participating in the interrogation of detainees had become a particular focus of concern at the Guantanamo Naval Base in Cuba in 2005. Concerns about national security and possibility that enhanced interrogationmight foil further terrorist attacks seemed to take priority over other concerns. Upon reading 2006 reports in The New Yorker magazine and theNewEngland Journal ofMedicine alleging psychiatrist participation in so-called “behavioral science consultation teams”, Sharfsteinwrote toAssistant Secretary forDefense for Health Affairs WilliamWinkenwerder, MD, stating that such participation “could be construed as facilitating treatment of prisoners in amanner inappropriate topsychiatryandpossibly in violation of medical ethics” (5). The American Psychiatric Association formally requestedavisit to theGuantanamoBase. This request led to an October 19, 2005 visit that included Department of Defense personnel; Steven Sharfstein, MD, in his role asPresidentof theAmericanPsychiatricAssociation; the President of the American Psychological Association; the Surgeon General of the United States; and the Surgeons General of the Army, Navy, and Air Force. The day-long visit included discussionswiththebasecommanderaswellasawalkthroughof the prison complex, observation of the detainee hospital, and atourof thenearly$3millionpsychiatricwing.Upontheirreturn at 8 p.m. to Andrews Air Force Base, participants engaged in aspiritedthree-hourdiscussion.Sharfsteindistributedaposition paper developed by the American Psychiatric Association Council of Psychiatry and Law that raised concerns regarding psychiatric participation in the interrogation of detainees. This statement had been developed after a two-day meeting of the American Psychiatric Association’s Council of Psychiatry and Law, Ethics Committee, the Committee on Judicial Action, the Committee on Misuse and Abuse of Psychiatry, and representatives of military psychiatry. It was clear at this postvisit dinner that the American Psychiatric Association position contrasted sharply with the position of the American Psychological Association. In 2005 the American Psychological Association had taken the position that “Psychologists may serve in various national security roles, such as consultants to an interrogation, in a manner that is consistent with their ethics code...”(6).Themilitaryhealthleadersatthemeetingaskedwhy psychiatristsmightobject toparticipation in these interrogations but not psychologists. Emphasizing our Hippocratic oath, our profoundethical obligations topatients, andourabidingconcern that such consultation could involve psychiatrists in facilitating deception and cruel and degrading treatment, we argued that it was wrong to permit skills that offer healing to ever be used for gaining intelligence. The difference between psychiatry and psychologywasclear in thedeeprootingof thepsychiatriccanon in medical ethics. Sharfstein then took the statement craftedby theCouncil of Psychiatry and Law to the American Psychiatric Association Board of Trustees for final debate and action. Therewas again spirited and open discussion that included both our national security role as psychiatrists and the ethics of psychiatric care. The position statement was passed by the American Psychiatric Association Assembly in May 2006, adopted later that afternoon by the American Psychiatric Association Board of Trustees, and immediatelymadepublic. It states:“TheAmerican Psychiatric Association reiterates its position that psychiatrists should not participate in, or otherwise assist or facilitate, the