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US medical ethics at Guantanamo criticized

Interrogators used health records, specialists allege

WASHINGTON -- Military interrogators at the US naval prison camp at Guantanamo Bay, Cuba, may have breached medical privacy and encouraged doctors to violate professional and legal standards, two specialists on medical ethics said in The New England Journal of Medicine yesterday.

They said their interviews with staff members at Guantanamo, along with records from the facility, indicate that prisoners' health records could be used against them to find the most effective ways to extract information from them.

The Pentagon's top health official said the allegations were ''an outrageous distortion" of operations in the camp, where the United States is holding more than 500 terrorism suspects.

Dr. Gregg Bloche of the Brookings Institution and a law professor at Georgetown University in Washington, and Jonathan Marks, a lawyer at Matrix Chambers in London and a bioethics fellow at Georgetown, made the allegations in a commentary in the medical journal.

Health professionals caring for prisoners at Guantanamo have been encouraged to alert military officials there about relevant health information, Bloche and Marks alleged.

''Health information has been routinely available to behavioral science consultants and others who are responsible for crafting and carrying out interrogation strategies," they wrote.

''Through early 2003 (and possibly later), interrogators themselves had access to medical records. And since late 2002, psychiatrists and psychologists have been part of a strategy that employs extreme stress, combined with behavior-shaping rewards, to extract actionable intelligence from resistant captives."

This makes caregivers into accessories for gathering intelligence, Bloche and Marks said.

''Not only does this undermine patient trust; it puts prisoners at greater risk for serious abuse. The global political fallout from such abuse may pose more of a threat to US security than any secrets still closely held by shackled internees at Guantanamo Bay," they said.

Dr. William Winkenwerder, the assistant secretary of defense for health affairs, denied the allegations and said the Guantanamo detainees had the same rights as federal or military inmates.

''To put it bluntly and plainly, Dr. Bloche's article is an outrageous distortion of the plain facts and the truth regarding our policies for our health personnel . . . and regarding our expectations for our personnel," Winkenwerder said.

While acknowledging that it was possible transgressions could have occurred before the policy was issued in 2002, he said Bloche deliberately distorted a small part of it that said confidentiality was not absolute.

He said it would be a judgment call, for example in cases of suicide, specific threats, or infectious diseases.

''For example, if a detainee offered up information that was about a plan or an intention to harm other people . . . if a medical provider has that kind of information, he or she is guided to provide that information to his or her chain of command and to appropriate authorities," Winkenwerder said.

The New York Times reported today that military doctors at the facility helped interrogators to refine interrogations of detainees, by providing advice on how to increase stress levels and exploit fears, according to new, detailed accounts given by former interrogators in interviews with the newspaper.

In one example, interrogators were told a detainee's medical files indicated the man had a severe phobia of the dark and ways to manipulate the fear to gain his cooperation were suggested, the Times said.

The United States has classified the detainees at Guantanamo as enemy combatants and denied them rights accorded to prisoners of war under the Geneva Conventions -- actions that have been criticized by groups such as Amnesty International.

Former detainees have said they were tortured, and an FBI memo accused Pentagon personnel at Guantanamo of using ''torture techniques."

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