Review - Oath Betrayed
Torture, Medical Complicity, and the War on Terror
by Steven Miles
Random House, 2006
Review by J. Jeremy Wisnewski, Ph.D.
Feb 5th 2008 (Volume 12, Issue 6)

Picture this: a prisoner is being suspended, arms tied behind his back, from a ceiling beam. He is being asked very difficult questions, some of which he seems not to understand. There is blood dripping from his nose. He is sweating profusely, and he is muttering what appears to be total nonsense. He has not eaten, or slept, for several days. He has been subject to random beatings. His situation seems hopeless.

But then: One of his interrogators motions for another man to come into the room. This man has a stethoscope and a first aid kit. He begins to listen to the prisoner’s heart. He takes his blood pressure. He flashes a small light into the prisoner’s eyes and looks at them closely. His appearance is grim as he turns to the interrogator. There is a moment of hope. “He can continue,” he says. And with that, the beatings begin again.

It would be nice if the fictionalized account just given were actually fiction. Sadly, it is anything but. As we have become aware, torture is a reality of both dictatorships and democracies; it is a relic of the past as well as a part of the present. Steven Miles’ recent book, Oath Betrayed: Torture, Medical Complicity, and the War on Terror brings this point home with force and precision. In this book, Miles documents the role of medical personnel in recent acts of human rights abuse--predominantly those abuses that have been carried out under the banner of military operations for the United States.

          The depth of scholarship in this book is impressive. Miles examines medical reports on prisoners, notes discrepancy, omission, and inconsistency in its multitude. Shocking events, such as the government classifying only “two of twenty-three self-hangings as attempted suicides” (105), are revealed for what they are: medical complicity in cover-up. Miles examines the policies promoted by former Secretary of Defense Rumsfeld, as well as by President George W. Bush, and demonstrates how these policies contributed to “the politics of extreme dehumanization” (163). The book as a whole stands as a searing indictment of medical malpractice on the part of those physicians and nurses present at Abu Ghraib and elsewhere. Indeed, as Miles remarks, his aim in writing Oath Betrayed was motivated by a simple question: “where were the doctors and nurses at Abu Ghraib? Why didn’t medical personnel blow the whistle on the abuse and neglect of prisoners that had been taking place long before the Abu Ghraib scandal became public?” (120).

          Miles’ answer to this question is unequivocal: insofar as human rights abuses went unreported, or were facilitated, by medical personnel, these personnel have committed grave ethical breaches. The silence of top medical personnel, in Miles’ verdict, is “inexplicable and inexcusable” (152). Moreover, a “medical examiner who allows a false official statement that a homicide is death by natural causes to stand for months or years is arguably an accessory after the fact if that delay obstructs the apprehension, trial, or punishment of an assailant” (88). In the case of Abu Ghraib, medical personnel have violated their supreme responsibility: “The responsibility for prisoners’ health and the healthfulness of their living conditions [which] falls squarely on medical personnel” (116).

That this duty is commonly acknowledged is evidenced by its presence in a number of ethical guidelines, not the least of which is the UN’s Principles of Medical Ethics regarding the treatment of prisoners and detainees. According to this document, prison physicians “have a duty to provide [prisoners and detainees] with protection of their physical and mental health and treatment of disease” (116). Elsewhere, UN rules stipulate that physicians and clinicians have an obligation to insure such things as quantity and quality of food, hygiene of prisoners and cleanliness of the detaining facility.

Had this been the extent of abuse--not reporting inadequate food and sanitation--Miles’ indictment would not be so severe. As he conclusively demonstrates, however, medical personnel were far more involved in the ‘torture lite’ that occurred under the supervision of the American military: medical personnel monitored ‘patients’ to insure they could be tortured without dying; they used prior medical knowledge to devise torments for particular prisoners; and they used their expertise to cover-up evidence of torture, both on paper and on the bodies of those who were its victims. As Miles succinctly puts it, “[t]orturers need medical accomplices to keep prisoners alive as trauma is inflicted, to predict how severely detainees can be twisted, and to see that torture evaporates, leaving behind neither scars nor documentation” (167)

          As a record of violations of medical ethics codes, Miles presents a compelling and comprehensive case. His scholarship is impeccable; his sense of outrage appropriate. What is missing in his account, however, is a proper diagnosis of what is wrong with torture. Miles is quick to admonish medical personnel for their repeated violations of the Hippocratic oath, AMA guidelines, and UN ethical codes. And he is surely correct to do so. Doctors, nurses, and medics who have been complicit in the abuse and torture of prisoners of war have broken their oaths and violated the dignity of their profession. But this wrong-doing, it must certainly be conceded, pales in comparison to the wrong-doing that is torture. It is one thing to break a vow; it is quite another to willfully harm persons by aiding in torture. Throughout the book, Miles seems more keen on demonstrating that professional ethical codes have been violated than offering principled philosophical arguments for the correctness of these codes; he seems more dedicated to showing that doctors have betrayed their profession than to showing what it is that is so reprehensible about torture: the fact that it destroys human agency--that it turns one against oneself, and that such damage is irreparable.

          Despite these shortcomings, Miles has done a service to the general public with this work. He has forcefully documented what might have otherwise escaped a larger audience. For this alone, the book is worth our time.

© 2008 J. Jeremy Wisnewski

J. Jeremy Wisnewski, PhD, Hartwick College

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