Biscuits, Anyone?
From: http://www.truthout.org/docs_2006/032806A.shtml
Tuesday 28 March 2006
"Press Office," chirped the Defense Department voice on the phone.
"Yes, good morning. My name is Bill Fisher. I write for TruthOut. I have a couple of questions about the Biscuit
Program. Would you be able to help me?"
"What are Biscuits?" said a confused voice.
"They are military shorthand for Behavioral Science Consultation Teams," said I.
"Let me connect you with the person who knows about that program," said the helpful voice.
Pause.
Then came an answering machine. "This is Jane Doe (I am not using her real name because I might get her in trouble).
Please leave your name and phone number and the nature of your question, and I'll call you back," said the disembodied
voice mail message.
I did, adding that I wanted to file a story today. Then I waited. And waited. And waited some more. From midday Friday
until 7 p.m. Monday.
Altogether, I called three times, each time being referred either to a different person (who was away from his/her
desk), or to another automated voice mailbox, where I left the same message.
The questions I never got to ask anyone at the DOD were:
"I'd like to know whether BISCUIT units are working at Abu Ghraib and Bagram and other US-controlled detention centers
as well as at Guantánamo," and "Some folks who are in the medical and other health-provider fields have been critical of
the BISCUITS at Guantánamo Bay, saying they have been using doctors and nurses and psychologists to help the
interrogators get information out of the detainees, and advising about how best to keep people alive who are on hunger
strike there."
Now, if my name happened to be Bob Woodward or Jane Mayer or Sy Hirsch or Walter Pincus or Jim Risen, I suppose I could
have called a "high level official close to the Bush administration," who might speak "on condition of anonymity."
But I wanted to discover whether a plain vanilla working-stiff journalist - and taxpayer - could actually get some
information on a sensitive subject from a famously secretive government.
I guess I got my answer. The silence was deafening.
Now, just in case you've been living on Pluto for the past year or so, BISCUITS - Behavioral Science Consultation Teams
- consist of military psychiatrists, psychologists, behavioral scientists, and other health care professionals. Their
role, it has been charged by former Guantánamo interrogators, is to advise the military on ways of increasing
psychological duress on detainees, sometimes using their medical records to find ways of exploiting their fears and
phobias, to make them more cooperative and willing to provide information.
In one example, published in the New York Times, "interrogators were told that a detainee's medical files showed he had
a severe phobia of the dark and suggested ways in which that could be manipulated to induce him to cooperate."
The DOD has said that there is very limited access to prisoners' medical records. But many members of the health care
community remain skeptical.
An article in the New England Journal of Medicine said interviews with doctors who helped devise and supervise the
interrogation regimen at Guantánamo showed that the BISCUIT program was explicitly designed to increase fear and
distress among detainees as a means of obtaining intelligence.
And between July 2003 and March 2004, a doctor was allegedly "pressured by OGA personnel into filling out death
certificates on Iraqi detainees" though the doctor was not given the opportunity to examine the bodies. The causes of
death given for two detainees were later found to be inaccurate. The term "OGA" (Other Government Agencies) is generally
used to refer to the CIA.
After April 2003, when Defense Secretary Donald H. Rumsfeld tightened rules on detainee treatment, one interrogator
said detainees' medical records had to be obtained through BISCUIT team doctors, but that the doctors always obliged.
The former interrogator said the BISCUIT team doctors usually observed interrogations from behind a one-way mirror, but
sometimes were also in the room with the detainee and interrogator.
The BISCUIT teams were also central, the former interrogators told the New York Times, in devising strategies like
"Operation Sandman," in which a detainee's sleep patterns were systematically interrupted several times a night.
Then there is the issue of the "autonomy" of a doctor's patients. That refers to a patient's fundamental right to
decide which medical interventions he will permit. That well-established canon of medical ethics requires that a
detainee who is on a hunger strike has the "autonomy" to remain on a hunger strike if that's what he wants. If one is a
health care provider, the patient is a patient whether or not he's a prisoner. Which means that medical personnel are
barred from forcing a prisoner to stay alive, or advising others about how to reach that objective.
So, to return to my unanswered questions to the DOD: Have the BISCUITs changed at all as a result of criticism from
civilian medical and other health care authorities? And are they being used elsewhere?
As to the "elsewhere" question, what we know is that Maj. Gen. Geoffrey Miller, the former commander at Guantánamo,
recommended the use of BSCT teams at Abu Ghraib when he was sent there to "GITMO-ize" it in August and September of
2003. According to the testimony of those who were at Abu Ghraib, psychologists were indeed involved in the
interrogations and abuse of detainees.
Gen. Miller recently invoked his right against self-incrimination in a case of two soldiers accused of using dogs to
intimidate detainees at Abu Ghraib. This invocation was the first sign by Miller that he might have information that
would implicate him in the abuses in Iraq. Numerous reports indicate that Miller instituted the use of dogs to
intimidate prisoners at Abu Ghraib after first using the technique at Guantánamo Bay. A military investigation
recommended that Gen. Miller, who is soon to retire, be reprimanded, but a higher-ranking officer denied the request.
And a senior human rights attorney told me on condition of anonymity, "I would suspect since the BSCTs continue to be
used as part of the intelligence apparatus at Gitmo" and because have been judged favorably by the military
establishment "they are likely in place at the very least at strategic interrogation facilities in Iraq and in
Afghanistan."
As to changes in the way the BISCUITs operate, the DOD finally issued revised guidelines last June, after various
health care professional organizations and prominent medical authorities ignited a firestorm of criticism. Both the
American Psychological Association and the American Psychiatric Association have made clear that it is unethical for
members of their profession - whether in the military or not - to participate in interrogations or to provide
information to interrogators about ways to "break" a detainee.
Dr. William Winkenwerder Jr., Assistant Secretary of Defense for Health Affairs, acknowledged that the new guidelines
came about as the result of a review of procedures begun after allegations of medical personnel assisting in abusing
prisoners surfaced. "What got the ball rolling was an awareness from all the information coming out of Abu Ghraib and
the various allegations," he said.
Some of the most passionate of these allegations have come from Brigadier General Stephen N. Xenakis, MD, who retired
from the US Army in 1998 after serving in many high-level positions, including Commanding General of the Southeast
Regional Army Medical Command. He has reportedly played a major role in driving the DOD to re-examine its medical
practices.
Last month he said: "Medical officers enjoy special privileges and status and are expected to abide by and stand up for
their professional principles at all times and in all situations. This operation - the War on Terror - is no
different.... It is important to remember that the burden of leadership is to ensure that high moral and ethical
practices are maintained in even the most demanding situations."
But, speaking about prisoner deaths while in US custody, Gen. Xenakis charged, "To date, we have no indication that
either the Army Medical Department or the Office of the Assistant Secretary of Defense for Health Affairs has conducted
a thorough investigation of the medical care provided to detainees and the circumstances surrounding the known deaths."
The new guidelines, said Dr. Winkenwerder, consolidate "principles and procedures for US military medical personnel
when working with detainees under control of US armed forces."
The guidelines specify that military medical personnel must observe medical ethics, make medically appropriate
decisions, and report inhumane treatment. Military health care professionals must "be guided by professional judgment
and standards similar to those that would be applied to members of the US armed forces, including duty to protect the
physical and mental health of the detainee" and "will not participate in any activity that is not consistent with
applicable law."
But in a briefing for reporters, Winkenwerder declined to say whether the guidelines would prohibit some of the
activities described by former interrogators and others. He said the medical personnel "were not driving the
interrogations" but were there as "consultants."
Winkenwerder added that "only a very, very small number of reports of observation of possible abuse" have been
recorded. Pentagon officials have previously said that the practices at Guantánamo did not violate ethics guidelines.
The Pentagon invited representatives of a number of health-related professional associations, including the American
Medical Association, to pay a one-day visit to Guantánamo Bay. But they were not allowed to interview any detainees.
One of those attending, Prof. Nancy Sherman, who teaches philosophy at Georgetown University and has written
extensively about ethics in the military, said that the DOD had worked hard to present a positive, upbeat image of what
occurred at Guantánamo. "I think what was being sought was some sort of confirmation that their practices were ethically
sound" and that some of the news accounts were wrong, she said.
Professor Sherman added that the distinction between using psychiatrists and psychologists as consultants rather than
as providers of medical care was a tenuous one that invited ethical problems.
Winkenwerder said the new procedures separate individuals who are providing care from health professionals who work in
other capacities in detention operations. Medical personnel who are in a provider-patient relationship with detainees -
those who actually provide treatment - "shall not and will not undertake detainee-related activities for purposes other
than to provide health care," he said.
"Such health care personnel shall not actively solicit information from detainees for purposes other than health care
purposes," he explained.
The guidelines say medical professionals in other roles in detention operations should not provide actual care for
detainees. Such individuals might include behavioral-science specialists, such as FBI profilers; forensic psychiatrists,
who are often appointed by a court to evaluate the mental competency or sanity of an individual; prison psychologists,
who evaluate the potential danger of somebody to society; or public-health experts, who evaluate potential for disease
outbreaks.
Which still leaves us with nagging questions: Aren't forensic psychiatrists physicians? Aren't they, as well as
behavioral science specialists and prison psychologists, governed by the ethical rules of their professions?
Medical doctors take an oath to "do no harm." While psychologists and behavioral science specialists may not have to
take such an oath, they are nonetheless committed to doing good, not harm.
And what part of "do no harm" don't they understand? It doesn't require an oath to act ethically. And there is nothing
ethical about advising interrogators about how to "break" detainees.
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William Fisher has managed economic development programs in the Middle East and in many other parts of the world for
the US State Department and USAID for the past thirty years. He began his work life as a journalist for newspapers and
for The Associated Press in Florida. Go to The World According to Bill Fisher for more.