American Psychiatric Association clarifies its position on human rights

Editor—Justo underscores the key principles on which the American Medical Association and the American Psychiatric Association (APA) have based their position statements on physicians' participation in the integration of detainees.¹ As immediate past president of the APA, I would like to elaborate on the rationale for the APA's position that would preclude psychiatrists from being part of the behavioural science consultation teams.

In the discussion and debate in American psychiatry that led to this position, some psychiatrists felt strongly that consulting with military or domestic law enforcement authorities was justifiable if interrogations were “non-coercive” and adhered to principles of disclosure and respect for persons. Furthermore, these psychiatrists thought it was our “patriotic duty” to participate in interrogations.

This point of view did not prevail. A large majority took the view that interrogations such as those taking place with the help of the behavioural science consultation teams in Guantanamo Bay, Cuba, are inherently coercive. In traditional forensic evaluations psychiatrists and other doctors always seek informed consent from a detainee before the beginning of an evaluation. If the detainee declines no further interaction takes place, but the nature of interrogations does not allow this refusal to participate. Interrogations, however, involve pressure to talk, psychological manipulation, and often induction of stress. This is true even in so called “non-coercive interrogations.”

Furthermore, interrogations are often deceptive in which the goal is to pressure or trick a detainee into revealing information that the detainee does not want disclosed. This is a legitimate task for law enforcement or the military, but not for doctors.

Finally, doctors' participation in interrogations will undermine detainees' trust in medical care, once it is known that doctors are part of the interrogation team detainees will justifiably suspect all doctors and their ability to treat detainees' medical needs.

The APA believes that participating in interrogations is inherently coercive and deceptive and undermines the trust in the doctor-patient relationship.