"If law be the bedrock of civil society, it can no more undergird torture than it could support slavery or genocide."
from the Introduction

The graphic photographs of U.S. military personnel grinning over abused Arab and Muslim prisoners shocked the world community. That the United States was systematically torturing inmates at prisons run by its military and civilian leaders divided the nation and brought deep shame to many. When Steven H. Miles, an expert in medical ethics and an advocate for human rights, learned of the neglect, mistreatment, and torture of prisoners at Abu Ghraib, Guantanamo Bay, and elsewhere, one of his first thoughts was: Where were the prison doctors while the abuses were taking place?

In Oath Betrayed, Miles explains the answer to this question. Not only were doctors, nurses, and medics silent while prisoners were abused; physicians and psychologists provided information that helped determine how much and what kind of mistreatment could be delivered to detainees during interrogation. Additionally, these harsh examinations were monitored by health professionals operating under the purview of the U.S. military.

Miles has based this book on meticulous research and a wealth of resources, including unprecedented eyewitness accounts from actual victims of prison abuse, and more than thirty-five thousand pages of documentation acquired through provisions of the Freedom of Information Act: army criminal investigations, FBI notes on debriefings of prisoners, autopsy reports, and prisoners' medical records. These documents tell a story markedly different from the official version of the truth, revealing involvement at every level of government, from Secretary of Defense Donald Rumsfeld to the Pentagon's senior health officials to prison health-care personnel.

Oath Betrayed is not a denunciation of American military policy or of war in general, but of a profound betrayal of traditions that have shaped the medical corps of the United States armed forces and of America's abdication of its leadership role in international human rights. This book is a vital document that will both open minds and reinvigorate Americans' understanding of why human rights matter, so that we can reaffirm and fortify the rules for international civil society.

"With Iran and North Korea looming as critical tests for the U.N. Security Council, with peacekeeping missions all over the news and with the failures of go-it-alone foreign policy so obvious, it's difficult to think of another moment in recent history when we've had greater need for a book that will explain the real value of the United Nations in the global system.

This, unfortunately, is... Washington Post Book Review (read the entire Washington Post review) not that book.

Perhaps what's most disappointing about 'The Parliament of Man' is that its author, the eminent Yale historian Paul Kennedy, has seized such historical moments before. Two decades ago, Kennedy warned Washington of the dangers of 'imperial overstretch' in 'The Rise and Fall of the Great Powers' (1987), a magisterial book that helped shape the U.S. foreign policy debate (and is now looking prescient again, given the costs of the Iraq War). In 1993, during a time of post-Cold War optimism, Kennedy delivered the grim news (in 'Preparing for the Twenty-First Century') that the world would face jarring new challenges over immigration, agricultural trade and the rich/poor divide, among other issues that have since moved to the forefront of the global agenda.

But this time, despite (or perhaps because of) his ambition to produce a definitive history of the United Nations, Kennedy lets the moment pass him by. Instead of a book that cuts through the alphabet soup of U.N. programs to focus on the world body's vital missions — it is, above all, the main forum for burden-sharing and conflict resolution by the planet's major powers — he has produced a book that is so bland and cautious that it reads as if it were written by a U.N. committee. This, in fact, may not be far from the truth. As he notes, 'The Parliament of Man' began as an 'independent working group' report requested by the distinguished former U.N. official Brian Urquhart, co-chaired by Kennedy and timed around the 50th anniversary of the signing of the U.N. Charter in 1945.

Kennedy starts out well, invoking the eerie foresight of Tennyson's 'Locksley Hall,' from which he takes his title. The poet, writing in 1837, seemed to anticipate the horrors and hopes of a century later, describing a future time in which nations launched 'airy navies' that 'rain'd a ghastly dew' upon the Earth, then saw the light by creating the 'Parliament of man, the Federation of the world' to bind the world 'in universal law.' Kennedy retraces the long, much-digressed-from road to international governance from Tennyson's time, beginning with the Congress of Vienna. He ably re-diagnoses the failures of Woodrow Wilson's beloved League of Nations, which led to the more realistically designed United Nations produced after World War II, and the chronic conundrum of how to launch robust missions to keep the peace (or enforce it) when U.N. member states won't pony up the troops and funds to let them succeed. Kennedy is also good at analyzing the deep problems blocking Security Council reform — which he passionately advocates — with the 'permanent five' veto-bearing powers (the World War II victors' club, consisting of the United States, Russia, China, Britain and France) thwarting even modest proposals to let more members, even temporarily, into their powerful group.

But then the book begins to wander as Kennedy takes us, painstakingly, through all the world body's myriad missions — many of them still wispy, unfulfilled dreams from the founding years. This misguided effort at giving equal time to nearly every major U.N. agency and program leads to some absurdities. Kennedy ends up devoting almost as much space to the postwar U.N. economic agenda, which quickly atrophied after it was taken over by the International Monetary Fund and the World Bank, as he does to peacekeeping and peace enforcement, issues as critical for the United Nations today as they were in 1945. And while he spends many pages trying to breathe life into the mummified ECOSOC (the U.N. Economic and Social Council), he ignores the International Atomic Energy Agency, a key player in the Iran and North Korea dramas and perhaps the single most important organization reporting to the United Nations today.

Kennedy's effort to draw attention to the little-known aspects of the U.N. system is commendable. The United Nations is a many-headed beast, and its numerous critics tend to behave like the proverbial blind man who grasps only part of the elephant, not comprehending the whole. But Kennedy never really gets his arms around the problem of describing the United Nations in totality either. For the most part, he seems to be giving us the view from the U.N. Secretariat, the executive branch of the world body — too often, it seems, from those 10 floors that U.S. Ambassador to the United Nations John R. Bolton once suggested should be demolished. For example, reflecting the longtime hopes of some U.N. officials, Kennedy calls for the creation of a U.N. intelligence service and standing army. He dismisses U.S. politicians' fears that such moves would violate national sovereignty as 'self-serving and obstructionist' or mere 'paranoia.' But Kennedy is describing a globalist fantasy here: In fact, no major nation is ever likely to grant such powers to the United Nations, period. The United Nations is a tool for member countries, not an independent body.

Kennedy spills a lot of ink parsing what the fine language of the U.N. Charter means about how the organization should run, even though the real answer was supplied long ago by a Soviet delegate, whom he quotes: 'We (the major powers) shall tell you.' By acting as a channel for the discontent of U.N. bureaucrats rather than viewing the United Nations as a world historian, Kennedy doesn't do nearly as much as he could have to dispel the misconception — so popular in Republican Washington — that the world body is a useless, hopelessly corrupt organization.

Kennedy also fails to capture the human side of the U.N. story, the many tales of high drama and personal courage out in the field. For example, Defense Secretary Donald Rumsfeld sometimes touts Afghanistan's successful formation of a post-Taliban government as an example of self-reliance. In fact, U.N. agencies played a critical role, almost single-handedly organizing the loya jirga assembly that set Afghanistan on the course to democracy. (Indeed, U.N. officials told me that the transport of 1,500 loya jirga delegates involved the largest airlift in the organization's history.) There are many such stories that could help restore luster to the world body. Telling them — reminding people how valuable the United Nations really is — may well be the best way to promote the reforms that Kennedy so avidly supports.

Michael Hirsh is a senior editor at Newsweek and the author of 'At War With Ourselves: Why America Is Squandering Its Chance to Build a Better World.'" Reviewed by Michael Hirsh, Washington Post Book World (Copyright 2006 Washington Post Book World Service/Washington Post Writers Group)
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"Vulnerable in body and mind, we look to our physicians for compassion — which makes torture that's abetted by the medical profession especially horrific. Jacobo Timerman, a victim of Argentina's 'dirty war,' wrote of the special pain of seeing a doctor present in the interrogation room, of the sense of abandonment that lay in knowing that a person of science 'is with you when you are tortured by... Washington Post Book Review (read the entire Washington Post review) the beasts.'

In the wake of the unspeakable acts of Nazi doctors during the Holocaust, modern governments adopted a series of international conventions that declared doctors' participation in torture to be unethical. Professional associations followed. A 1999 ruling of the American Medical Association's judicial council is typical; it prohibits U.S. physicians from 'providing or withholding any services, substances, or knowledge to facilitate the practice of torture' and obliges doctors to support victims and to 'strive to change situations in which torture is practiced.'

But the link between healing and torture is hard to sever. In the Renaissance, special 'torture doctors' helped inquisitors choose their interrogation methods. In August 2004, Steven H. Miles, a bioethicist and professor of medicine at the University of Minnesota, reported in the British medical journal the Lancet that the United States had, in effect, returned to the era of the torture doctor. In Iraq and Afghanistan and at Guantanamo Bay, Cuba, Miles wrote, 'The medical system collaborated with designing and implementing psychologically and physically coercive interrogations.' Miles' charges were detailed: Death certificates had been falsified, he wrote, and military health personnel had reported incidences of torture belatedly, if at all.

'Oath Betrayed' is Miles' expansion of his Lancet article. It is rich in examples. Miles describes the work of the Behavioral Science Consultation Teams (known as BSCTs, or 'biscuits') active in Iraq and Guantanamo: groups of psychiatrists and psychologists who used detainees' medical charts and test data to devise 'physically and psychologically coercive interrogation plans' designed to break their resistance. In at least one camp in Iraq, all harsh interrogations reportedly were first approved by the medical team.

Expanding on his 2004 charge that medical personnel were rigging death certificates, Miles writes of an Afghan prisoner named Dilawar, an innocent 22-year-old who drove his taxi to 'the wrong place at the wrong time.' At the U.S. airfield detention center in Bagram, Afghanistan, in December 2002, Miles reports, Dilawar was suffocated with a sandbag and then shackled, suspended by his arms and beaten until his legs were (in the words of the coroner) 'pulpified.' He was then chained to the ceiling of his cell, where he died. Although a Dec. 13 autopsy called Dilawar's death a homicide, Miles writes, Gen. Daniel McNeil told reporters in February that Dilawar had died of natural causes on the grounds that one of his coronary arteries was partly occluded. The words 'coronary artery disease' were typed in a different font on the prisoner's death certificate.

Cases like this lay bare the absurdity of the position in which doctors at facilities such as Bagram and Guantanamo are placed. For interrogations in which leg pulpifying is planned, should the screening physical include a cardiac stress test?

Many of the documents that Miles cites are available online, so readers can judge his allegations for themselves. My impression is that while Miles' overall conclusions regarding unethical behavior by physicians are probably justified, the evidence he cites for medical complicity in specific instances of torture sometimes falls short of definitive proof. But his accumulation of disturbing reports effectively buttresses his larger charge that — at Abu Ghraib, Guantanamo and elsewhere — post-9/11 America has become 'a torturing society.'

The debate over the ethics of torture often contrasts idealism with pragmatism. Opponents of torture tend to follow the Harvard scholar Elaine Scarry, who characterized the practice as 'close to being an absolute of immorality,' an 'undoing of civilization' whose connection to the proclaimed aim of obtaining information is rarely to be taken at face value. Those who argue that torture may sometimes be permissible — Miles uses the psychiatrist and Washington Post columnist Charles Krauthammer as his prime example — usually begin with the 'ticking bomb' scenario, in which torturing a detainee might produce the intelligence to prevent mass murder. Krauthammer quips, 'Once you've established the principle' that torture must sometimes be used to elicit information that saves innocent lives, then 'to paraphrase George Bernard Shaw, all that's left to haggle about is the price.' The hope, Krauthammer continues, is that the 'level of inhumanity of the measures used ... would be proportional to the need and value of the information.'

Miles' book lends strong support to the absolutist foes of torture, on humane and practical grounds alike. His numerous examples of heedless cruelty make the case that authorizing torture creates a subculture that knows nothing of proportionality; if torture is permitted in the rare crisis, it will be put to use routinely. He also argues convincingly that confessions elicited under torture are of dubious reliability. In July 2004, the British ambassador to Uzbekistan protested the Uzbek intelligence service's interrogation practices: 'Tortured dupes are forced to sign up to confessions showing what the Uzbek government wants the U.S. and UK to believe. ... This material is useless — we are selling our souls for dross.'

Though medical complicity is a deeply troubling element in the torture enterprise, it is hardly a decisive one. In May, the American Psychiatric Association strengthened its opposition to doctors' 'asking or suggesting questions, or advising authorities on the use of specific techniques of interrogation with particular detainees.' The Pentagon countered by announcing that it would continue its program but try to use psychologists only.

Ending our status as 'a torturing society' requires change at a higher political level — for instance, the Bush administration's recent acknowledgment that the Geneva Conventions' ban on 'humiliating and degrading treatment' applies to all terrorism suspects in U.S. custody, including alleged al-Qaeda operatives. But who is to say that such movement does not occasionally begin with moral suasion — as a result of the sort of witness Miles offers here?

Peter D. Kramer is the author, most recently, of 'Against Depression.' His brief biography of Sigmund Freud will be published in November." Reviewed by Peter D. Kramer, Washington Post Book World (Copyright 2006 Washington Post Book World Service/Washington Post Writers Group)
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"This, quite simply, is the most devastating and detailed investigation into a question that has remained a no-no in the current debate on American torture in George Bush's war on terror: the role of military physicians, nurses, and other medical personnel. Dr. Miles writes in a white rage, with great justification — but he lets the facts tell the story." Seymour M. Hersh, author of Chain of Command

"Steven Miles has written exactly the book we require on medical complicity in torture. His admirable combination of scholarship and moral passion does great service to the medical profession and to our country." Robert Jay Lifton, M.D., author of The Nazi Doctors: Medical Killing and the Psychology of Genocide, and co-editor of Crimes of War: Iraq

Steven H. Miles, M.D., is an expert in medical ethics, human rights, and international health care. A professor of medicine at the University of Minnesota Medical School and a faculty member of its Center for Bioethics, Miles is also a practicing physician. He has served as the chief medical officer for a Cambodian refugee camp and worked on AIDS prevention in Sudan and on tsunami relief in Indonesia with the American Refugee Committee. He has also worked with the research committee of the Center for Victims of Torture. The recipient of the Distinguished Service Award of the American Society of Bioethics and Humanities, Miles is widely published on a wide range of health- and health-care-related topics. He lives in Minneapolis.