The comments and opinions in this post reflect only those of Renée LLanusa-Cestero, director of La Cesta Consultants, LLC, and do not necessarily represent the opinion of PRIM&R or its Board of Directors.

This is Part II of a two-part series. Read Part I here.

The Draft OMS [Office of Medical Services] Guidelines on Medical and Psychological Support to Detainee Interrogation, (the Guidelines), from Appendix F of the CIA Inspector General Special Review of Counterterrorism Detention and Interrogation Activities (IG Report) mention medical dimensions that need to be monitored to ensure the safety of the detainees, but redact the following paragraph[s] that presumably detail the role of physicians and psychologists in that task fundamental to the ethical conduct of human research (F:9).

Unlike trainees in other U.S. government programs subjected to a single waterboard application, the subject detainees did not volunteer nor were they engaged in an informed consent process. The IG Report cites the Office of Medical Services’ opinion that the waterboard training experience is so different from the subsequent CIA use as to make it almost irrelevant (¶43fn26).

The IG Report details the evolution of the international, multi-site Detention and Interrogation Program, over a two-year period, including distinct roles for interrogators, debriefers and analysts (¶15fn6 and ¶204). In interrogation sessions where the waterboard is applied, an unresponsive subject should be righted immediately and the interrogator should deliver a sub-xyphoid thrust to expel the water. It is the interrogator who is tasked with the application of first aid to an unresponsive subject detainee. Only if the interrogator’s intervention fails to restore normal breathing is aggressive medical intervention required, administered, presumably, by the physician observing and documenting the use of the waterboard. The physician’s primarily role in waterboard interrogation is observation and documentation for research purposes and medical intervention only in extremis.

Is the risk-to-benefit analysis socially beneficial? No.
The IG Report points to on-site medical oversight as evidence that all the enhanced interrogation techniques pose risk. It identified concerns about whether the risks of the use of the waterboard were justified by the results and whether it has been unnecessarily used in some instances (¶220). The IG Report documents, according to the Chief of Medical Services:

OMS was neither consulted nor involved in the initial analysis of the risk and benefits of enhanced interrogation techniques (EITs) . . . OMS contends that the reported sophistication of the preliminary EIT review was exaggerated, at least as it related to the waterboard, and that the power of this EIT was appreciably overstated . . . Consequently, according to OMS, there was no a priori reason to believe that applying the waterboard with the frequency and intensity with which it was used by the psychologist/interrogators was either efficacious or medically safe. (¶43fn26)

Moreover, the IG Report documents a number of Agency officers expressing concern that a human rights group might pursue them for their activities and that Agency would not stand behind them if this occurred (¶231).

Whether the authors were making a point, or due to proofreading oversight, ¶266 repeats, word-for-word, the warning raised in ¶19:

The Agency faces potentially serious long-term political and legal challenges as a result of the CTC Detention and Interrogation Program, particularly its use of EITs and the inability of the U.S. Government to decide what it will ultimately do with terrorists detained by the Agency.

The IG Report describes a systematic investigation designed to develop and contribute to generalizable knowledge in the use of the waterboard in subject detainee interrogation.

The idea that an agency of the federal government engaged in human research on torture is an appalling thing to contemplate. This post hoc exercise in research ethics setting aside the legal and moral issues has been dizzying and, as the Spanish say, like trying to block out the sun with your hand.