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Physicians for Human Rights Experiments in Torture Cia Interrogation Program 2010

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EXPeRIMeNTS
IN TORTURe:

Evidence of Human Subject
Research and Experimentation
in the “Enhanced” Interrogation Program
A White Paper by
Physicians for Human Rights
June 2010

Authors &
Acknowledgements
The lead author for this report is Nathaniel Raymond,
Director of the Campaign Against Torture/Campaign for
Accountability at Physicians for Human Rights (PHR). The
lead medical author is Scott Allen, MD, Co-Director of the
Center for Prisoner Health and Human Rights at Brown
University and Medical Advisor to PHR. They were joined
in writing the report by Vincent Iacopino, MD, PhD, PHR
Senior Medical Advisor; Allen Keller, MD, Bellevue/NYU
Program for Survivors of Torture; Stephen Soldz, PhD,
President-elect of Psychologists for Social Responsibility
and Director of the Center for Research, Evaluation and
Program Development at the Boston Graduate School of
Psychoanalysis; Steven Reisner, PhD, PHR Advisor on
Ethics and Psychology; and John Bradshaw, JD, PHR Chief
Policy Officer and Director of PHR’s Washington DC Office.
This report has benefited from review by Deborah
Ascheim, MD, Associate Professor of Health Policy and
Medicine, Mount Sinai School of Medicine, and PHR board
member; Frank Davidoff, MD, Editor Emeritus of Annals of
Internal Medicine and vice-chair of the PHR board of directors; Robert S. Lawrence, MD, Professor in Environmental
Health Sciences, Johns Hopkins Bloomberg School of Public
Health, and chair of the PHR board of directors; Robert Jay
Lifton, MD, Lecturer in Psychiatry at Harvard Medical
School/Cambridge Health Alliance, and Distinguished
Professor Emeritus of Psychiatry and Psychology, The City
University of New York; Renée Llanusa-Cestero, MA,
CIP, La-Cesta Consultants LLC; Deborah Popowski,
JD, Skirball Fellow, Harvard Law School Human Rights
Program; and Leonard S. Rubenstein, JD, Visiting Scholar,
Johns Hopkins Bloomberg School of Public Health.
Kathleen Sullivan, JD, Chief Program Officer of
Custody Programs at PHR, oversaw the report and provided
guidance on the report’s structure and content. A. Frank
Donaghue, MA, MS, PHR Chief Executive Officer, and
Susannah Sirkin, ME, PHR Deputy Director, reviewed and
edited the report. Benjamin Greenberg, PHR Director of
Online Communications, and Sarah Kalloch, Outreach and
Constituency Organizing Director, provided critical support
to the launch of the report.
Isaac Baker, Assistant to the PHR Campaign Against
Torture/Campaign for Accountability, provided background
research and assisted in writing, editing and formatting the
report. Katrina Welt and Andrew Angely, PHR interns and
students at Northeastern University School of Law, provided legal background research for the report. Kevin Vickers,
Harvard Law School, and Klara Bolen, LLD, also contributed to legal review of the report.

This report was reviewed and edited by Stephen Greene,
Communications Consultant to PHR. It was prepared for
publication by Gurukarm Khalsa, PHR Web Editor/
Producer. Jared Voss, PHR Web Editor/Producer, produced
the video associated with the report.
PHR is deeply indebted to critical research performed
by Daniel Scarvalone, Louise Place, and Jesse Hamlin.
This report could not have been written without their
contributions.

Physicians for
Human Rights
PHR was founded in 1986 on the idea that health professionals, with their specialized skills, ethical commitments,
and credible voices, are uniquely positioned to investigate
the health consequences of human rights violations and
work to stop them.
Since 2005, PHR has documented the systematic use of
psychological and physical torture by US personnel against
detainees held at Guantánamo Bay, Abu Ghraib, Bagram
airbase, and elsewhere in its groundbreaking reports Break
Them Down; Leave No Marks; Broken Laws, Broken Lives;
and Aiding Torture.
PHR is a non-profit, non-sectarian organization funded
through private foundations and by individual donors.
Membership is open to all, not only health professionals.
PHR shared the 1997 Nobel Peace Prize.
2 Arrow Street, Suite 301
Cambridge, MA 02138 USA
Tel: +1.617.301.4200
Fax: +1.617.301.4250
http://physiciansforhumanrights.org
http://phrtorturepapers.org
Washington DC Office:
1156 15th St. NW, Suite 1001
Washington, DC 20005 USA
Tel: +1.202.728.5335
Fax: +1.202.728.3053
© 2010, Physicians for Human Rights

Cover Photo:
	

Chris Hondros/Getty Images

Table of Contents
Executive Summary -

 -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 3

Methods and Limitations -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 4
Recommendations  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 4

Background on Illegal and Unethical Research and Experimentation -  -

 -  -  -  -  -  -  -  -  -  -  - 5

US Laws and Regulations Governing Human Subject Research and Experimentation  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 5
The Bush Administration Violated Human Subject Protections after Sept. 11, 2001  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 6
Three Instances of Human Subject Research and Experimentation  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 7

Evidence of Research and Experimentation -  -

 -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 7

Health Professionals Develop New Methods and Procedures for Waterboarding -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 7
The Use of Saline as Part of Waterboarding -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 8
“Waterboarding 2.0” -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 8
Researching the “Susceptibility” of Detainees to Severe Pain -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 9
Researching the Effects of Sleep Deprivation on Detainees -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 10

Apparent Purposes for Human Research and
Experimentation on Detainees -  -  -  -  -  -  -  -  -  -  -

 -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 10

Limited Practical Scientific Knowledge on How to Deploy EITs -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 10
Calibrating Levels of Pain and Suffering in Accordance with the OLC Memos -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 10
Human Experimentation to Provide a Basis for a “Good Faith”
Legal Defense Against Charges of Torture -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 11
Operational Implementation of OLC Guidance by the CIA -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 11
The Bradbury “Combined Techniques” Memo Relied on Research Data from Detainees -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 12

Human Experimentation and Human Subject Protections  -  -

 -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 13

The Nuremberg Code -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 13
The National Commission  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 13
The Common Rule -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 13
Legal and Ethical Standards Violated Following Sept. 11, 2001  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 14

14
Contravention of the Nuremberg Code -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 14
Disregarding and Amending the US War Crimes Act  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 14
Violation of the Geneva Conventions -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -

Conclusions and Recommendations  -

 -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 15

Recommendations  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 16

continued

Evidence of Human Subject Research and Experimentation in the “Enhanced” Interrogation Program

1

Glossary of Abbreviations and Terms
Appendix 1 -  -

 -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 17

 -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 18

The Nature of Experimentation: Health Professional Monitoring
of the “Enhanced” Interrogation Program -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 18
The SERE Studies: A Summary of Research Findings on the
Effects of “Enhanced” Interrogation Techniques on Voluntary Soldier-Subjects -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 19
Detailed Summary of Military Survival Training (SERE) Studies and
What They Teach Us about the Effects of “Enhanced” Interrogation Techniques -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 20
Methodology of SERE Studies  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 21
Results -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 21
Neuroendocrine changes  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 21
Cortisol  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 22
Norepinephrine and Epinephrine (Noradrenaline and Adrenaline) -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 22
Neuropeptide-Y (NPY)  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 22
Testosterone  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 22
Thyroid Function  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 23
Psychological Assessment -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 23
Factors affecting level of psychological stress: unavoidable stress  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 23
Variability between subjects -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 24
Limitations of the Studies  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 24
Later SERE Studies -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 24
The SERE Studies in the Context of Alleged Human Experimentation
in the US Torture Program  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 24

Appendix 2 -  -

 -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 25

Health Professional Ethics on Detainee Research and Interrogation -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 25
American Medical Association -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 25
American Psychiatric Association  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 26
American Psychological Association  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 26
United Nations -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 26
World Medical Association -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  - 26

2	

Experiments in Torture

Executive Summary
Following the Sept. 11, 2001, attacks, the Bush administration initiated new human intelligence collection programs. To that end, it detained and questioned an unknown
number of people suspected of having links to terrorist organizations. As part of these programs, the Bush administration redefined acts, such as waterboarding, forced nudity,
sleep deprivation, temperature extremes, stress positions and
prolonged isolation, that had previously been recognized as
illegal, to be “safe, legal and effective” “enhanced” interrogation techniques (EITs).
Bush administration lawyers at the Department of
Justice’s (DoJ’s) Office of Legal Counsel (OLC) accomplished this redefinition by establishing legal thresholds for
torture, which required medical monitoring of every application of “enhanced” interrogation. Medical personnel were
ostensibly responsible for ensuring that the legal threshold
for “severe physical and mental pain” was not crossed by
interrogators, but their presence and complicity in intentionally harmful interrogation practices were not only apparently intended to enable the routine practice of torture, but
also to serve as a potential legal defense against criminal
liability for torture.
Investigation and analysis of US government documents
by Physicians for Human Rights (PHR) provides evidence indicating that the Bush administration, in the period after Sept.
11, conducted human research and experimentation on prisoners in US custody as part of this monitoring role. Health
professionals working for and on behalf of the CIA monitored
the interrogations of detainees, collected and analyzed the
results of those interrogations, and sought to derive generalizable inferences to be applied to subsequent interrogations.
Such acts may be seen as the conduct of research and experimentation by health professionals on prisoners, which could
violate accepted standards of medical ethics, as well as domestic and international law. These practices could, in some
cases, constitute war crimes and crimes against humanity.
The knowledge obtained through this process appears to
have been motivated by a need to justify and to shape future
interrogation policy and procedure, as well as to justify and
to shape the legal environment in which the interrogation
program operated.
PHR analyzes three instances of apparent illegal and unethical human subject research for this report:
1.	Medical personnel were required to monitor all
waterboarding practices and collect detailed medical
information that was used to design, develop, and
deploy subsequent waterboarding procedures;
2.	Information on the effects of simultaneous versus
sequential application of the interrogation techniques
on detainees was collected and used to establish the

policy for using tactics in combination. These data
were gathered through an assessment of the presumed
“susceptibility” of the subjects to severe pain;
3.	Information collected by health professionals on the
effects of sleep deprivation on detainees was used to
establish the “enhanced” interrogation program’s (EIP)
sleep deprivation policy.
The human subject research apparently served several
purposes. It increased information on the physical and psychological impact of the CIA’s application of the “enhanced”
interrogation techniques, which previously had been limited
mostly to data from experiments using US military volunteers under very limited, simulated conditions of torture. It
served to calibrate the level of pain experienced by detainees during interrogation, ostensibly to keep it from crossing the administration’s legal threshold of what it claimed
constituted torture. It also served as an attempt to provide
a basis for a legal defense against possible torture charges
against those who carried out the interrogations, since medical monitoring would demonstrate, according to the Office
of Legal Counsel memos, a lack of intent to cause harm to
the subjects of interrogations.
Yet the Bush administration’s legal framework to protect
CIA interrogators from violating US statutory and treaty
obligations prohibiting torture effectively contravened
well-established legal and ethical codes, that, had they been
enforced, should have protected prisoners against human
experimentation, and should have prevented the “enhanced”
interrogation program from being initiated in the first place.
There is no evidence that the Office of Legal Counsel ever
assessed the lawfulness of the medical monitoring of torture, as it did with the use of the “enhanced” techniques
themselves.
The use of torture and cruel and inhuman treatment in interrogations of detainees in US custody has been well-documented by Physicians for Human Rights (PHR) and others.
The role of health professionals in designing, monitoring
and participating in torture also has been investigated and
publicly documented. This current report provides evidence
that in addition to medical complicity in torture, health professionals participated in research and experimentation on
detainees in US custody.
The use of human beings as research subjects has a long
and disturbing history filled with misguided and often willfully unethical experimentation. Ethical codes and federal
regulations have been established to protect human subjects
from harm and include clear standards for informed consent
of participants in research, an absence of coercion, and a
requirement for rigorous scientific procedures. The essence
of the ethical and legal protections for human subjects is
that the subjects, especially vulnerable populations such as
prisoners, must be treated with the dignity befitting human
beings and not simply as experimental guinea pigs.  

Evidence of Human Subject Research and Experimentation in the “Enhanced” Interrogation Program

3

The use of health professionals to monitor intentionally
harmful interrogation techniques places them in the service of
national security objectives which are in conflict with the interests of those who they are monitoring. The result has been
a co-opting of health professionals by the national security apparatus and a violation of the highest medical admonition to
“do no harm.” Until the questions examined in this paper are
answered and, if ethical violations or crimes were committed,
those responsible are held accountable, the misuse of medical and scientific expertise for expedient and non-therapeutic
goals jeopardizes the ethical integrity of the profession, and
the public trust in the healing professions risks being seriously compromised. 

Methods and Limitations
This PHR report draws primarily upon US government
documents in the public record, including memoranda
from the Office of Legal Counsel and the CIA’s Office of
Inspector General Special Review of the CIA Enhanced
Interrogation Program.
Most of these documents are heavily redacted and many
additional, relevant documents remain classified. While
the observational medical monitoring data are not publicly
available for the instances indicating human experimentation cited by PHR, and while the specific extent to which
medical personnel complied with requirements of the CIA’s
Office of Medical Services (OMS) monitoring requirements
is not known, there is clear evidence that medical personnel were required to monitor and document all EIT practices
and that generalizable knowledge derived therefrom subsequently was used to refine harmful EIT practices.
While this report provides evidence that data from human research were compiled, apparently analyzed, and used
to affect subsequent interrogations and to set policy, a comprehensive federal investigation is required to answer the
questions this evidence raises.

Recommendations
Physicians for Human Rights calls on the White House
and Congress to investigate thoroughly the full scope of the
possible human experimentation designed and implemented
in the post-Sept. 11 period. The War Crimes Act must be
amended to restore traditional human subject protections.
Those who authorized, designed, implemented and supervised these alleged practices of human experimentation
— whether health professionals, uniformed personnel, or civilian national security officials — must be held to account
for their actions if they are found to have violated what international tribunals previously have held to constitute war
crimes and crimes against humanity.
If any victims of research and experimentation perpetrated
by the United States are found, they must be offered compensation, including health care services, to address ongoing health
effects related to the experimentation, and a formal apology.
4	

Experiments in Torture

Based on the findings of this investigation, the United
States should take the following actions:
1.	President Obama must order the attorney general to
undertake an immediate criminal investigation of alleged
illegal human experimentation and research on detainees
conducted by the CIA and other government agencies
following the attacks on Sept. 11, 2001.
2.	 The secretary of the Department of Health and Human
Services must instruct the Office for Human Research
Protections (OHRP) to begin an investigation of alleged
violations of the Common Rule by the CIA and other government agencies as part of the “enhanced” interrogation
program.
3.	 Congress must amend the War Crimes Act to eliminate
changes made to the Act in 2006 which weaken the
prohibition on biological experimentation on detainees,
and ensure that the War Crimes Act definition of the grave
breach of biological experimentation is consistent with the
definition of that crime under the Geneva Conventions.
4.	Congress should convene a joint select committee comprising members of the House and Senate committees responsible for oversight on intelligence, military, judiciary
and health and human services matters to conduct a full
investigation of alleged human research and experimentation activities on detainees in US custody.
5.	President Obama should issue an executive order
immediately suspending any federally funded human
subject research currently occurring in secret — regardless
of whether or not it involves detainees.
6.	The Department of Justice’s Office of Professional
Responsibility should commence an investigation into
alleged professional misconduct by OLC lawyers related
to violations of domestic and international law and
regulations governing prohibitions on human subject
experimentation and research on detainees.
7.	 President Obama should appoint a presidential task force
to restore the integrity of the US regime of protections for
human research subjects. This task force, comprising current and former officials from the Department of Health and
Human Services, the Food and Drug Administration, the
National Institutes of Health, the human rights community,
and leading health professional associations, should review
current human subject protections for detainees, and recommend changes to ensure that the human rights of those in US
custody are upheld.
8.	States should adopt policies specifically prohibiting participation in torture and improper treatment of prisoners by
health care professionals. Such participation is considered
professional misconduct and is grounds for loss of professional licensure. Proposed legislation in New York State
provides a model for such policy.
9.	The United Nations special rapporteur on torture should
undertake an investigation of allegations that the United
States engaged in gross violations of international human
rights law by engaging in human subject research and
experimentation on detainees in its custody.

Background on Illegal
and Unethical Research
and Experimentation
Bush administration lawyers at the Department of
Justice’s (DoJ’s) Office of Legal Counsel (OLC) utilized
the collection and application of medical information from
detainees for the purpose of drawing conclusions about the
potential harm inflicted from the acts committed during “enhanced” interrogation, in an attempt to redefine acts previously recognized as torture to be “safe, legal and effective”
interrogation techniques.
The OLC lawyers accomplished this by establishing
legal thresholds for “severe physical and mental pain” for
torture that could only be assessed by meticulous medical
monitoring of individual enhanced interrogation techniques.
Whether the OLC lawyers or the health professionals involved realized that the federally-funded systematic collection and recording of those observations for such purposes
constitutes human experimentation may be important in assessing intent, but has no bearing on whether or not it can
constitute a crime. It is important to understand that the
evidence of human experimentation presented in this report
was part of an interrogation program that authorized torture
and required the complicity of health professionals in the
intentional infliction of harm.

US Laws and Regulations Governing
Human Subject Research and
Experimentation
Human subject experimentation and research have
specific meanings in US law. Federal regulations define
research as follows:
Research means a systematic investigation, including
research development, testing and evaluation, designed
to develop or contribute to generalizable knowledge.
Activities which meet this definition constitute research
for purposes of this policy, whether or not they are conducted or supported under a program which is considered research for other purposes.1
Human subject research is defined under federal regulations as follows:
Human subject means a living individual about whom
an investigator (whether professional or student) conducting research obtains
1.	data through intervention or interaction with the 	
individual, or
2.	identifiable private information.2
1.	 45 Code of Federal Regulations (C.F.R.) § 46.102(d) (2005)
2.	 Ibid

Human research, therefore, involves the systematic collection of data for the purpose of drawing generalizable inferences. Activities that constitute human subject research
and experimentation do not require a particular research
study design, the testing of hypotheses, or the use of control
groups. Many types of legitimate human subject research3
constitute human experimentation, including observational
studies, such as the SERE4 (Survival, Evasion, Resistance,
and Escape) studies, which evaluated the effects of various
interrogation techniques on US soldier-subjects, and for
which human subject protections applied and informed consent was required and obtained. The systematic collection of
personalized information from any human subjects, whether
patients, volunteers, soldier-subjects, prisoners, or any other
group, for purposes other than their direct benefit requires
human subject protections, such as informed consent, and
prospective review of and approval by an institutional review board (IRB), regardless of the information-gathering
methods used or the stated purpose of the inquiry.
In general, federally funded experimentation involving
human subjects can occur only with the prior informed consent of the study subjects. Human experimentation without
the consent of the subject is a violation of international human rights law to which the United States is subject; federal
statutes; the Common Rule, which comprises the federal
regulations for research on human subjects and applies to
17 federal agencies, including the Central Intelligence
Agency (CIA) and the Department of Defense (DoD); and
universally accepted health professional ethics, including
the Nuremberg Code.5 Human experimentation on detainees
also can constitute a war crime6 and a crime against humanity7 in certain circumstances.
In US medical and other scientific settings, federally
funded research regimes involving human subjects are subjected to a rigorous pre-approval process by the research
institution’s IRB or similar mechanism. In both civilian and
government settings, the institutional review board prospectively reviews the purposes, methods, and goals of the project, the benefits expected to result, the potential harm to volunteer subjects, the investigators’ efforts to minimize these
harms, and specific details about how informed consent of
3.	 Legitimate human subject research conducted by health professionals,
academic researchers, and other scientists can include studying the
effectiveness of specific medical treatments on patients, collecting data to
better understand a sociological problem, or assessing the susceptibility of
certain demographic groups to disease, etc.
4.	 US military and intelligence services participate in Survival, Evasion,
Resistance, Escape (SERE) training to prepare their personnel to withstand
torture and abuse if captured by a hostile force that does not observe the
Geneva Conventions’ standards for POW treatment.
5.	 45 C.F.R. §§ 46.101-46.124 (2005).
6.	 Nuremberg Code, reprinted in Trials of War Criminals before the
Nuremberg Military Tribunals Under Control Council Law No. 10. Vol. 2.
Washington: GPO, 1949: 181-82. 15 vols. 1946-49.
7.	 Rome Statute of the International Criminal Court. Part 2: Jurisdiction,
Admissibility and Applicable Law, Article 7: Crimes Against Humanity
(1998-2002). Web. 01 Jun. 2010. <http://untreaty.un.org/cod/icc/statute/
romefra.htm>.

Evidence of Human Subject Research and Experimentation in the “Enhanced” Interrogation Program

5

the volunteer subjects will be obtained. Any US health professional who has participated in research involving humans
is required to be fully familiar with such approval mechanisms, which credible institutions undertake with the utmost
rigor and seriousness in promoting the ethical conduct of
human research, in compliance with the Nuremberg Code
and other international and US research standards.
The essence of the extensive ethical and legal protections
for human subjects is that the subjects, especially vulnerable
populations such as prisoners, must be treated with the dignity befitting human beings and not simply as experimental
guinea pigs. The Nuremberg Code and other guidances also
call on the medical professional to treat persons with their
best interests in mind and to minimize pain or other risks
and harms in the service of a research goal. Doctors are required to use treatments that are expected to be effective and
not to engage in speculative medicine at the expense of a
human research subject. 
By contrast, no official, explicit review and authorization by an institutional review board for research on detainees who were designated as enemy combatants during the
period in question exists in the public record, to fulfill the
requirements of the Common Rule.8 No publicly-available
evidence indicates that the Bush administration ever sought
or received such formal authorization for the “enhanced” intelligence research program. There is also no evidence that
the CIA or DoD ever filed a waiver for informed consent
covering this research with the Department of Health and
Human Services (HHS), as required by federal regulations.9
No evidence has yet been made public of a formal
protocol for research by the CIA’s Office of Medical Services
(OMS) on detainees in US custody. However, several
examples within the DoJ memos and other government
documents reveal the implementation of a program of
medical monitoring that involved many core elements
of a research regime,10 namely, the meticulous collection
and analysis of data to derive generalizable knowledge (in
this case, knowledge relating to the “safety” and effects
of torture techniques). As Llanusa-Cestero documented in
Accountability in Research, the core elements, goals, roles,
and rationales of a research plan are present in declassified
documents related to the “enhanced” intelligence program

8.	 Llanusa-Cestero, Renée. “Unethical Research and the C.I.A. Inspector
General Report of 2004: Observations Implicit in Terms of the Common
Rule.” Accountability in Research 17.2 (2010): 99. Print.
9.	 45 C.F.R. § 46.117(c) (2005).
10.	 See generally Memorandum from Steven G. Bradbury, Principal
Deputy Assistant Attorney General, for John A. Rizzo, Senior Deputy
General Counsel, Central Intelligence Agency (10 May 2005). Web. 11
Mar. 2010 <http://i.cdn.turner.com/cnn/2009/images/05/22/bradbury3.
pdf>; see also generally Memorandum from Steven G. Bradbury, Principal
Deputy Assistant Attorney General, for John A. Rizzo, Senior Deputy
General Counsel, Central Intelligence Agency (10 May 2005). Web. 11
Mar. 2010 <http://luxmedia.vo.llnwd.net/o10/clients/aclu/olc_05102005_
bradbury46pg.pdf>.
6	

Experiments in Torture

(EIP), despite there being no public evidence of IRB
approval or a formalized research plan.11
Both before and after Sept. 11, 2001, experimentation for
non-clinical purposes on detainees by US military and intelligence services—either with or without their consent—
would not have been permissible under widely accepted and
understood interpretations of US and international law and
medical ethics. Such experimentation violates accepted US
legal interpretations, as well as all governing codes of conduct for any health professionals involved.
Also, the “science” on which the authorization of the EIP
was based is flawed by any reasonable standard because it
served as a means of justifying a predetermined legal end
of aiding in the authorization of torture.12 Even the claim
of systematic medical monitoring in the name of making
“enhanced” intelligence techniques (EITs) “safe, legal, and
effective” is contradicted by official monitoring policy,
which failed to adequately take into account the mental
harm caused by the tactics, among other factors.13 In fact,
the “enhanced” interrogation techniques are premised on the
infliction of mental harm, so the concept of studying them
to make them more effective is ethically impermissible, and
studying them to make them “safer” is logically untenable
— as the techniques are unsafe by design.

The Bush Administration Violated
Human Subject Protections after
Sept. 11, 2001
Physicians for Human Rights (PHR) has identified
evidence that in the months and years following the Sept.
11, 2001 attacks, the Bush administration violated essential
standards that prohibited human experimentation on
detainees. The experimentation that ensued by evading these
legal and ethical standards was then in turn apparently used
by the Office of Legal Counsel as a basis for concluding that
the EIP did not constitute torture and that those who carried
out the program would not be subject to prosecution.
No publicly available “blueprint” has come to light regarding the implementation of detainee experimentation as
a component of the EIP during the Bush years. PHR’s assessment of this program therefore relies upon facts from
the public record that require further inquiry by Congress
11.	 See generally Llanusa-Cestero, Renée. “Unethical Research and the
C.I.A. Inspector General Report of 2004: Observations Implicit in Terms of
the Common Rule.” Accountability in Research 17.2 (2010): 96-113. Print.
12.	 The body of this report analyzes declassified Bush-era documents from
Department of Justice’s Office of Legal Counsel, the CIA’s Office of Inspector
General, the Department of Justice’s Office of Professional Responsibility,
and related documents demonstrating evidence of illegal and unethical human
subject research and experimentation. Appendix 1 reviews the medical
literature generated by IRB-approved studies of the US government’s military
survival training program performed prior to Sept. 11, 2001.
13.	 Central Intelligence Agency, Office of Inspector
General. Counterterrorism Detention and Interrogations, Special Review.
Central Intelligence Agency (2004): Appendix F, 10. Web. 11 Mar. 2010.
<http://www.gwu.edu/~nsarchiv/torture_archive/20040507.pdf>.

and government investigators who have full access to information currently unavailable to the public. Declassified
public documents do not demonstrate that the experimental
regime employed on detainees came complete with stated
hypotheses, methodology, results, and conclusions — the
fundamental elements of all legitimate scientific investigation. The declassified public documents do, however, provide evidence of human experimentation that is consistent
with legal definitions of human subject research and experimentation cited above, namely, the systematic collection of
data and/or identifiable personal information for the purpose
of drawing generalizable inferences.
The subject of interrogation and research is not simply
relevant to the issue of accountability for alleged crimes
committed in the recent past by the Bush administration.
It also pertains to ongoing activities by the US intelligence
community. In testimony before the House Intelligence
Committee in February 2010, President Obama’s director of
national intelligence, Admiral Dennis Blair (USN-Ret.), disclosed that the United States has established an elite interrogation unit that will conduct “scientific research” to find
better ways to question suspected terrorists.
While stating that the unit’s responsibility is to do “the
scientific research to determine if there are better ways to
get information from people that are consistent with our
values,” the director declined to provide details about this
research effort, including whether or not it would involve
human subjects, and, in particular, subjects in vulnerable
populations. A spokesman for the director stressed that the
program would follow US law.14 Given recent history, this
program must be subject to rigorous oversight to avoid potential violations of human subject research protections.

Three Instances of Human Subject
Research and Experimentation
The available evidence of human experimentation comes
from declassified government documents which detail a
policy of systematic medical monitoring of the “enhanced”
interrogation techniques by health professionals, and describes the use of the medical information so collected to
produce generalizable knowledge that could inform specific
EIT practices and to justify the EI program.

lection was required by OMS monitoring guidelines,15 and a
Justice Department memo draws legal conclusions about the
permissibility of the techniques based on apparent scientific
analysis of the OMS data referenced in the memos.
1.	Medical personnel were required to monitor all
waterboarding practices and collect detailed medical
information that was used to design, develop, and
deploy subsequent waterboarding procedures;
2.	Information on the effects of simultaneous versus
sequential application of the abusive interrogation
techniques on detainees was collected and used to
establish the policy for using tactics in combination.
These data were gathered through an assessment of the
presumed “susceptibility” of the subjects to severe pain;
3.	Information collected by health professionals on the
effects of sleep deprivation on detainees was used to
establish EIP sleep deprivation policy.

Evidence of Research
and Experimentation
Health Professionals Develop
New Methods and Procedures for
Waterboarding
In the instance of waterboarding, the evidence of human
experimentation consists of highly specific OMS guidelines
for the systematic collection and documentation of medical
data and subsequent refinement of waterboarding practices
which apparently made use of such required medical monitoring and documentation (i.e. the use of potable saline and a
specialized gurney). Although actual waterboarding medical
observations/data are not publicly available, and the extent
to which medical personnel complied with OMS monitoring
guidelines is not known, it is clear that the OMS policy of
compulsory monitoring was followed by a series of revised
waterboarding practices.

Three instances that provide evidence of illegal and unethical human subject research and experimentation are analyzed by Physicians for Human Rights in this report. Actual
observational medical monitoring data are not publicly
available in the instances cited below. However, data col-

It is important to note that the involvement of medical
personnel in waterboarding could represent evidence of human experimentation. Such medical involvement illustrates
the danger and harm inherent in the practice of waterboarding and the enlistment of medical personnel in an effort to
disguise a universally recognized torture tactic as a “safe,
legal and effective” interrogation tactic.

14.	 “US doing ‘scientific research’ to boost interrogations.” AFP. AFP,
3 Feb. 2010. Web. 12 Mar. 2010 <http://www.google.com/hostednews/
afp/article/ALeqM5jnITWjCSzrqYadyYwZ8e_p4C347Q>; Mann, Simon.
“Interrogators will do ‘research,’ not torture.” Sydney Morning Herald 5 Feb.
2010. 12 Mar. 2010 <http://www.smh.com.au/world/interrogators-will-doresearch-not-torture-20100204-nga9.html>.

15.	 Central Intelligence Agency, Office of Inspector
General. Counterterrorism Detention and Interrogations, Special Review.
Central Intelligence Agency (2004): Appendix F, 10. Web. 11 Mar. 2010.
<http://www.gwu.edu/~nsarchiv/torture_archive/20040507.pdf>.

Evidence of Human Subject Research and Experimentation in the “Enhanced” Interrogation Program

7

In this excerpt from the CIA guidelines for OMS health
professionals involved in the EIP, the health professionals
are explicitly directed to record:
…how long each application (and the entire procedure)
lasted, how much water was applied (realizing that much
splashes off), how exactly the water was applied, if a
seal was achieved, if the naso- or oropharynx was filled,
what sort of volume was expelled, how long was the
break between applications, and how the subject looked
between each treatment.16
The results of this monitoring were apparently used in
subsequent assessments of the procedure’s safety. Then
Principal Deputy Assistant Attorney General Steven G.
Bradbury to then Acting CIA General Counsel John A.
Rizzo states in his 2005 “combined techniques” memo that:
We understand that these limitations have been established with extensive input from OMS, based on experience to date with this technique and OMS’s professional
judgment that use of the waterboard on a healthy individual subject to these limitations would be ‘medically
acceptable.’17
Prior to the experimental use of large-volume waterboarding on detainees in US custody, little scientific information
was apparently available to OMS to develop parameters for
the application of this technique. The OMS guidelines state:
A rigid guide to the medically approved use of the
waterboard in essentially healthy individuals is not
possible, as safety will depend on how the water is applied and the specific response each time it is used. The
following general guidelines are based on very limited
knowledge, drawn from very few subjects whose experience and response was quite varied.18
OMS health professionals were directed by their superiors at CIA to collect information on, and apply their findings to the application of waterboarding. That knowledge
appears explicitly intended to be used to “best inform future
medical judgments,” or to develop generalizable knowledge about new procedures for applying the technique of
waterboarding.

The Use of Saline as Part of Waterboarding
According to the Bradbury memoranda (see page 12,
this paper), OMS teams, based on their observation of
detainee responses to waterboarding, replaced water in the
waterboarding procedure with saline solution ostensibly to
reduce the detainees’ risk of contracting pneumonia and/
16.	 Ibid.
17.	 Memorandum from Steven G. Bradbury, Principal Deputy Assistant
Attorney General, for John A. Rizzo, Senior Deputy General Counsel,
Central Intelligence Agency (10 May 2005): 14. Web. 11 Mar. 2010 <http://
luxmedia.vo.llnwd.net/o10/clients/aclu/olc_05102005_bradbury46pg.pdf>.
18.	 Central Intelligence Agency, Office of Inspector General. 
Counterterrorism Detention and Interrogations, Special Review. Central
Intelligence Agency (2004): Appendix F, 9. Web. 11 Mar. 2010. <http://
www.gwu.edu/~nsarchiv/torture_archive/20040507.pdf>.
8	

Experiments in Torture

or hyponatremia, a condition of low sodium levels in the
blood caused by free water intoxication, which can lead to
brain edema and herniation, coma, and death.19 Bradbury
stated that, “based on advice of medical personnel, the CIA
requires that saline solution be used instead of plain water
to reduce the possibility of hyponatremia (i.e., reduced
concentration of sodium in the blood) if the detainee drinks
the water.”20
Prior to the procedures for waterboarding described in
these memoranda, the experience with waterboarding was
limited to resricted applications of waterboarding in SERE
training. The use of saline in the CIA’s application of waterboarding, as a response to potential medical conditions
induced by uncontrolled ingestion of large volumes of
water, contrasts with the application of the waterboarding
technique in SERE training. Pouring saline into the detainee
instead of water would be medically necessary only if the
tactic were being used repeatedly on a subject, which was
not done to participants in the SERE project. In the case of
one CIA detainee, Khalid Sheik Mohammed, the technique
was used at least 183 times.21 Under the SERE program’s
guidelines (established under an IRB regime and implemented with the informed consent of the military trainees
who participated in it), the waterboard technique employed
water, not saline, and was used on trainees only once:
WATERBOARD: Subject is interrogated while strapped
to a wooden board, approximately 4’x7’. Often the subject’s feet are elevated after being strapped down and having their torso stripped. Up to 1.5 gallons of water is slowly poured directly onto the subject’s face from a height of
12-24 inches. In some cases, a wet cloth is placed over the
subject’s face. It will remain in place for a short period of
time. Trained supervisory and medial [sic] staff monitors
the subject’s physical condition… However, no student
will have water applied a second time.22

“Waterboarding 2.0”
Changes to the waterboarding technique described above
resulted in a set of procedures and protocols that differs
markedly from those used in the SERE training program.
The differences between the CIA’s eventual application of
waterboarding and that of the SERE program indicate that
CIA medical personnel helped modify the SERE version of
19.	 Medline Plus. “Hyponatremia.” U.S. National Library of Medicine and
National Institutes of Health, 6 Nov. 2009. Web. 11 March 2010 <http://
www.nlm.nih.gov/medlineplus/ency/article/000394.htm>.
20.	 Memorandum from Steven G. Bradbury, Principal Deputy Assistant
Attorney General, for John A. Rizzo, Senior Deputy General Counsel,
Central Intelligence Agency (10 May 2005): 13. Web. 11 Mar. 2010 <http://
luxmedia.vo.llnwd.net/o10/clients/aclu/olc_05102005_bradbury46pg.pdf>.
21.	 Memorandum from Steven G. Bradbury, Principal Deputy Assistant
Attorney General, for John A. Rizzo, Senior Deputy General Counsel,
Central Intelligence Agency (30 May 2005): 37. Web. 12 Mar. 2010 <http://
luxmedia.vo.llnwd.net/o10/clients/aclu/olc_05302005_bradbury.pdf>.
22.	 United States. Cong. Senate. Committee on Armed Services. Hearing,
The Treatment of Detainees in U.S. Custody. 110th Cong., 2nd Sess.
Washington: GPO, 2008: Annex A, 209. Web. 11 Mar. 2010 <http://www.
fas.org/irp/congress/2008_hr/treatment.pdf>.

the technique.23 “Waterboarding 2.0” was the product of the
CIA’s developing and field-testing an intentionally harmful
practice using systematic medical monitoring and the application of subsequent generalizable knowledge.
In addition to introducing the use of potable saline to the
CIA’s use of waterboarding, OMS supervised the introduction of other specific medical equipment and procedures for
waterboarding. These included a “specially designed” gurney to move the detainee upright quickly in case of choking,
the use of a blood oximeter to measure detainee vital signs,
placing detainees on a liquid diet so their emesis would be
soft and less likely to cause choking or aspiration pneumonia if the detainee were to vomit, and having a tracheotomy
kit “not visible to the detainee” present in case a detainee’s
airway had to be surgically opened in order to prevent
drowning.24
Without evidence of a procedurally appropriate amendment to the SERE IRB process, the series of changes to
the waterboarding technique implemented by CIA personnel cannot scientifically or legally be considered merely an
extension of previous SERE IRB approvals. Importantly,
SERE research on the effect of the tactics on humans was
done with the subjects’ signed consent. OMS personnel
were likely performing this particular experiment without
informed consent because they were engaging in purposeful
torture of the subject. Even with some form of IRB approval,
this research and subsequent modification of waterboarding
or any other torture technique would still represent a serious
violation of medical ethics and international human rights
law because of the nature of the two acts being carried out
— research on a prisoner and the infliction of torture.

Researching the “Susceptibility” of
Detainees to Severe Pain
In the second and third instances indicating human
experimentation presented here, the evidence also suggests
that the collection of medical information was acquired
and applied to inform subsequent EI practices. In the
second instance, health professionals analyzed data based
on observations of 25 detainees who were subjected to
individual and combined applications of the EITs. They
derived generalizable knowledge about whether one type
of application over another would increase the subjects’
susceptibility to severe pain.
This investigation had no direct clinical health care application, nor was it in the detainees’ personal interest nor
23.	 Physicians for Human Rights. Aiding Torture: Health Professionals’
Ethics and Human Rights Violations Revealed in the May 2004 CIA
Inspector General’s Report. Cambridge: Physicians for Human Rights
(2009). Web. 15 Mar. 2010 <http://physiciansforhumanrights.org/library/
documents/reports/aiding-torture.pdf>.
24.	 Memorandum from Steven G. Bradbury, Principal Deputy Assistant
Attorney General, for John A. Rizzo, Senior Deputy General Counsel,
Central Intelligence Agency (10 May 2005): 14. Web. 11 Mar. 2010 <http://
luxmedia.vo.llnwd.net/o10/clients/aclu/olc_05102005_bradbury46pg.pdf>.

part of their medical management. It appears to have been
used primarily to enable the Bush administration to assess
the legality of the tactics, and to inform medical monitoring policy and procedure for future application of the techniques. While the actual findings and/or observational data
are not publicly available and may not even exist, it is clear
that the authorized policy of using multiple EITs simultaneously was officially based on medical observations of 25
detainees.
This evidence of research on detainees is documented in
the 2005 OLC memo (known as the “combined techniques”
memo) from Bradbury to Rizzo. In the following excerpt,
Bradbury references OMS observations of 25 detainees subjected to the tactics to argue that the use of the EITs in combination, rather than individually, would not likely make
detainees more susceptible to pain:25
But as we understand the experience involving the
combination of various techniques, the OMS medical
and psychological personnel have not observed any such
increase in susceptibility. Other than the waterboard,
the specific techniques under consideration in this
memorandum – including sleep deprivation – have been
applied to more than 25 detainees. See [redacted] Fax
at 1-3. No apparent increase in susceptibility to severe
pain has been observed either when techniques are used
sequentially or when they are used simultaneously – for
example, when an insult slap is simultaneously combined with water dousing or a kneeling stress position,
or when wall standing is simultaneously combined
with an abdominal slap and water dousing. Nor does
experience show that, even apart from changes in susceptibility to pain, combinations of these techniques
cause the techniques to operate differently so as to cause
severe pain. OMS doctors and psychologists, moreover,
confirm that they expect that the techniques, when combined as described in the Background Paper and in the
April 22 [redacted] Fax, would not operate in a different
manner from the way they do individually, so as to cause
severe pain.26
The relationship between the collection of medical
knowledge on 25 detainees and the justification of the official practice of simultaneous application of multiple EITs
is stated explicitly in the Bradbury memo on the combined
techniques. It is unclear whether the data referenced in the
memo were collected specifically for the purpose of determining the “susceptibility” to severe pain caused by combined application of the techniques, or whether they were
analyzed after being generally collected as part of standard
OMS monitoring policy. Regardless, the data and the conclusions drawn from it were utilized to justify the application of simultaneous and combined “enhanced” techniques.
25.	 The validity of such conclusions are questionable given major
limitations associated with the outcome measures described in the study.
26.	 Memorandum from Steven G. Bradbury, Principal Deputy Assistant
Attorney General, for John A. Rizzo, Senior Deputy General Counsel,
Central Intelligence Agency (10 May 2005): 12. Web. 11 Mar. 2010
<http://i.cdn.turner.com/cnn/2009/images/05/22/bradbury3.pdf>.

Evidence of Human Subject Research and Experimentation in the “Enhanced” Interrogation Program

9

Researching the Effects of Sleep
Deprivation on Detainees
The specific process of data analysis of varied applications
of sleep deprivation, and the identities of those who performed it, are not currently evident from public documents.
It is clear, however, that the application of this particular
course of monitoring and assessment demonstrates that US
government lawyers used such observational data collected
by health professionals from varying applications of sleep
deprivation to inform legal evaluations regarding the risk of
inflicting certain levels of harm on the detainee, and to shape
policy that would guide further application of the technique
on other detainees:27
You have informed us that to date, more than a dozen detainees have been subjected to sleep deprivation of more
than 48 hours, and three detainees have been subjected
to sleep deprivation of more than 96 hours; the longest
period of time for which any detainee has been deprived
of sleep by the CIA is 180 hours. Under the CIA’s
guidelines, sleep deprivation could be resumed after a
period of eight hours of uninterrupted sleep, but only if
OMS personnel specifically determined that there are no
medical or psychological contraindications based on the
detainee’s condition at that time. As discussed below,
however, in this memorandum we will evaluate only one
application of up to 180 hours of sleep deprivation.28

Apparent Purposes for
Human Research and
Experimentation on
Detainees
While Physicians for Human Rights does not yet know
the motives of the various actors involved in initiating and
reviewing what appears to be human experimentation on
detainees, including health professionals, interrogators, CIA
officials, and administration lawyers, it appears that the program served at least three distinct purposes.

27.	 Memorandum from Steven G. Bradbury, Principal Deputy Assistant
Attorney General, for John A. Rizzo, Senior Deputy General Counsel, Central
Intelligence Agency (10 May 2005): FN 36. 30.
“To assist in monitoring experience with the detainees, we understand that
there is regular reporting on medical and psychological experience with the
use of these techniques on detainees and that there are special instructions
on documenting experience with sleep deprivation and the waterboard. See
OMS Guidelines at 6-7, 16, 20.”
Web. 01 Jun. 2010 <http://luxmedia.vo.llnwd.net/o10/clients/aclu/
olc_05102005_bradbury46pg.pdf>.
28.	 Ibid.
10 	

Experiments in Torture

Limited Practical Scientific Knowledge
on How to Deploy EITs
The first purpose of experimentation was to determine
how EITs should be deployed. Because the EITs had previously been considered torture, there was little scientific
evidence prior to Sept. 11, 2001, to guide the deployment of
these techniques on detainees. Questions about their impact
and effectiveness were arising as the program proceeded.
Before the initiation of the EIP, which occurred simultaneously with a finding by the Bush administration that the
Geneva Conventions did not apply to Taliban and Al Qaeda
prisoners, experience with the techniques was limited to
studies in two settings: repatriated US prisoners of war who
had been subjected to torture, and the restricted environment
of US military survival-training courses, in which members
of the military and intelligence community participated only
after providing signed consent. While there is a rich literature regarding the harmful effects of these techniques,29 that
literature appears to have been ignored by the authors of the
legal memos. At the same time, health professionals in OMS
appear to have accepted the unachievable assignment of designing torture-based interrogation techniques that were both
“safe” and “effective.”30

Calibrating Levels of Pain and
Suffering in Accordance with
the OLC Memos
A second purpose of collecting generalizable medical information appears to have been an attempt to calibrate the
level of pain caused by the techniques in an effort to keep
the pain from crossing the threshold they had defined as
constituting torture. The research information gathered was
used by government lawyers to create a basis for defending
interrogators against potential charges of violating US antitorture law.31 OLC lawyers’ attempted inoculation of interrogators against torture charges depended upon an interpretation of the US anti-torture statute that permitted the use of
techniques previously deemed to be illegal.
The OLC interpretation defined torture as an act causing
“long-term” mental harm or physical “pain and suffering”
equal to the pain and suffering inflicted by either organ failure

29.	 The following publication summarizes the medical literature on the
effects of torture, available prior to Sept. 11, 2001. Leave No Marks:
Enhanced Interrogation Techniques and the Risk of Criminality: Executive
Summary. Cambridge: Physicians for Human Rights, 2007. 01 Jun. 2010.
<http://physiciansforhumanrights.org/library/documents/reports/2007-phrhrf-summary.pdf >.
30.	 Shane, Scott. “China Inspired Interrogations at Guantánamo.” New
York Times. New York Times, 2 Jul. 2008. Web. 21 Apr. 2010 <http://www.
nytimes.com/2008/07/02/us/02detain.html?_r=2>.
31.	 18 U.S.C. §§ 2340-2340A (2001).

or death.32 In particular, the authors of the OLC memos
argued that the “enhanced” techniques would not constitute
torture as long as they were applied in a manner that was
“safe.” In a legal context, concepts of “pain,” “suffering,” and
“safety” are questions of fact that relate to the experiences of
the individual interrogators and people being interrogated.
The OLC memo authors argued that if medical professionals
approved the interrogations and monitored the application
of the “enhanced” techniques, the abusive acts would not
constitute torture.33
Under the legal framework established by the OLC legal
memoranda, health professionals thus became responsible
for ensuring that the authorized tactics did not inflict a level
of “severe and long-lasting” mental and physical pain and
suffering that ostensibly, under the lawyers’ rationale, could
be considered “torture.” In order to measure the harm inflicted by the tactics, health professionals were required to
collect medical information and make inferences from it that
constituted generalized knowledge: i.e., to engage in human
subject research and experimentation.

Providing a Basis for a “Good Faith”
Legal Defense against Torture Charges
A third purpose for such experimentation appears to have
been to create a basis for legal defenses for individuals engaging in acts that arguably constituted torture. In a circular
application of science to law, and in violation of the ethical
principles of both professions, experimentation relating to
the EITs apparently was used by Bush administration lawyers in an effort to protect US personnel engaged in the EIP
from potential legal liability for their acts. OLC lawyers
argued that efforts to refine and improve the application of
techniques would provide a potential “good faith” defense
for interrogators against charges of torture.34 They argued
that such a medical monitoring regime would remove the
element of intent to cause harm from the act, which is a necessary requirement for a successful prosecution of a torture
charge under US law, and that “a good faith belief need not
be a reasonable belief; it need only be an honest belief.”35
Thus, research on the detainees became a key part of the
OLC’s legal strategy to demonstrate the lack of intent to
commit torture. The following section from a 2003 memo
32.	 Memorandum from John C. Yoo, Deputy Assistant Attorney General
for William J. Haynes II, General Counsel of the Dept. of Defense (14 Mar.
2003): 45. Web. 16 Mar. 2010 <http://www.aclu.org/files/pdfs/safefree/
yoo_army_torture_memo.pdf>.
“In a remarkably circular argument, the OLC lawyers argued that it was
not torture if it was safe. The medical professionals, it seemed, said it was
safe as long as the lawyers assured them it wasn’t torture. The illusion of
safety was based on an exaggerated claim of expertise regarding the effects
of these techniques, as described later in this report.”
33.	 Memorandum from Scott W. Muller, Office of General Counsel,
Central Intelligence Agency for Jack L. Goldsmith III, Assistant Attorney
General, Office of Legal Counsel, Dept. of Justice (2 Mar. 2004): 7. Web.
16 Mar. 2010 <http://www.aclu.org/files/torturefoia/released/082409/
olcremand/2004olc22.pdf> [Hereinafter referred to as “CIA Bullet Points.”]
34.	 CIA Bullet Points, supra note 12, at 7.
35.	 Ibid.

written by then Deputy Assistant Attorney General John Yoo
refers specifically to prolonged mental harm:
A defendant could show that he acted in good faith by
taking such steps as surveying professional literature,
consulting with experts, or reviewing evidence gained
from past experience. See, e.g., Ratzlaf, 510 U.S. at
142 n.10 (noting that where the statute required that the
defendant act with the specific intent to violate the law,
the specific intent element “might be negated by, e.g.,
proof that defendant relied in good faith on advice of
counsel.”)... All of these steps would show that he has
drawn on the relevant body of knowledge concerning
the result proscribed by the statute, namely prolonged
mental harm.36 [Emphasis added]
A 2008 DoJ Office of Professional Responsibility (OPR)
report evaluating allegations of professional misconduct by
OLC lawyers Yoo and Jay Bybee37 details how pivotal this
medical supervision was considered to be in circumventing
the “intent” language in the US torture statute.  The report
says that then Assistant Attorney General for the Criminal
Division Michael Chertoff told Yoo in 2002 that:
…the more investigation into the physical and mental
consequences of the techniques they did, the more likely
it would be that an interrogator could successfully assert
that he acted in good faith and did not intend to inflict
severe physical or mental pain or suffering.38

Operational Implementation of OLC Guidance
by the CIA
Documenting and understanding the effects of the techniques as part of mounting a “good faith” defense against
torture charges affected how the CIA subsequently implemented the guidance provided by the OLC into a research
program. A document entitled “Legal Principles Applicable
to CIA Detention and Interrogation of Captured Al-Qa’ida
Personnel,” referred to hereafter as the CIA “Bullet Points,”
was prepared in 2003 by the CIA’s general counsel, Scott
Muller.39
36.	 Memorandum from John C. Yoo, Deputy Assistant Attorney General
for William J. Haynes II, General Counsel of the Dept. of Defense (14 Mar.
2003): 41. Web. 16 Mar. 2010 <http://www.aclu.org/files/pdfs/safefree/
yoo_army_torture_memo.pdf> (bolding and italics added).
37.	 The 2008 DoJ OPR Report was the result of OPR’s investigation of
the OLC’s legal memoranda concerning the use of “enhanced interrogation
techniques” on suspected terrorists by the CIA. The initial report concluded
that the drafters of the first OLC memos (Bybee and Yoo) failed to act under
standards of DoJ professional conduct, inter alia, but this conclusion was not
accepted by other DoJ officials.
38.	 United States. Dept. of Justice. Office of Professional Responsibility.
Investigation into the Office of Legal Counsel’s Memoranda on Issues
Relating to the Central Intelligence Agency’s Use of “Enhanced
Interrogation Techniques” on Suspected Terrorists. Dept. of Justice, 29 July
2009: 59. Web. 15 Mar. 2010 <http://judiciary.house.gov/hearings/pdf/
OPRFinalReport090729.pdf>.  
39.	 The CIA Bullet Points were written, according to the OPR, with the
assistance of both CTC (CIA-Counter-Terrorism Center) staff and the OLC for use
by the CIA-OIG in its inquiry of CIA treatment of detainees. Ibid. at 100-101.  

Evidence of Human Subject Research and Experimentation in the “Enhanced” Interrogation Program

11

One of the Bullet Points states:
The interrogation of al-Qa’ida detainees does not constitute torture within the meaning of [the torture statute]
where the interrogators do not have the specific intent to
cause “severe physical or mental pain or suffering.” The
absence of specific intent (i.e., good faith) can be established through, among other things, evidence of efforts
to review relevant professional literature, consulting with
experts, reviewing evidence gained from past experience
where available (including experience gained in the
course of U.S. interrogations of detainees), providing
medical and psychological assessments of a detainee
(including the ability of the detainee to withstand interrogation without experiencing severe physical or mental
pain or suffering), providing medical and psychological
personnel on site during the conduct of interrogations,
or conducting legal and policy reviews of the interrogation process (such as the review of reports from the interrogation facilities and visits to those locations). A good
faith belief need not be a reasonable belief; it need only
be an honest belief.40 [Emphasis added.]
The Bullet Points demonstrate that documentation and
review of the impact of the tactics on the detainees was central to the CIA program — not for ensuring the well-being or
medical treatment of the detainee, but for displaying “good
faith” as an inoculation for the agency against potential prosecution for torture.

The Bradbury “Combined Techniques” Memo
Relied on Research Data from Detainees
The Bullet Points, based upon Yoo’s March 14, 2003,
memo, were rescinded by the OLC in 2004.41 The Yoo memo
was withdrawn the same year. Even after these initial memoranda authorizing torture were rescinded, health professionals continued to document the impact of the tactics and the
new knowledge obtained to refine the application of the EITs. 
A memorandum from Bradbury to the CIA dated May 10,
2005 (known as “the Combined Techniques Memo”), like
the OLC memoranda that preceded it, explicitly relied on
“medical screening, monitoring, and ongoing evaluations” as
a means of supposedly preventing “serious or lasting physical or psychological harm.”42
Bradbury’s 2005 opinion was apparently based on information collected by the OMS monitoring and research program that the Yoo memo had called for to inoculate interrogators against torture charges. At that point, OMS had been
40.	 CIA Bullet Points, supra note 33, at 7 (bolding and italics added).
41.	 United States. Dept. of Justice. Office of Professional Responsibility.
Investigation into the Office of Legal Counsel’s Memoranda on Issues
Relating to the Central Intelligence Agency’s Use of “Enhanced Interrogation
Techniques” on Suspected Terrorists. Dept. of Justice, 29 July 2009:
116. Web. 15 Mar. 2010 <http://judiciary.house.gov/hearings/pdf/
OPRFinalReport090729.pdf>.
42.	 Memorandum from Steven G. Bradbury, Principal Deputy Assistant
Attorney General for John A. Rizzo, Senior Deputy General Counsel, Central
Intelligence Agency (30 May 2005): 3. Web. 12 Mar. 2010 <http://luxmedia.
vo.llnwd.net/o10/clients/aclu/olc_05302005_bradbury.pdf>.
12 	

Experiments in Torture

monitoring the EIT program for more than two years.43 Yoo
and Bybee appeared to have relied only on the limited SERE
research available to them when they wrote their opinions,
as well as input from selected experts on the effects of the
techniques. The Bradbury memo,44 however, demonstrates
that the OMS had closely followed the guidance of the CIA
Bullet Points. OMS personnel collected “evidence gained
from past experience where available (including experience
gained in the course of U.S. interrogations of detainees),”
performed medical and psychological assessments, including assessing a detainee’s ostensible ability to withstand the
techniques without incurring severe mental pain or suffering,
and methodically amassed other, tactic-specific information
from human subjects.45 The outcomes were used not only
to monitor stress levels in individual detainees undergoing
“enhanced” interrogation but also apparently to perform research with the goal of calibrating interrogation techniques
in the interest of achieving maximum effect with detainees
in the future. In short, the OMS had conducted a program of
human subject research.46
The OLC lawyers apparently, therefore, used human experimentation both as a justification for torture and as a way
of mitigating legal liability for torture. But in attempting to
legitimize the crime of torture, the lawyers left those who
authorized and performed the research open to the charge of
illegal human experimentation. Even if medical monitoring
was dutifully applied for the intended purpose of mitigating
the infliction of severe physical and psychological harm, the
medical monitoring itself, because it generated research that
was applied to future application of the techniques and as
part of efforts to mitigate legal liability, could be considered
a major breach of professional medical ethics, and could
constitute a crime.
Despite the apparent scrupulousness with which OLC
lawyers approached the issue of the legality of the harsh interrogation techniques, as of 2005, the OLC appears never
to have directly assessed the legality of the monitoring and
research regime itself. If such guidance exists, it has not yet
been publicly disclosed. 

43.	 Central Intelligence Agency, Office of Inspector
General. Counterterrorism Detention and Interrogations, Special Review.
Central Intelligence Agency (2004): 4. Web. 11 Mar. 2010. <http://www.gwu.
edu/~nsarchiv/torture_archive/20040507.pdf>.
44	 Memorandum from Steven G. Bradbury, Principal Deputy Assistant
Attorney General for John A. Rizzo, Senior Deputy General Counsel, Central
Intelligence Agency (10 May 2005). Web. 11 Mar. 2010 <http://i.cdn.turner.
com/cnn/2009/images/05/22/bradbury3.pdf>.
45.	 CIA Bullet Points, supra note 33, at 7.
46.	 45 C.F.R. § 46.102(d) (2005); see also Standards for Privacy of
Individually Identifiable Health Information, 65 Fed. Reg. 82,462, 82,497 (28
Dec. 2000).

Human Experimentation
and Human Subject
Protections
The Bush administration’s legal framework to protect
CIA interrogators from violating US statutory and treaty
obligations prohibiting torture47 effectively contravened
well-established legal and ethical codes that, had they been
enforced, should have protected prisoners against human
experimentation, and should have prevented the EIP itself
from being initiated in the first place. This strategy therefore
may have effectively employed one criminal act to protect
against liability for another, as illegal and non-consensual
human experimentation can constitute a war crime48 and a
crime against humanity,49 when its perpetration is systematic
and widespread.50

The Nuremberg Code
International and US prohibitions restricting human
experimentation were developed in response to some of
the most serious human rights violations of the 20th century. Following the trials of German health professionals at
Nuremberg after World War II, international attention was
focused on the practice of human experimentation inflicted
upon vulnerable human subjects. The fundamental right of
individuals to choose not to be subjected to human experimentation was first codified in the form of the Nuremberg
Code—a direct response to atrocities that took place during
the war. Among other protections, the Nuremberg Code states
that the voluntary informed consent of the human subject in
any experiment is absolutely essential, and that volunteer
subjects should always be at liberty to end their participation
in the experiment. In addition, the Nuremberg Code states
that any experiment should be conducted so as to avoid all
unnecessary physical and mental suffering and injury.
Implementation of the Nuremberg Code was neither immediate nor consistent. Despite the experiences of World
War II, human experimentation on vulnerable populations
without the participants’ consent continued in the United
States into the second half of the 20th century. One of the
most egregious examples was the Tuskegee syphilis experiment, in which poor African-American men in the South
were denied treatment for syphilis so that researchers could
study the natural progression of the untreated disease.

47.	 18 U.S.C. §§ 2340-2340A (2001).
48.	 18 U.S.C. § 2441 (2006).
49.	 Harris, Sheldon H. “Medical Experiments on POWs.” Crimes Of War:
¶9. Web. 11 Apr. 2010 <http://www.crimesofwar.org/thebook/medicalexperiments.html>.
50.	 Annas, George J. “Globalized Clinical Trials and Informed Consent.”
The New England Journal of Medicine 360.20 (2009): 2052. Web. 16 Mar.
2010. <http://content.nejm.org/cgi/content/full/360/20/2050>.

The National Commission
In the wake of public outrage surrounding these nonconsensual experiments, the US Congress created the
National Commission for the Protection of Human
Subjects of Biomedical and Behavioral Research (National
Commission), a group of leading experts in medicine, law,
and ethics, charged with developing guidelines on human
subject research based on ethical principles. The National
Commission made its recommendations in the Belmont
Report, establishing “respect, beneficence and justice” as
principles guiding the ethical conduct of research, including the right of informed consent.51 The Belmont Report
established the concept that the ethical conduct of research
required that volunteer subjects be informed about the risks
and benefits, if any, that might accrue to them before they
gave their consent. Additional protections were established
for vulnerable populations, such as prisoners, whose ability
to give truly informed consent may be problematic.
As further protection for human subjects, the National
Commission called for establishment of institutional review
boards within medical and scientific organizations. These
bodies comprise combinations of researchers, ethics experts,
and laypeople that oversee study design based upon ethical
principles.

The Common Rule
These human subject protections became codified in federal regulations,52 as well as in codes of professional conduct.
Collectively, these regulations are known as the Common
Rule. The Common Rule applies to all federally funded human subject experimentation, including all research conducted by the CIA and the DoD.53
By the end of the 20th century, therefore, all people who
were subject to US experimentation were protected by three
interconnected bodies of law: customary international law,
US federal statute, and federal regulations — specifically,
the Common Rule. Although the Nuremberg Code is a code
of conduct and not, by its terms, a treaty binding explicitly
named parties, in the decades following the 1947 articulation of Nuremberg, prohibitions against human experimentation without the informed consent of the volunteer subjects
have been deemed by international legal scholars to be
part of “customary international law.” This makes human
51.	 See generally United States. National Commission for the Protection
of Human Subjects of Biomedical and Behavioral Research. The Belmont
Report: Ethical Principles and Guidelines for the Protection of Human
Subjects of Research. Department of Health, Education, and Welfare, 18
Apr. 1979. Web. 27 Apr. 2010 <http://www.hhs.gov/ohrp/humansubjects/
guidance/belmont.htm>.
52.	 45 C.F.R. §§ 46.101-46.124 (2005).
53.	 Strengthened Protections for Human Subjects of Classified Research, 62
Fed. Reg. 26,369 (27 Mar. 1997). Web. 21 Apr. 2010 <http://www.fas.org/
sgp/clinton/humexp.html>.

Evidence of Human Subject Research and Experimentation in the “Enhanced” Interrogation Program

13

experimentation without the informed consent of volunteer
subjects one of a small number of acts (including genocide and
torture) that are so heinous that they are universally considered to be crimes against humanity.

Legal and Ethical Standards Violated
Following Sept. 11, 2001
Under the existing system of human research protections,
experimentation on detainees in US custody was not permitted. If CIA personnel had followed the Common Rule, prospective review by an IRB would have protected the rights
and welfare of the targeted detainee subjects by forbidding
the proposed research on legal, ethical, scientific, and moral
grounds. Other violations may include:
*	 Violation of the Geneva Conventions:
The four Geneva Conventions, treaties completed in 1949,
and to which the United States traditionally has adhered, as
well as their additional protocols, form the core elements of
the law of armed combat. On February 7, 2002, President
Bush issued an executive order finding that “Taliban detainees are unlawful combatants and, therefore, do not qualify
as prisoners of war under Article 4 of Geneva.” While this
conclusion is generally viewed as legally accurate given the
Third Geneva Convention’s narrow definition of POWs, the
executive order went on to state that “Geneva does not apply
to our conflict with al-Qaida . . . .”54
As the Supreme Court determined in Hamdan v.
Rumsfeld,55 this assessment is incorrect: Whereas Taliban
and al-Qaida prisoners did not have all the specific POW
protections provided under the Third Geneva Convention,
Common Article 3 provisions did continue to apply.56
Common Article 3 is a provision common to all four
Geneva Conventions. Among other things, it proscribes
“cruel treatment and torture” and “humiliating and degrading treatment.” The appropriate enforcement of Common
Article 3 would have precluded any human subject research
and experimentation on detainees unrelated to their hospital
treatment or their medical interest.57 Beyond the applicability
54.	 “In a February 2002 memorandum, President Bush issued a formal
decision that Common Article Three did not apply to the armed conflict
with Al Qaeda.” United States. Dept. of Justice. Office of Professional
Responsibility. Investigation into the Office of Legal Counsel’s Memoranda
on Issues Relating to the Central Intelligence Agency’s Use of “Enhanced
Interrogation Techniques” on Suspected Terrorists. Dept. of Justice, 29 July
2009: 26. Web. 15 Mar. 2010 <http://judiciary.house.gov/hearings/pdf/
OPRFinalReport090729.pdf>.  
55.	 Hamdan v. Rumsfeld, 548 U.S. 557 (2006).
56.	 Id. at 562.
57.	 See Geneva Convention for the Amelioration of the Condition of the
Wounded and Sick in Armed Forces in the Field art. 3, 12 Aug. 1949, 6 U.S.T.
3114, 75 U.N.T.S. 31; Geneva Convention for the Amelioration of the Condition
of Wounded, Sick and Shipwrecked Members of Armed Forces at Sea art. 3,
12 Aug. 1949, 6 U.S.T. 3217, 75 U.N.T.S. 85; Geneva Convention Relative
to the Protection of Civilian Persons in Time of War art. 3, 12 Aug. 1949, 6
U.S.T. 3516, 75 U.N.T.S. 287; Geneva Convention Relative to the Treatment of
Prisoners of War art. 3, 12 Aug. 1949, 6 U.S.T. 3316, 75 U.N.T.S. 135.
14 	

Experiments in Torture

of Common Article 3 it has not been clearly determined what
other provisions of the Geneva Conventions apply to detainees deemed “unlawful combatants,” yet it is important to
note that all four Geneva Conventions explicitly state that
“biological experiments” are grave breaches of the respective
conventions — and apply to all detainees, whether POWs or
otherwise.58
*	 Contravention of the Nuremberg Code:
As discussed above, well prior to Sept. 11, 2001, there
was widespread international consensus that the Nuremberg
Code prohibiting human subject experimentation without
consent had become customary international law binding
upon all countries. In 2003, however, a CIA legal interpretation indicated that the US government’s position was that
“customary international law imposes no obligations regarding the treatment of al-Qaida detainees beyond that which the
Convention [Against Torture], as interpreted and understood
by the United States in its reservations, understandings, and
declarations, imposes.”59 It is not clear whether those conducting the US experimentation program believed that they
were not bound by the Nuremberg Code, or simply ignored
its requirements. In any case, the experimental regime clearly
violated the code as well as applicable US laws and regulations that remained in place.
*	 Disregarding and Amending the US War Crimes Act:
Enacted by a Republican Congress in 1996, the Jones War
Crimes Act for the first time imposed US criminal penalties
for “grave breaches” of any of the Geneva Conventions. In
1997, the legislation was expanded, at the request of the
Departments of State and Defense, to encompass a broader
range of war crimes, including violations of Common Article
3. As previously noted, all four Geneva Conventions list
“biological experiments” as grave breaches, which may have
created liability for human experimentation on detainees
even under the original act. Once Common Article 3 was included as a war crime in the amended WCA, its prohibitions
on “cruel treatment and torture” and “degrading treatment”
would likely create criminal liability for experimentation on
detainees. Due to the Bush administration’s erroneous conclusion that it could detain “war on terror” prisoners outside
of Geneva protections, it appears to have concluded before
2006 that interrogators were not liable to criminal prosecution under the War Crimes Act.60
Subsequent to the program of experimentation discussed
in this report, changes were made to the War Crimes Act
58.	 Geneva Convention for the Amelioration of the Condition of the
Wounded and Sick in Armed Forces in the Field art. 50(4), 12 Aug. 1949, 6
U.S.T. 3114, 75 U.N.T.S. 31; Geneva Convention for the Amelioration of the
Condition of Wounded, Sick and Shipwrecked Members of Armed Forces
at Sea art. 51(D), 12 Aug. 1949, 6 U.S.T. 3217, 75 U.N.T.S. 85; Geneva
Convention Relative to the Protection of Civilian Persons in Time of War art.
130(D), 12 Aug. 1949, 6 U.S.T. 3516, 75 U.N.T.S. 287; Geneva Convention
Relative to the Treatment of Prisoners of War art. 147(1), 12 Aug. 1949, 6
U.S.T. 3316, 75 U.N.T.S. 135.
59.	 Bullet Points, supra note 33, at 6.
60.	 Bullet Points, supra note 33, at 7.

which, despite occurring after the experimentation, are still
relevant to the legality of the program because of their retroactivity. Following the Supreme Court’s 2006 Hamdan v.
Rumsfeld decision, which clearly established that enemy
combatants were protected by Common Article 3, the Bush
administration quickly sought again to limit potential legal
exposure of its personnel by amending the WCA. The administration expressed concerns that it was unclear under the act
exactly which forms of detainee treatment or interrogation
constituted punishable offenses. As part of the 2006 Military
Commissions Act, the WCA was amended to delineate the
specific violations of Common Article 3 that would be punishable. Among those violations is “performing biological
experiments.” The amended language prohibits:
The act of a person who subjects, or conspires or attempts to subject, one or more persons within his custody
or physical control to biological experiments without a
legitimate medical or dental purpose and in so doing endangers the body or health of such person or persons.61
While this language maintains the existing prohibition on
biological experiments contained in the previous version of
the WCA, the effect of this amendment appears to weaken
the prohibition by moving away from the type of strict language found in the Geneva Conventions (Third Geneva
Convention, Article 13), which states:
No prisoner of war may be subjected to physical mutilation or to medical or scientific experiments of any kind
which are not justified by the medical, dental, or hospital
treatment of the prisoner concerned and carried out in his
interest.62
The new language of the WCA added two qualifications
that appear to have lowered the bar on biological experimentation on prisoners. That language requires that the experiment have a “legitimate” purpose, but does not require that
it be carried out in the interest of the subject. It also adds the
requirement that the experiment not “endanger” the subject,
which appears to raise the threshold for what will be considered illegal biological experimentation.
Neither the source of this language change nor the reason
for it is clear. It is possible that the language was changed in
an attempt to protect those involved in experiments before
2006. Because changes to the WCA were made retroactive to
1997, the new weaker language applied to the EIP discussed
in this report, and these provisions became the standard for
determining if a grave breach occurred.
Another component of the amended WCA that is relevant
to the experimentation program provides immunity for military and intelligence officials from criminal prosecution for
acts after Sept. 11, 2001, that were part of “authorized interrogations.” While this language seems directed at those who
61.	 18 U.S.C. § 2441(d)(1)(C) (2006).
62.	 Convention (III) relative to the Treatment of Prisoners of War, Article 13.
Geneva, 12 August 1949. Web. 01 Jun 2010. <http://www.icrc.org/ihl.nsf/7c4d
08d9b287a42141256739003e63bb/6fef854a3517b75ac125641e004a9e68>.

may have engaged in torture during interrogations, it would
also apply to the grave breach of biological experimentation
that is listed as a war crime.
Regardless of whether the rationale for legislative amendments undertaken by the Bush administration is ever fully
known, it is important to note that human subject protections have not been restored to their previous state. Despite
President Obama’s Jan. 22, 2009, executive order barring the
use of almost all “enhanced interrogation techniques,” Bush
administration revisions to the WCA remain in effect. As
long as weakened statutory language exists that may permit
experimentation on detainees in US custody, the risk remains
that current and future detainees could be subjected to serious violations of human rights.

Conclusions and
Recommendations
This report identifies evidence of unethical and illegal human subject experimentation conducted by US health professionals on detainees. Human experimentation, in the form of
systematic medical monitoring and subsequent transformation of the data obtained into generalizable knowledge, appears to have been used to justify practices previously recognized as torture, to inform specific “enhanced” interrogation
practices, and to serve as a part of the US government’s legal
defense against criminal liability for torture.
It is evident from this analysis that the premise and practice of what was erroneously claimed to be “safe, legal and
effective” torture depended on what appears to be research
and experimentation on detainees, which could rise to the
level of war crimes and crimes against humanity. This program engaged in violations of the detainees’ health and human rights that are explicitly prohibited by international human rights agreements to which the United States is party —
including the United Nations Conventions Against Torture,63
the International Covenant on Civil and Political Rights,64
and the Universal Declaration of Human Rights.65
The claim that health professionals served to ensure the safety
of the detainees through the systematic monitoring of intentionally
63.	 Convention Against Torture and Other Cruel, Inhuman, or Degrading
Treatment or Punishment. G.A. Res. 39/46. U.N. GAOR. 39th Sess. Supp. No.
51. 1984:197. Entered into force June 26, 1987. U.N. Doc. A/Res/39/46. Web.
17 May 2010. <http://www.un.org/documents/ga/res/39/a39r046.htm>.
64.	 International Covenant on Civil and Political Rights, opened for signature
December 16, 1966. Article 7. 999 U.N.T.S. 171. Entered into force March 23,
1976. Web. 17 May 2010. <http://www.un.org/millennium/law/iv-4.htm>.
65.	 Article 5 of UDHR states: “No one shall be subjected to torture or to
cruel, inhuman or degrading treatment or punishment.” Universal Declaration
of Human Rights, G.A. res. 217A (III), U.N. Doc A/810, at 71. (1948). Web.
17 May 2010. <http://www.un.org/en/documents/udhr/>.

Evidence of Human Subject Research and Experimentation in the “Enhanced” Interrogation Program

15

harmful practices is not only inherently contradictory but also a
perversion of centuries of health professional ethics.66
Those who authorized, designed, implemented, and supervised this regime of human experimentation — whether
health professionals, uniformed personnel, or civilian national security officials — must be held to account if further
in-depth investigation confirms that they have violated ethical and legal strictures on professional behavior in ways that
previously have been found to constitute war crimes and
crimes against humanity by international tribunals.
Physicians for Human Rights calls on the White House
and Congress to investigate thoroughly the full scope of the
human experimentation designed and implemented in the
post-Sept. 11 period. The War Crimes Act must be amended
to restore the previous language protecting detainees from
being subjects of experimentation. Any victims of research
and experimentation perpetrated as part of the CIA’s “enhanced” interrogation program who may be found through
further investigations must be offered compensation and
health care services to address ongoing health effects related
to the experimentation, as well as a formal apology by the
United States.

Recommendations
Based on the findings of this investigation, the United
States should take the following actions:
1.	President Obama must order the attorney general to
undertake an immediate criminal investigation of alleged
illegal human experimentation and research on detainees
conducted by the CIA and other government agencies
following the attacks on Sept. 11, 2001.
2.	The secretary of the Department of Health and Human
Services must instruct the Office for Human Research
Protections (OHRP) to begin an investigation of
alleged violations of the Common Rule by the CIA and
other government agencies as part of the “enhanced”
interrogation program.
3.	Congress must amend the War Crimes Act to eliminate
changes made to the Act in 2006 which weaken the
prohibition on biological experimentation on detainees,

66.	 See appendix 2.
16 	

Experiments in Torture

and ensure that the War Crimes Act definition of the
grave breach of biological experimentation is consistent
with the definition of that crime under the Geneva
Conventions.
4.	Congress should convene a joint select committee comprising members of the House and Senate committees responsible for oversight on intelligence, military, judiciary
and health and human services matters to conduct a full
investigation of alleged human research and experimentation activities on detainees in US custody.
5.	President Obama should issue an executive order
immediately suspending any federally funded human
subject research currently occurring in secret —
regardless of whether or not it involves detainees.
6.	The Department of Justice’s Office of Professional
Responsibility should commence an investigation into
alleged professional misconduct by OLC lawyers related
to violations of domestic and international law and
regulations governing prohibitions on human subject
experimentation and research on detainees.
7.	President Obama should appoint a presidential task force
to restore the integrity of the US regime of protections
for human research subjects. This task force, comprising current and former officials from the Department
of Health and Human Services, the Food and Drug
Administration, the National Institutes of Health, the human rights community, and leading health professional
associations, should review current human subject protections for detainees, and recommend changes to ensure
that the human rights of those in US custody are upheld.
8.	States should adopt policies specifically prohibiting
participation in torture and improper treatment of
prisoners by health care professionals. Such participation
is considered professional misconduct and is grounds
for loss of professional licensure. Proposed legislation in
New York State provides a model for such policy.
9.	The United Nations special rapporteur on torture should
undertake an investigation of allegations that the United
States engaged in gross violations of international human
rights law by engaging in human subject research and
experimentation on detainees in its custody.

Glossary of Abbreviations and Terms
APA: . . 	American Psychological Association
CIA: . . .	Central Intelligence Agency
CTC: . . 	CIA Counter-Terrorism Center
DoD: . .	 Department of Defense
DoJ: . . .	Department of Justice
EI: . . . . 	Enhanced interrogation, the Bush administration’s euphemism for its program of physical
and psychological torture
EIT: . . . 	Enhanced interrogation techniques. These include isolation, sensory deprivation,
sensory bombardment, stress positions and waterboarding, among many others
EIP: . . . 	Enhanced interrogation program
Experimentation: . . . To carry out experiments or try out a new procedure, idea, or activity
HHS: . . 	Department of Health and Human Services
IRB: . . .	Institutional Review Board
JPRA: . .:Joint Personnel Recovery Agency
MCA: . .	2006 Military Commissions Act
OGC: . .	CIA Office of General Counsel
OHRP: .	HHS Office for Human Research Protections
OIG: . . .	CIA Office of Inspector General
OLC: . .	DoJ Office of Legal Counsel
OMS: . .	CIA Office of Medical Services
OPR: . .	 DoJ Office of Professional Responsibility
OTS: . . 	CIA Office of Technical Services
SERE: . 	“Survival, Evasion, Resistance and Escape.” A survival training program for US soldiers
at high risk for capture and torture by enemies. Also the setting for clinical research done
on US soldiers with their informed consent
WCA: . .:War Crimes Act

Evidence of Human Subject Research and Experimentation in the “Enhanced” Interrogation Program

17

Appendix 1
The Nature of Experimentation:
Health Professional Monitoring of the
“Enhanced” Interrogation Program
The involvement of health professionals in a torture
program was clearly illegal prior to the issuance of legal
memoranda by the Department of Justice’s Office of Legal
Counsel (OLC). It was also unethical by standards of the
medical profession. The task of keeping subjects of the “enhanced” interrogation program “safe” was also illegitimate
in that it placed health professionals in the role of calibrating
pain and injury in a non-therapeutic act. But, beyond that,
a program in which health professionals were tasked with
keeping subjects of “enhanced” interrogation safe was by
its very nature experimental, in that it was based on untested
ideas or techniques not yet established or finalized.
One example of the lack of prior knowledge and established procedure for the “safe” administration of the socalled “enhanced” interrogation techniques (EITs), in this
case waterboarding, is found in the 2004 CIA OIG (Office
of Inspector General) Report:
In retrospect based on the OLC extracts of the OTS
(Office of Technical Services) report, OMS (Office of
Medical Services) 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 in the report.
Furthermore, OMS contends that the expertise of the
SERE (Survival, Evasion, Resistance, Escape) psychologist/interrogators on the waterboard was probably misrepresented at the time, as the SERE waterboard experience is so different from the subsequent Agency usage
as to make it almost irrelevant. 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.1
At the time when the program was being designed and
approved, there was no established or accepted way to keep
an interrogation using EI techniques safe. Any medical
monitoring by a health professional to keep the subject safe
was therefore by its very nature experimental.
The Belmont Report2 acknowledged that there is a gray
zone in medical certainty between accepted medical practice and experimental practice. In distinguishing between
accepted practice and research, the National Commission
1.	 Central Intelligence Agency, Office of Inspector General.  Counterterrorism Detention and Interrogations, Special Review. Central Intelligence
Agency (2004): 22. Web. 11 Mar. 2010. <http://www.gwu.edu/~nsarchiv/
torture_archive/20040507.pdf>.
2.	 See footnote 51, main text.
18 	

Experiments in Torture

for the Protection of Human Subjects of Biomedical and
Behavioral Research examined two factors:
1.	the level of risk to the subject, and
2.	the intent of the physician.3
Schuchardt interprets the Belmont Report as follows:
The most important difference between “research” and
“practice” is the degree of risk each procedure entails.
Research, by its very nature, involves procedures that
are new and not well understood. The risk to the human
subject is that the procedure will be unnecessarily applied, performed in a negligent manner, or cause anomalous injuries due to the ignorance about the procedure.
Practice, on the other hand, involves therapies that are
standard or performed frequently because their risks
are known and the procedure is expected to benefit the
patient.4
In addressing physician intent as it relates to the distinction
between research and practice, Schuchardt comments:
Physicians engage in practice when they seek to benefit
the patient and patient alone through the best-known
treatment. On the other hand, physicians engage in research whenever they intend to develop new knowledge
through their dealings with the patient. The intent of the
physician is important because it determines whether the
physician has a conflict of interest between the patient
and the research.5
This conflict is important to note in this context, because
the primary goal of health professionals working in US
interrogation programs was supporting the interrogation
process. Patient care and treatment duties were made a secondary priority to the operational objective of implementing the techniques in a manner that limited legal liability for
torture.
In reviewing the proposed use of experimental drugs
to protect US troops from biological weapons, Annas and
Grodin have argued, however, that it is “the investigational
nature of the intervention, not the intent of the physician or
researcher, that determines whether or not an intervention is
research or therapy,” and they note that “the absence … of
effective alternatives does not convert an existing investigational intervention into a therapeutic one.”6

The Belmont Report does note that a procedure does
3.	 Boyce, Ross M. “Waiver of Consent: The Use of Pyridostigmine Bromide
during the Persian Gulf War.” Journal of Military Ethics 8.1 (2009): 8. Print.
4.	 Schuchardt, Elliott J. Walking a Thin Line: Distinguishing Between
Research and Medical Practice during Operation Desert Storm. 26 Colum.
J.L. & Soc. Probs. 77 (1992): 6. Print.
5.	 Schuchardt, Elliott J. Walking a Thin Line: Distinguishing Between
Research and Medical Practice during Operation Desert Storm. 26 Colum.
J.L. & Soc. Probs. 77 (1992): 6. Print.
6.	 Annas, George J., and Michael A. Grodin. “‘Treating the Troops’:
Commentary.” The Hastings Center Report 21.2 (1991): 25. Print.

not automatically qualify as research just because it is
experimental.
Thus, any program employing health professionals to
keep a SERE-based interrogation program safe was not only
illegal and unethical, but it was experimental. The CIA’s
own Inspector General’s report supports the assertion that
OMS personnel did not believe that sufficient information
and adequate review had existed at the time the tactics were
authorized to support judging them either medically safe or
efficacious.
Furthermore, simply saying this conduct was illegal
and unethical does not fully describe the problem of having health professionals serve as “safety officers.” A doctor
who robs a bank has done something illegal, in a manner not
directly related to his or her professional skills. Similarly, a
doctor who accepts sexual favors from a patient in exchange
for standard medical care is, among other things, guilty of
unethical professional misconduct in a manner that brings
harm to the patient and the profession, but in a manner that
does not involve misapplication of scientific knowledge.
In this case, health professionals were involved in unethical experimentation. Doctors here were engaged in activities that likely involved the infliction of physical and mental
pain and were not following any accepted, established, or
proven medical practice. The activities directly involved
“bad medicine” and “bad science,” and the doctors were not
acting primarily in the patient’s interest, but supporting the
interrogators.
This argument has not been prominent to this point in the
debate over health professional support of the “enhanced”
interrogation program. We believe it is essential to a full
understanding of what occurred. Note that we are separating
the discussion about whether the “safety officer role” was
formal research, from the discussion of whether the role
was experimental by virtue of being without sufficient
scientific basis or clinical standards.
It is important to clarify that we do not concede the legitimacy of the safety officer role on any grounds. But it
must be recognized, however, that it was the key rationale
used to justify the involvement of health professionals used
by the Bush administration and is still used by the current
administration and DoD.

The SERE Studies: A Summary of
Research Findings on the Effects of
“Enhanced” Interrogation Techniques
on Voluntary Soldier-Subjects
In establishing the legal rationale for the torture regime,
the OLC not only cited the health professional presence as a
safety mechanism limiting pain and injury, it also cited expert opinion of health professionals and referenced medical
literature describing the likely effects of these techniques.
We argue that neither the professional opinions nor the literature cited were a good-faith, accurate representation of the
limited state of knowledge regarding the health effects of
the “enhanced” interrogation techniques. In fact, the SERE
studies demonstrate that even mild applications of EITs
were harmful, despite incomplete measures of their physical
and psychological effects.
A review of the literature describing the experience of US
servicemen subjects in the survival training programs (SERE)
clearly established several facts. First, the techniques resulted
in marked stress responses as indicated by significant hormone spikes and troughs, and significant adverse psychological effects. In other words, the literature demonstrated that
these techniques were likely to cause significant harm to the
subjects even though they were exposed to limited forms of
EITs, provided their consent for the study, and were able to
stop their participation at any time. The OLC discussion does
not demonstrate an appreciation of these risks, nor does it
document a balanced review of these data, including marked
differences between consenting US servicemen and “suspected terrorists” detained in US custody.
SERE subjects were volunteers who gave consent; they
could terminate consent during the exercise; and they were
exposed to limited application of the interrogation techniques
over a short and discrete period of several days. In addition,
the context of the experience differed greatly — especially
the uncertainty regarding possible injury and/or death as well
as the purpose and meaning of the harm inflicted, since SERE
participants understood that their discomfort could serve a
useful, even patriotic, purpose by helping to protect future US
military personnel subjected to torture.
In addition, the SERE literature documents that the techniques as applied in these studies differed markedly from
the techniques as applied in the field on detainees undergoing “enhanced” interrogation.
Understanding the state of knowledge about the physical and psychological effects of the EITs at the time the
EI program began is essential for assessing whether or not
the tactics health professionals were supervising could be
deemed experimental. The CIA OIG report, among other
Bush administration documents now in the public record,
specifically cites extant SERE/JPRA (Joint Personnel

Evidence of Human Subject Research and Experimentation in the “Enhanced” Interrogation Program

19

Recovery Agency) research as the basis for the legal analysis conducted by the DoJ and other administration lawyers,
including the attorney general, of the EITs.
OTS also solicited input from DoD /Joint Personnel
Recovery Agency (JPRA) regarding techniques used in
its SERE training and any subsequent psychological effects on students. DoD / JPRA concluded no long-term
psychological effects resulted from use of the EITs,
including the most taxing technique, the waterboard, on
SERE students. The OTS analysis was used by OGC
[Office of General Counsel] in evaluating the legality of
techniques.7
The SERE studies provide information on the very techniques that were later “reverse-engineered” and deployed
as the EIP. The SERE studies not only demonstrate that the
EITs carried high risk of harm; they serve as a foundation
for understanding that:
1.	more severe and prolonged applications of EITs would
likely result in increased harm;
2.	the differences between volunteer US soldiers and
detainees in US custody would likely amplify the
physical and psychological harm associated with EITs;
3.	the physical and psychological effects of EITs were
not adequately measured (e.g., 96% experienced
dissociative symptoms, which can lead to posttraumatic stress disorder (PTSD), but PTSD and other
trauma-related conditions were not assessed); and
4.	systematic medical monitoring would be necessary to
know the effects of EITs under an entirely different set
of circumstances.
Among other findings, the SERE studies indicated that
the exposure of the soldier-subjects to the “uncontrollable
stress” of the survival training exercise produced “rapid and
profound changes in cortisol”8 and other stress hormones.
The cortisol levels measured were found to be high enough
to produce immune suppression and adversely affect memory and were comparable to levels measured in subjects
undergoing major surgery.9 Norepinephrine and epinephrine
(noradrenaline and adrenaline) levels were comparable to
levels measured in novice parachutists and during tracheal
suctioning in intubated patients.10 The protective neuropeptide, NPY, was found to be rapidly depleted during the short
7.	 Central Intelligence Agency, Office of Inspector General.  Counterterrorism Detention and Interrogations, Special Review. Central Intelligence
Agency (2004): 14. Web. 11 Mar. 2010. <http://www.gwu.edu/~nsarchiv/
torture_archive/20040507.pdf>. (Emphasis added).
8.	 Morgan, C. A., et al. “Hormone Profiles in Humans Experiencing
Military Survival Training.” Biol Psychiatry 47.10 (2000): 891-901. Print.
9.	 Morgan, C. A., et al. “Plasma Neuropeptide-Y Concentrations in Humans
Exposed to Military Survival Training.” Biol Psychiatry 47.10 (2000): 902909. Print; Morgan, C. A., et al. “Hormone Profiles in Humans Experiencing
Military Survival Training.” Biol Psychiatry 47.10 (2000): 891-901. Print.
10.	 Morgan, C. A., et al. “Relationship Among Plasma Cortisol,
Catecholamines, Neuropeptide Y, and Human Performance During Exposure
to Uncontrollable Stress.” Psychosomatic Medicine. 63.3 (2001): 412422. Web. 17 Mar. 2010 <http://www.psychosomaticmedicine.org/cgi/
reprint/63/3/412>.
20 	

Experiments in Torture

exercise,11 and testosterone levels were reduced by over
50% (all participants studied were men).12
The SERE literature describes significant limitations in
the investigators’ understanding of how the complex neuroendocrine and psychological responses to uncontrollable
stress are mediated. Subject follow-up studies are too short
to provide any insight into the risk of development of adverse sequelae to the groups such as long-lasting immune
dysfunction, endocrine dysfunction, or PTSD and related
disorders.
Finally, the SERE studies are important in establishing
that the EITs were known to be harmful among consenting
soldier-subjects and, therefore, likely to be much more harmful among detainees in US custody exposed to more intense
forms of EITs. Even if the SERE studies did not demonstrate harm among volunteer soldier-subjects, their application to an entirely different population under very different
circumstances would have to be considered experimental at
best. When these techniques were applied to US soldiers in
a mock setting and were monitored by health professionals,
that protocol was submitted for approval by an institutional
review board and the informed consent of the subject was
obtained. The EI program deployed these techniques and
monitoring on a vulnerable detainee population in a much
higher risk setting (in terms of uncontrollable psychological stress and its physical response) and did so for durations
that greatly exceeded the experimental training setting. The
SERE studies demonstrate that health professionals who
monitored the EITs should have known that severe physical
and psychological harm was likely and that their presence in
assessing thresholds for “severe and long-lasting” physical
and mental pain and applying their medical knowledge to
calibrate the level of pain inflicted constituted complicity in
both torture and human experimentation.

Detailed Summary of Military
Survival Training (SERE) Studies and
What They Teach Us about
the Effects of “Enhanced”
Interrogation Techniques
The literature describing the results of the SERE studies13
warrants review because these studies confirm that, even in
mock settings, EITs have significant adverse physical and
mental health effects.

11.	 Morgan, C. A., et al. “Plasma Neuropeptide-Y Concentrations in
Humans Exposed to Military Survival Training.” Biol Psychiatry 47.10
(2000): 902-909. Print.
12.	 Morgan, C. A., et al. “Hormone Profiles in Humans Experiencing
Military Survival Training.” Biol Psychiatry 47.10 (2000): 891-901. Print.
13.	 For convenience, the group of studies involving survival training
including interrogation components will be referred to throughout as “SERE
studies.” However, it should be noted that not all papers refer to SERE
explicitly.

Among the goals of the SERE program is to increase
soldiers’ resistance to stress, particularly in detention and
interrogation, in order to prepare them for the possibility of
becoming prisoners in time of conflict. With this in mind,
investigators have worked with the SERE program to study
soldiers’ reactions to a mock survival program that involves
evading capture, eventual capture, and interrogation. At the
same time, investigators and the SERE program share a goal
of identifying subject characteristics associated with resistance to stress, and potentially developing ways to reduce
soldiers’ stress responses to intentionally harmful interrogation tactics.
Physicians for Human Rights has described the adverse
health effects of “enhanced” interrogation in earlier reports
involving extensive review of the literature of torture survivors and occupational health, government documents in
the public domain, and firsthand evaluation of survivors of
the “enhanced” interrogation program.14 The SERE studies,
however, represent another important source of scientific
evidence and provide insights into of the effects of the techniques on human subjects.
The SERE studies expanded upon a literature examining
the link between various measurable phenomena such as
stress hormone levels, heart rate variability, psychological
state (as measured by standardized psychological assessment tools) and the development and treatment of stressrelated pathology such as PTSD15 and of studies of soldiers
in other stressful settings such as skydiving.16

Methodology of SERE Studies
Although the various SERE studies differ in their focus
and measurements, the SERE or SERE-like survival component was common to all of them. In a curious lack of clarity
for a peer-reviewed paper, one of the earliest SERE studies
describes the methodology by saying, “The methodology
employed in this study has been reported elsewhere,” and
14.	 Physicians for Human Rights. Aiding Torture: Health Professionals’
Ethics and Human Rights Violations Revealed in the May 2004 CIA Inspector
General’s Report. Cambridge: Physicians for Human Rights, 2009. 15 Mar.
2010 <http://physiciansforhumanrights.org/library/documents/reports/
aiding-torture.pdf>; Physicians for Human Rights. Broken Laws, Broken
Lives. Cambridge: Physicians for Human Rights, 2008. 16 Mar. 2010 <http://
brokenlives.info/?page_id=69>; Physicians for Human Rights, and Human
Rights First. Leave No Marks: Enhanced Interrogation Techniques and the
Risk of Criminality. Cambridge: Physicians for Human Rights, 2007. 15 Mar.
2010 <http://physiciansforhumanrights.org/library/documents/reports/
leave-no-marks.pdf>; Physicians for Human Rights. Break Them Down:
Systemic use of Psychological Torture by U.S. Forces. Cambridge: Physicians
for Human Rights, 2005. 16 Mar. 2010 < http://physiciansforhumanrights.
org/library/documents/reports/break-them-down-the.pdf>.
15.	 See, for example, Southwick, S. M., et al. “Neurotransmitter
Alterations in PTSD: Catecholamines and Serotonin.” Seminars in Clinical
Neuropsychiatry, 4.4. (1999): 242-248. Print; see also Southwick, S. M., et al.
“Role of Norepinephrine in Pathophysiology and Treatment of Posttraumatic
Stress Disorder.” Biol Psychiatry 46.9 (1999): 1192-1204. Print.
16.	 See, for example, Chatterton, R., et al. “Hormonal Responses to
Psychological Stress in Men Preparing for Skydiving.” Journal of Clinical
Endocrinology & Metabolism 82.8 (1997). Web. 16 Mar. 2010 <http://
jcem.endojournals.org/cgi/reprint/82/8/2503>.

then goes on to cite unpublished data.17 In the self-described
brief summary that follows, the authors go on to describe subject recruitment, screening, and the informed consent process.
After baseline assessments including physical and psychological assessment and blood tests, the subjects were given
… in as highly realistic manner as possible, a captivity
experience in the Army’s training laboratory (TL). In the
TL, each subject was subjected to intense and uncontrollable stress, and each attempted to avoid exploitation
by their captors. Because of the classified nature of the
course, a detailed description of the individuals is not
possible.18
The authors then state that the stressors were modeled after those experienced by American captives in WWII, Korea,
and Vietnam. The SERE program, of course, has been more
fully described in other sources unrelated to this literature,
and was the basis of the “enhanced” interrogation program.19
While the authors decline to describe specific stressors in
detail for the reasons already stated, they do describe the
use of hostile interrogation, sleep deprivation (subjects were
allowed to sleep 19 minutes in a 72-hour period), exposure
to extreme heat and cold, and food deprivation. All subjects
were monitored by medical staff, and were reevaluated during a recovery period after the training.20

Results
In the studies, a variety of variables were measured, including stress hormone levels (serum neuropeptide-Y, serum and saliva cortisol, testosterone, and thyroid hormones)
and standardized psychological instruments. Those results
were correlated to “behavioral scores” grading soldier performance during the interrogation exercise.

Neuroendocrine Changes
SERE studies demonstrated significant changes in stress
hormone levels comparable to those associated with major surgery or actual combat. In the investigators’ words,
“[t]he realistic stress of the training laboratory produced

17.	 Morgan, C. A., et al. “Plasma Neuropeptide-Y Concentrations in
Humans Exposed to Military Survival Training.” Biol Psychiatry 47.10
(2000): 902-909. Print.
18.	 Morgan, C. A., et al. “Plasma Neuropeptide-Y Concentrations in
Humans Exposed to Military Survival Training.” Biol Psychiatry 47.10
(2000): 902-909. Print.
19.	 Central Intelligence Agency, Office of Inspector General.  Counterterrorism Detention and Interrogations, Special Review. Central Intelligence
Agency (2004): 15. 21. Web. 11 Mar. 2010. <http://www.gwu.edu/~nsarchiv/
torture_archive/20040507.pdf>; Physicians for Human Rights. Aiding
Torture: Health Professionals’ Ethics and Human Rights Violations Revealed
in the May 2004 CIA Inspector General’s Report. Cambridge: Physicians for
Human Rights, 2009: 1-2. 15 Mar. 2010 <http://physiciansforhumanrights.
org/library/documents/reports/aiding-torture.pdf>.
20.	 Morgan, C. A., et al. “Plasma Neuropeptide-Y Concentrations in
Humans Exposed to Military Survival Training.” Biol Psychiatry 47.10
(2000): 902-909. Print.

Evidence of Human Subject Research and Experimentation in the “Enhanced” Interrogation Program

21

rapid and profound changes in cortisol, testosterone, and
thyroid hormone levels.”21
In discussing SERE study results in the following paragraphs of this report, it is essential to appreciate that, in the
words of the investigators — who have researched human
reactions to stress — ‘Multiple neurobiological systems
become activated when animals and humans are threatened
by dangerous stimuli. Complex interactions between brain
regions and neurochemical systems’ are involved.”22
While the research literature described here has added to
the understanding of the human response to uncontrollable
stress, it is clear in reviewing these studies that the understanding of this complex response, and how it might be manipulated to reduce the risk of enduring harm such as PTSD,
is extremely limited.

Cortisol
Cortisol, a hormone produced by the adrenal gland, is
usually referred to as the “stress hormone” because it is involved in response to stress and anxiety. It increases blood
pressure and blood sugar and reduces immune responses,
among many other effects. The SERE studies documented
very high levels of cortisol during interrogation stress (927
nmol/L) that were higher than any other point during the
study, and were higher than those measured in individuals undergoing major surgery (717 nmol/L), continuous
and exhausting exercise (731 nmol/L), or skydiving (450
nmol/L). The authors note that theirs is the first study to
demonstrate that psychological stress significantly increases
bio-available cortisol in humans and also noted that the response varied from subject to subject. The authors note that
the stress-induced elevations of cortisol are of a magnitude
comparable with levels of glucocorticoids (including cortisol) known to be associated with immune suppression, and
provide anecdotal notes of frequent episodes of cellulitis
(skin and soft tissue infections) in survival training subjects.
They also note that cortisol levels measured in their study
are compatible with glucocorticoid-induced memory deficits, and they go on to note “reports by survival school participants that they cannot remember many aspects of their
[training] experience.”23

Norepinephrine and Epinephrine (Noradrenaline and
Adrenaline)
Norepinephrine (NE) and epinephrine (EPI) are the socalled “fight or flight” hormones and they also act as neurotransmitters. The SERE studies noted that interrogation
21.	 Morgan, C. A., et al. “Hormone Profiles in Humans Experiencing
Military Survival Training.” Biol Psychiatry 47.10 (2000): 891-901. Print.
22.	 Southwick, S. M., et al. “Neurotransmitter Alterations in PTSD:
Catecholamines and Serotonin.” Seminars in Clinical Neuropsychiatry 4.4
(1999): 242-248. Print.
23.	 Morgan, C. A., et al. “Plasma Neuropeptide-Y Concentrations in Humans
Exposed to Military Survival Training.” Biol Psychiatry 47.10 (2000): 902909. Print; Morgan, C. A., et al. “Hormone Profiles in Humans Experiencing
Military Survival Training.” Biol Psychiatry 47.10 (2000): 891-901. Print.
22 	

Experiments in Torture

stress resulted in significant elevations in both NE and EPI
(1309.8 pg/ml and 133.2 pg/ml respectively). These elevations were comparable to NE and EPI levels measured in
novice parachutists (900 and 400 pg/ml respectively) and intubated patients undergoing endobronchial suctioning (1673
and 369 pg/ml respectively).24 In earlier studies, the authors
described the evidence for norepinephrine’s role in encoding
of memory for arousing and aversive events and in subsequent re-experiencing symptoms such as intrusive memories
and nightmares, symptoms characteristic of PTSD.25

Neuropeptide-Y (NPY)
NPY is a peptide that is released with neurons containing
norepinephrine and epinephrine and is intimately involved
with the regulation of both central and peripheral noradrenergic functioning. Based on preclinical studies, NPY is
believed to function as an endogenous anxiolytic (a natural
anti-anxiety mediator) that “may buffer the effects of stress
on the mammalian brain.”26 In the SERE studies, the investigators demonstrated that uncontrollable stress significantly
increased NPY levels in humans, and when stress was prolonged, it produced a significant depletion of plasma NPY.
In addition, investigators found that NPY levels were significantly higher in Special Forces subjects than in general
infantry subjects.
The authors describe NPY levels declining within days, and
note that depletion is possible with prolonged stress (meaning
more than a few days) in some subjects. This suggests that
detainees who experience much more intense and prolonged
application of EITs would likely experience marked and prolonged depletion of the anti-anxiety effects of NPY.

Testosterone
Testosterone is a steroid hormone from the androgen
group. Among other effects, it is the principal male sex hormone, and is an anabolic steroid. The SERE studies indicated that serum testosterone levels were reduced by over
50% during interrogation stress and remained reduced during recovery.27

24.	 Morgan, C. A., et al. “Relationship Among Plasma Cortisol,
Catecholamines, Neuropeptide Y, and Human Performance During Exposure
to Uncontrollable Stress.” Psychosomatic Medicine. 63.3 (2001): 412422. Web. 17 Mar. 2010 <http://www.psychosomaticmedicine.org/cgi/
reprint/63/3/412>.
25.	 Southwick, S.M., et al. “Role of Norepinephrine in Pathophysiology
and Treatment of Posttraumatic Stress Disorder.” Biol Psychiatry 46.9
(1999): 1192-1204. Print.
26.	 Morgan, C. A., et al. “Plasma Neuropeptide-Y Concentrations in
Humans Exposed to Military Survival Training.” Biol Psychiatry 47.10
(2000): 902-909. Print. In animal studies, NPY has been shown to produce
behavioral effects similar to benzodiazepine (the class of medications that
includes Valium and Xanax).
27.	 Morgan, C. A., et al. “Hormone Profiles in Humans Experiencing
Military Survival Training.” Biol Psychiatry 47.10 (2000): 891-901. Print.

Thyroid Function
Thyroid studies, including TSH, total and free T3 and T4,28
thyroid hormones T3 (free and total) and total T4 were significantly reduced during interrogation stress, and TSH significantly increased from baseline in the recovery period.29

Psychological Assessment
Investigators employed standardized psychological instruments to measure stress, including a Subjective Units of
Stress Scale, or SUDS, and a valid and reliable self-reporting instrument to measure dissociative experiences referred
to as the Clinician-Administered Dissociative Symptom
Scale, or CADSS.30
Dissociation is a disruption in the usually integrated functions of consciousness, memory, identity, and perception.31
Dissociation (when subjects under stress have altered perceptions such as time moving slowly, feeling as if they were
in a dream, or feeling as if they were watching things from
outside their body), and in particular peritraumatic dissociation, has been associated with the development of PTSD.32
Subjects of the survival training were evaluated using a standardized instrument for measuring symptoms of
dissociation. The investigators found that before and after
“the period of the experiential phase of the training where
soldiers were subject to semi-starvation, sleep deprivation,
lack of control over personal hygiene, and external control
over movement, social contact and communication” the
subjects reported significantly more dissociative symptoms.
Whereas 42% of the subjects had reported dissociative
symptoms prior to acute stress, 96% of them reported dissociative symptoms in response to acute stress, and dissociative symptoms before and after stress were significantly
higher in subjects who had reported perceiving their lives to
be in danger.
Despite the nearly uniform prevalence of dissociative
symptoms among SERE subjects, there was no assessment
of common psychological sequelae to extreme stress such
as PTSD or other anxiety disorders and depression. The
significance of the CADSS findings is difficult to assess,
28.	 TSH is thyroid stimulating hormone, and T3 and T4 are thyroid hormones.
29.	 Morgan, C. A., et al. “Hormone Profiles in Humans Experiencing
Military Survival Training.” Biol Psychiatry 47.10 (2000): 891-901. Print.
30.	 Morgan, C. A., et al. “Relationship Among Plasma Cortisol,
Catecholamines, Neuropeptide Y, and Human Performance During Exposure
to Uncontrollable Stress.” Psychosomatic Medicine. 63.3 (2001): 412422. Web. 17 Mar. 2010 <http://www.psychosomaticmedicine.org/cgi/
reprint/63/3/412>; Morgan, C. A., et al. “Symptoms of Dissociation
in Human Experiencing Acute, Uncontrollable Stress: a Prospective
Investigation.” Am. J. Psychiatry 158.8 (2001): 1239-1246. Web. 17 Mar.
2010 <http://ajp.psychiatryonline.org/cgi/reprint/158/8/1239>.
31.	 American Psychiatric Association. Diagnostic and Statistical Manual
of Mental Disorders. Fourth Ed. Washington, D.C.: American Psychiatric
Association, 2000. Print.
32.	 Ozer, E. J., et al. “Predictors of Posttraumatic Stress Disorder and
Symptoms in Adults: a Meta-Analysis.” Psychol Bull 129.1 (2003); 1243. Print.

as the evaluations were done within days of the exposure,
and there was no long-term follow-up. There was a positive correlation between dissociation and reports of somatic
complaints. Mean dissociation scores for soldier subjects of
survival training on the CADSS scale were 9.7 (SD=5.8)
for Special Forces subjects and 21.3 (SD=14.6) for general infantry subjects.33 For reference, in earlier non-SERE
related studies of subjects not under acute stress, CADSS
scores for subjects with PTSD were 18.9 (SD=118.3), 3.7
(SD=5.2) for patients with schizophrenia, 7.5 (SD=9.6) in
subjects with affective disorders such as anxiety or depression, 1.3 (SD=3.9) in Vietnam veterans without PTSD, and
1.5 (SD=2.5) in healthy control subjects.34
Higher levels of plasma NPY during acute stress exposure were associated with fewer psychological symptoms of
dissociation as well as with superior military performance.35
The SERE studies did not track how dissociation scores
might have changed in the weeks, months, or years after the
training experience. This would have been helpful, since
dissociation has greater association with the risk of developing PTSD.36 Rather, SERE investigators make the striking claim that because the vast majority of their subjects
experience dissociative symptoms, the causal link between
peritraumatic dissociation and PTSD “must be viewed with
caution.”37 This claim is made in the complete absence of
data regarding the number of subjects who go on to have
persistent symptoms of dissociation, and more importantly,
about the number of their subjects who go on to develop
PTSD — which in some cases is only evident decades after
the initial trauma.

Factors affecting level of psychological stress:
unavoidable stress
The authors cite preclinical evidence that “unavoidable
stress” (the subject cannot avoid or manipulate the stressor)
33.	 Morgan, C. A., et al. “Symptoms of Dissociation in Human
Experiencing Acute, Uncontrollable Stress: a Prospective Investigation.”
Am. J. Psychiatry 158.8 (2001): 1239-1246. Web. 17 Mar. 2010 <http://ajp.
psychiatryonline.org/cgi/reprint/158/8/1239>.
34.	 Bremner, J. Douglas, et al. “Measurement of Dissociative States with
Clinical-Administered Dissociative States Scale (CADSS).” Journal of
Traumatic Stress 11.1 (1998): 132. Web. 17 Mar. 2010 <http://userwww.
service.emory.edu/~jdbremn/papers/CADSS%20paper.pdf>.
35.	 Morgan, C. A., et al. “Plasma Neuropeptide-Y Concentrations in
Humans Exposed to Military Survival Training.” Biol Psychiatry 47.10
(2000): 902-909. Print; Morgan, C. A., et al. “Relationship Among Plasma
Cortisol, Catecholamines, Neuropeptide Y, and Human Performance During
Exposure to Uncontrollable Stress.” Psychosomatic Medicine. 63.3 (2001):
412-422. Web. 17 Mar. 2010 <http://www.psychosomaticmedicine.org/cgi/
reprint/63/3/412>; Morgan, C. A., et al. “Neuropeptide-Y, Cortisol, and
Subjective Distress in Humans Exposed to Acute Stress: Replication and
Extension of Previous Report.” Biol Psychiatry. 52.2 (2002): 136-142. Print.
36.	 Bremner, J. Douglas, et al. “Measurement of Dissociative States with
Clinical-Administered Dissociative States Scale (CADSS).” Journal of
Traumatic Stress 11.1 (1998): 126-127 Web. 17 Mar. 2010 <http://userwww.
service.emory.edu/~jdbremn/papers/CADSS%20paper.pdf>.
37.	 Morgan, C. A., et al. “Symptoms of Dissociation in Human
Experiencing Acute, Uncontrollable Stress: a Prospective Investigation.”
Am. J. Psychiatry 158.8 (2001): 1245. Web. 17 Mar. 2010 <http://ajp.
psychiatryonline.org/cgi/reprint/158/8/1239>.

Evidence of Human Subject Research and Experimentation in the “Enhanced” Interrogation Program

23

has a greater impact on neuroendocrine function than “avoidable stress.” They note that subjects of the training exercise
had “no physical or verbal control” over the stressors.38

Variability between subjects
The studies note variability between subjects in both neuroendocrine responses and symptoms of dissociation, and
specifically note more favorable stress responses in Special
Forces subjects compared with general infantry subjects.
The investigators postulate that factors such as prior stress
exposure and personality factors may affect “stress hardiness” or ability to withstand uncontrollable stress.39, 40 They
also note that individual factors prior to stress exposure affect response to acute stress and may affect the risk of development of PTSD, although PTSD was not measured.

Limitations of the Studies
The authors themselves cite a number of limitations of
the studies. They point out that the studies may underestimate the true effects of stress for a number of reasons. First,
they note that their soldier-subjects were “stress hardy” and
note evidence that stress-naïve populations have different neuroendocrine responses. Second, they note that they
were measuring stress in a mock exercise where “subjects
are aware they will not die” and note that the subjects were
volunteers who are able to withdraw from the exercise at
any time. Third, they note the baseline measures were taken
at the classroom phase where it is likely the soldier-subjects
were already experiencing some stress.41 Finally, with regard to standardized psychological assessments, they note
that “[s]oldiers are familiar with psychological testing and
often worry that their responses might negatively affect
their status in training.”42

Later SERE Studies
This review has focused on the state of knowledge regarding the SERE-related research as of 2002, when the
“enhanced” interrogation program was being designed and
deployed. More importantly, this is the period in which some
38.	 Morgan, C. A., et al. “Hormone Profiles in Humans Experiencing
Military Survival Training.” Biol Psychiatry 47.10 (2000): 891-901. Print.
39.	 Morgan, C. A., et al. “Relationship Among Plasma Cortisol,
Catecholamines, Neuropeptide Y, and Human Performance During Exposure
to Uncontrollable Stress.” Psychosomatic Medicine. 63.3 (2001): 412422. Web. 17 Mar. 2010 <http://www.psychosomaticmedicine.org/cgi/
reprint/63/3/412>.
40.	 Morgan, C. A., et al. “Symptoms of Dissociation in Human
Experiencing Acute, Uncontrollable Stress: a Prospective Investigation.”
Am. J. Psychiatry 158.8 (2001): 1239-1247. Web. 17 Mar. 2010 <http://ajp.
psychiatryonline.org/cgi/reprint/158/8/1239>.
41.	 Morgan, C. A., et al. “Hormone Profiles in Humans Experiencing
Military Survival Training.” Biol Psychiatry 47.10 (2000): 891-901. Print.
42.	 Morgan, C. A., et al. “Relationship Among Plasma Cortisol,
Catecholamines, Neuropeptide Y, and Human Performance During Exposure
to Uncontrollable Stress.” Psychosomatic Medicine. 63.3 (2001): 412422. Web. 17 Mar. 2010 <http://www.psychosomaticmedicine.org/cgi/
reprint/63/3/412>.
24 	

Experiments in Torture

psychologists and psychiatrists advised the government that
these techniques were safe. This literature contradicts those
claims. Later SERE studies did expand the understanding of
the effects of uncontrollable stress in the mock training setting, but did not demonstrate the safety or effectiveness of
these techniques, and continued to document risks of harm.

The SERE Studies in the Context
of Alleged Human Experimentation in
the US Torture Program
Consideration of the SERE literature is essential in understanding the development of the US EIP. To begin with,
the SERE program itself was reverse-engineered to develop
the “enhanced” interrogation program. Second, professional
opinions about the effects of the techniques were used to
inform the legal rationale for the program. Third, the experimental framework of these studies intentionally or unintentionally laid the groundwork for unethical and illegal human
experimentation that would follow.
Still, the “enhanced” interrogation program consisted of
techniques long established as physical and psychological
torture. No further experiments were required to demonstrate that these techniques caused and were designed to
cause significant pain and suffering and carried significant
risk of long-term harm.
It is not surprising, therefore, that the studies reviewed
here confirmed that SERE and EI techniques, even when used
in limited and controlled settings, produce harmful health
effects on consenting soldier-subjects exposed to them. The
knowledge of these harmful effects and the understanding
that the physical and mental pain associated with EITs would
likely be much greater among non-consenting detainees in
US custody exposed to more intense forms of EITs, indicate
that the EITs conuld not reasonably be applied without the
intent to cause significant physical and mental pain.
OLC lawyers nonetheless used the SERE studies as part
of their justification for redefining previously recognized acts
of torture to be “safe, legal and effective” EITs. Subsequent
EI policy required health professionals to assume the role of
“safety officers” by monitoring each EIT to ensure, according
to OLC logic, that any pain inflicted did not exceed the legal
thresholds for severe physical or mental pain. The intentional
infliction of pain, whether severe or not, in the absence of
any therapeutic purpose and without informed consent cannot reasonably be construed as ensuring “safety”; it is both
unreasonable and dishonest. As PHR’s analysis demonstrates,
apparent human experimentation, in the form of systematic
medical monitoring of and subsequent application of generalizable knowledge, served other instrumental purposes: to justify previously recognized torture practices, to inform specific
EI practices, and to serve as a potential legal defense against
criminal liability for torture.

Appendix 2

to treat is imminent. In special circumstances, it may be
appropriate to postpone disclosure of information.43

Health Professional Ethics on
Detainee Research and Interrogation
The Bush administration’s apparent research and experimentation on detainees in US custody violated accepted
standards of medical conduct enshrined in the ethics codes
of major American and international health professional
associations, including the American Medical Association
(AMA) and the World Medical Association (WMA).
Each of the associations — with the sole exception of the
American Psychological Association (APA) — prohibits
human subject research without prior informed consent, in
keeping with the Nuremberg Code. All applicable codes of
ethics — even the APA’s weaker human subject protections
— can be read to explicitly prohibit the research carried out
on detainees by personnel of the CIA’s Office of Medical
Services (OMS).
Universally recognized standards of health professional
ethics forbid participation in torture and in the act of interrogation itself. Health professionals who participated in
any of the core functions of the OMS program — whether
physicians, psychologists, psychiatrists, or nurses — committed grave violations of their ethics codes. They should
be investigated by the relevant professional associations and
licensing boards and, if found to have been involved, should
face appropriate professional sanctions, including loss of
their ability to practice their professions.

American Medical Association
The AMA’s Code of Medical Ethics prohibits the research
activities of the OMS because it requires that subjects be
thoroughly and accurately informed by a physician before
choosing whether to participate in any research. According
to Section 8 of the AMA’s ethical guidelines, it is mandatory
that physicians abide by this rule unless a subject is unable
physically or otherwise to consent:
The patient’s right of self-decision can be effectively
exercised only if the patient possesses enough information to enable an informed choice. The patient should
make his or her own determination about treatment. The
physician’s obligation is to present the medical facts
accurately to the patient or to the individual responsible
for the patient’s care and to make recommendations for
management in accordance with good medical practice.
The physician has an ethical obligation to help the patient make choices from among the therapeutic alternatives consistent with good medical practice. Informed
consent is a basic policy in both ethics and law that physicians must honor, unless the patient is unconscious or
otherwise incapable of consenting and harm from failure

The AMA’s Code of Ethics also states that health professionals are prohibited from using their skills and expertise
in interrogations, and are prohibited from being involved in
any form of interrogation, whether the involvement is direct
or indirect. They also cannot monitor or participate in interrogations in any way—all principles that OMS physicians
violated:
Interrogation is defined as questioning related to
law enforcement or to military and national security
intelligence gathering, designed to prevent harm or
danger to individuals, the public, or national security.
Interrogations are distinct from questioning used by
physicians to assess the physical or mental condition
of an individual. To be appropriate, interrogations must
avoid the use of coercion — that is, threatening or causing harm through physical injury or mental suffering. In
this Opinion, “detainee” is defined as a criminal suspect,
prisoner of war, or any other individual who is being
held involuntarily.
Physicians who engage in any activity that relies on their
medical knowledge and skills must continue to uphold principles of medical ethics. Questions about the propriety of
physician participation in interrogations and in the development of interrogation strategies may be addressed by balancing obligations to individuals with obligations to protect
third parties and the public. The further removed the physician is from direct involvement with a detainee, the more
justifiable is a role serving the public interest. Applying this
general approach, physician involvement with interrogations
during law enforcement or intelligence gathering should be
guided by the following:
1.	Physicians may perform physical and mental
assessments of detainees to determine the need for and
to provide medical care. When so doing, physicians
must disclose to the detainee the extent to which
others have access to information included in medical
records. Treatment must never be conditional on a
patient’s participation in an interrogation.
2.	Physicians must neither conduct nor directly
participate in an interrogation, because a role as
physician-interrogator undermines the physician’s role
as healer and thereby erodes trust in the individual
physician-interrogator and in the medical profession.
3.	Physicians must not monitor interrogations with the
intention of intervening in the process, because this
constitutes direct participation in interrogation.
4.	Physicians may participate in developing effective
interrogation strategies for general training purposes.
These strategies must not threaten or cause physical
43.	 American Medical Association, AMA’s Code of Ethics 8.08. Web.
12 May 2010 <http://www.ama-assn.org/ama/pub/physician-resources/
medical-ethics/code-medical-ethics/opinion808.shtml>.

Evidence of Human Subject Research and Experimentation in the “Enhanced” Interrogation Program

25

injury or mental suffering and must be humane and
respect the rights of individuals.
5.	When physicians have reason to believe that
interrogations are coercive, they must report their
observations to the appropriate authorities. If
authorities are aware of coercive interrogations but
have not intervened, physicians are ethically obligated
to report the offenses to independent authorities that
have the power to investigate or adjudicate such
allegations.44

American Psychiatric Association
In May 2006, the American Psychiatric Association45 adopted an ethical prohibition against direct participation by
psychiatrists in interrogations; as an affiliate organization of
the AMA, it also abides by AMA guidelines on human subject research and interrogations.

American Psychological Association
Amendments to the APA’s ethics code in 2002 weakened
human subject research protections. The APA changes allowed a waiver of the requirement for prior informed consent in circumstances “where otherwise permitted by law or
federal or institutional regulations.”46 While the APA ethics
standards for research offer significantly less protection than
the codes of the other associations, the “enhanced” interrogation program (EIP) research program still appears to violate the amended APA code.
There is no evidence in the public record that the Bush
administration provided health professionals with an official
exemption from the Common Rule, the federal regulations
governing federally funded human subject research.47 Thus,
the 2002 APA ethics code as currently written does not protect psychologists involved in EIP research from ethics violation charges as long as the Common Rule applies.

44.	 American Medical Association, AMA’s Code of Ethics 2.068. Web.
12 May 2010 <http://www.ama-assn.org/ama/pub/physician-resources/
medical-ethics/code-medical-ethics/opinion2068.shtml>.
45.	 Ibid.
46.	 American Psychological Association. “Ethical Principals of
Psychologists and Code of Conduct—Standard 8: Research and Publication.”
American Psychological Association, 2010. Web. 12 May 2010. <http://
www.apa.org/ethics/code/index.aspx>.
47.	 45 C.F.R. § 46.102(d) (2005)
26 	

Experiments in Torture

United Nations
The UN document called Principles of Medical Ethics
relevant to the Role of Health Personnel, particularly
Physicians, in the Protection of Prisoners and Detainees
against Torture and Other Cruel, Inhuman or Degrading
Treatment or Punishment prohibits the involvement of OMS
health professionals in interrogations. Under the UN principles, a health professional would violate medical ethics by
using medical experience and expertise to facilitate interrogations of detainees:
It is a contravention of medical ethics for health personnel, particularly physicians: To apply their knowledge
and skills in order to assist in the interrogation of prisoners and detainees in a manner that may adversely affect
the physical or mental health or condition of such prisoners or detainees and which is not in accordance with
the relevant international instruments...48

World Medical Association
The WMA Medical Ethics Manual, which was adopted
from the Declaration of Helsinki (DoH),49 requires written documentation of informed consent by the subject. The
manual also guarantees the right of research subjects to terminate their involvement in research at any point:
The DoH, like other research ethics documents, recommends that informed consent be demonstrated by having
the research subject sign a ‘consent form’ (paragraph
24). Many ethics review committees require the researcher to provide them with the consent form they
intend to use for their project. In some countries these
forms have become so long and detailed that they no
longer serve the purpose of informing the research subject about the project.
In any case, the process of obtaining informed consent
does not begin and end with the form being signed but
must involve a careful oral explanation of the project and
all that participation in it will mean to the research subject.

48.	 The United Nations. Principles of Medical Ethics relevant to the Role
of Health Personnel, particularly Physicians, in the Protection of Prisoners
and Detainees against Torture and Other Cruel, Inhuman or Degrading
Treatment or Punishment. Adopted by General Assembly resolution 37/194
of 18. December 1982. Web. 16 May 2010. <http://www.un.org/documents/
ga/res/37/a37r194.htm>.
49.	 World Medical Association. The Declaration Of Helsinki. WMA, 2008.
Web. 12 May 2010. <http://www.wma.net/en/30publications/10policies/
b3/17c.pdf>.

Moreover, research subjects should be informed that they
are free to withdraw their consent to participate at any time,
even after the project has begun, without any sort of reprisal
from the researchers or other physicians and without any
compromise of their healthcare.50
The WMA’s guidelines on interrogations also prohibit the
use of medical expertise to aid in interrogation practices on
detainees, and provide that a physician must report to authorities any breach of the Geneva Conventions:
When providing medical assistance to detainees or prisoners who are, or who could later be, under interrogation, physicians should be particularly careful to ensure
the confidentiality of all personal medical information.
A breach of the Geneva Conventions shall in any case be
reported by the physician to relevant authorities.
The physician shall not use nor allow to be used, as far
as he or she can, medical knowledge or skills, or health
information specific to individuals, to facilitate or otherwise aid any interrogation, legal or illegal, of those
individuals.51

50.	 World Medical Association. The WMA Medical Ethics Manual.
Ferney–Voltaire: WMA, 2005: 105. Web. 10 May 2010. <http://www.wma.
net/en/30publications/30ethicsmanual/pdf/chap_5_en.pdf>.
51.	 World Medical Association. WMA Declaration of Tokyo - Guidelines
for Physicians Concerning Torture and other Cruel, Inhuman or Degrading
Treatment or Punishment in Relation to Detention and Imprisonment.
Adopted by the 29th World Medical Assembly, Tokyo, Japan, October
1975, and editorially revised at the 170th Council Session, Divonne-lesBains, France, May 2005 and the 173rd Council Session, Divonne-lesBains, France. 20 May 2006. Web. 16 May 2010. <http://www.wma.net/
en/30publications/10policies/c18/index.html>.
Evidence of Human Subject Research and Experimentation in the “Enhanced” Interrogation Program

27

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© 2010, Physicians for Human Rights

 

 

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