Human Rights in the Military: The Role of Psychology

FAILING ETHICS 101: PSYCHOLOGISTS,

THE U.S. MILITARY ESTABLISHMENT,
AND HUMAN RIGHTS
J. Wesley Boyd, Alice LoCicero, Monica Malowney,
Rajendra Aldis, and Robert P. Marlin
The American Psychological Association (APA) has long maintained a
close, even symbiotic, relationship with the Department of Defense (DOD)
and the Veterans Administration (VA). Herein we highlight these close ties
and describe psychologists participation in interrogations by U.S. military
and intelligence entities. We then review the APAs statements about the
permissibility of psychologist participation in the interrogation and torture
of suspected terrorists. These issues are significant in and of themselves
and because the VA and DOD have been described as growth careers
for psychologists of the future (1). Additionally, the Health Care Personnel
Delivery System allows the drafting of civilian clinical psychologists into
military service even in the absence of a general draft. In light of psychol-
ogists extensive involvement in the interrogation process of suspected
terrorists, and the possibility that psychologists without prior military experi-
ence may be drafted, we wondered how much psychologists have been taught
about their ethical duties should they find themselves in military settings.
The results of our pilot study of U.S. psychology graduate students, which
assessed their knowledge of military ethics, raise concerns that psycholo-
gists receive inadequate formal training in these matters. This may leave
psychologists vulnerable to misinformation about proper ethical conduct in
their future work.
Psychology in the United States has a longstanding, close relationship with
the military. Psychologists contributed significantly to the U.S. military effort in
both World Wars, including evaluating new recruits, assisting in the treatment of
International Journal of Health Services, Volume 44, Number 3, Pages 615625, 2014
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615
soldiers with shell shock, and offering advice about the enemy in order to
make interrogations more effective (2).
After World War II, the relationship between psychology and the military
took new and various forms. The Army and the Navy, for example, utilized
psychological input and consultation in addressing various Cold War issues and
tactics, including mind control and sensory deprivation. U.S. Department of
Defense (DOD) funding went to leaders within the American Psychological
Association (APA) and actually drove the research agenda of the APA in par-
ticular and the discipline in general (2). Psychology became so integral to the
DOD that by 1952, 78 percent of all federal funding to psychology came through
the DOD. By 1960, the DOD was spending almost its entire US$15 million
social science research budget on psychology, equivalent to roughly US$120
million in todays dollars (2).
The APA has experienced dramatic growth over the last 70 years. Between
1945 and 1970, the APAs membership grew from just over 4,000 to more than
30,000. Today the APA has approximately 134,000 members (3). Many credit
the prominence that psychology achieved through its work in the military as
pivotal to the growth of the APA: The burgeoning of psychology from a small
academic discipline to the largest of the social sciences with 70 percent prac-
titioners would have been unimaginable without the resources, support, and
respect of the DOD and CIA (4).
This close relationship continues to this day, and research in psychology
in academic settings still depends largely on military funding. The behavioral
science research budget of the DOD is approximately US$400 million annually,
with the majority devoted to psychological research, dwarfing other funders of
psychological research (4).
At the outset of the U.S. War on Terror in general and Operation Iraqi Freedom
in particular, the U.S. government condoned interrogation tactics that were his-
torically considered to constitute torture. It has been reported that psychologists
conceived of the entire interrogation system employed by U.S. interrogators
and, in some instances, informed interrogators about prisoners phobias and
other psychological vulnerabilities that could be exploited during interrogation
(58). For instance, an Army psychologist reportedly wrote to interrogators at
Guantanamo about an inmate, He appears to be rather frightened, and it looks
as if he could break easily if he were isolated from his support network and made
to rely solely on the interrogator.Make him as uncomfortable as possible.
Work him as hard as possible (9).
GENEVA CONVENTIONS AND OTHER
INTERNATIONAL STANDARDS
The Geneva Conventions are clear that prisoners of war are only obligated
to divulge their name, service type, rank, and nothing more. The dictates to their
616 / Boyd et al.
captors are clear: No physical or mental torture, nor any other form of coercion,
may be inflicted on prisoners of war to secure from them information of any kind
whatever. Prisoners of war who refuse to answer may not be threatened, insulted,
or exposed to unpleasant or disadvantageous treatment of any kind (10).
Although the Geneva Conventions ban threatening, coercing, humiliating,
degrading, injuring, or murdering prisoners of war for any reason, psychologists
who have participated in interrogations of prisoners might not have been aware
that they were engaged in conduct that violates international agreements. During
President George W. Bushs two terms in office, the U.S. government argued that
prisoners arrested in the war on terror were detainees or enemy combatants
rather than prisoners of war so the Geneva Conventions did not apply to
their treatment, a position with which many ethical and legal analysts disagreed
(11, 12). Psychologists without prior knowledge of international codes such
as the Geneva Conventions and the Nuremberg Conventions, unprepared to
disobey orders that violated these agreements, were likely to be unquestioning
and compliant when told to assist the interrogators. Given that violating the
Geneva Conventions can carry with it a death sentence, the stakes are high (13).
AMERICAN PSYCHOLOGICAL ASSOCIATION STANCE
ON PSYCHOLOGIST PARTICIPATION
IN INTERROGATION
In concert with the Bush administrations efforts to bypass the mandates of
the Geneva Conventions, the APA adopted a position that supported military
psychologists who might decide to violate the organizations own code of ethics if
ordered to take an unethical action. The APA Ethics Code Principle 1.02 in effect
from 2002 and 2010 and the 2005 Report of the Presidential Task Force on
Psychological Ethics and National Security (PENS) allow for psychologists to
participate in interrogations, including those that meet the definition of torture under
international standards: Psychologists may serve in various national security-
related roles, such as a consultant to an interrogation, in a manner that is consistent
with the Ethics Code, and when doing so psychologists are mindful of factors unique
to these roles and contexts that require special ethical consideration (14). It states
further, Psychologists do not engage in behaviors that violate the laws of the United
States, although psychologists may refuse for ethical reasons to follow laws or
orders that are unjust or that violate basic principles of human rights. If there is a
conflict between ethics and the law, the PENS report allows for psychologists to
violate prevailing ethical norms and adhere to the requirements of the law (14). In
so doing, the PENS report attempts to justify and codify what is generally called the
Nuremberg defense, the stance taken by the Nazi doctors at Nuremberg who
declared that they were merely following orders, a position repeatedly rejected by
international courts and ethicists (15).
Psychologists, U.S. Military, and Human Rights / 617
The PENS report angered a number of psychologists, who assert that psychol-
ogists should never participate in interrogations and torture, a stance that the
American Medical Association and the American Psychiatric Association have
adopted for physicians and psychiatrists. As a result, in 2008 the APA adopted
a referendum (approved by 59% of the 14,949 voting members) that concluded
psychologists may not work in settings where persons are held outside of, or in
violation of, either International Law (e.g., the UN Convention Against Torture
and the Geneva Conventions) or the U.S. Constitution (where appropriate), unless
they are working directly for the persons being detained or for an independent
third party working to protect human rights (17). This policy effectively pro-
hibits psychologists from working with the U.S. government in settings such
as Guantanamo Bay. Despite the adoption of this 2008 referendum, to date the
APA has not refuted, rescinded, or otherwise withdrawn support for the PENS
report. Thus, the APA currently holds conflicting positions on the ethics of
psychologist participation in interrogations and torture.
This issue remains vitally important because the historical ties between
psychology and the military remain strong. For example, 7 percent of APA
members are employed directly by, or are working directly with, the DOD, and
5 percent of licensed psychologists in the United States are employed by the
Veterans Administration (VA) (18, 19). The VA is also the largest provider
of internships in clinical psychology in the United States, with 106 locations
offering approximately 480 internship positions, 16 percent of the 3,071 intern-
ships available nationwide in 20112012 (20, 21). In addition, the APA has
cited the DOD and the VA as growth areas where more psychologists will be
needed, especially given the large number of active service personnel who suffer
psychological injury and will require further care in the VA systemlong after they
leave active service (1).
HEALTH CARE PERSONNEL DELIVERY SYSTEM
The APA position on psychologists role in interrogation is important not only
because of the large number of psychologists currently working with and in the
military, but also because of the existence of the Health Care Personnel Delivery
System (HCPDS) (22). The HCPDS is a plan for drafting health care personnel
into military service in a time of crisis. It was authorized by Congress in 1987 and
remains in place. Congress and the president can activate this process and begin
drafting civilian health care personnel, including psychologists, in a matter of
weeks. The HCPDS allows for few exemptions and assumes a priori that pro-
fessionals practicing in the civilian sector are physically fit for military service.
Thus, were the government to implement it, the HCPDS would rapidly place
numerous private psychologists into military service.
Based on previous studies of medical students, we hypothesized that most
psychology students would not know about the existence of the HCPDS, and
618 / Boyd et al.
would be largely unfamiliar with the mandates of international ethical standards
and agreed-upon conventions (23). Inadequate knowledge and instruction on
ethical issues are of particular concern given the APAs lack of clear ethical
guidance for military psychologists.
SURVEY OF GRADUATE STUDENTS
To explore psychology students knowledge of military psychologists ethical
responsibilities, we developed an Internet survey and, with Cambridge Health
Alliance Institutional Review Board approval, distributed it to graduate students
in clinical psychology programs in several U.S. states. Utilizing contacts at
graduate schools, we distributed the survey to students in 20 psychology graduate
programs and received a total of 185 responses. Since we are unable to ascertain
how many students received the e-mail invitation to complete the survey, we
cannot calculate an exact response rate; however, we believe about 2040 percent
of those who received the survey completed it. Thus, we report our findings as
preliminary and suggest that they warrant more rigorous study.
Of our respondents, 81 percent were female, 82 percent were members of
the APA, and 6 percent had present, past, or future obligations for military
service (see Table 1). The vast majority of respondents, 73.6 percent, had received
less than one hour of training in military ethics while in graduate school;
23 percent had received between one and five hours of such training; and only
3.4 percent had received more than five hours.
Many of the psychology graduate students in our survey did not know about
some of the major connections between the profession of psychology and the
U.S. government (see Table 2). For example, although 57.5 percent were aware
that the VA is the single largest provider of internships for psychologists, only
13.7 percent were aware that 7 percent of APA members work with or for the
DOD. Only 5.1 percent were aware of the HCPDS.
If drafted into military service, 14.4 percent of our respondents said they
would volunteer for service. Most would not volunteer: 43.1 percent would
await draft notification, 27.0 percent would use all legal means to avoid service,
11.5 percent would consider emigration, and 4.0 percent would refuse military
induction as an act of civil disobedience.
While almost three quarters of respondents said that they were either
very familiar or somewhat familiar with the Geneva Conventions, only
36.7 percent correctly answered that the Geneva Conventions apply regard-
less of whether or not ones country has formally declared war. When asked
which wounded individuals should be treated first, 57.2 percent of our sample
answered correctly that physicians should treat the sickest first, regardless of
nationality. Just over one quarter (26.5%) incorrectly answered that they should
treat their own soldiers according to level of severity and then attend to the
wounded enemy.
Psychologists, U.S. Military, and Human Rights / 619
We asked about acceptable interrogation practices according to the Geneva
Conventions if a prisoner is refusing to answer questions about a recent skirmish
in which U.S. soldiers died. Almost half (49.7%) of respondents did not know
that the Geneva Conventions stipulate that it is never acceptable to deprive
prisoners of war of food or water, expose them to physical stresses such as heat,
cold, and uncomfortable positions, or threaten them with physical violence even
if these threats are not carried out.
We asked under what circumstances an officer is ethically required to disobey
a direct order froma superior and offered the following options: (a) when ordered
to threaten a prisoner with injection of a psychoactive drug that will not actually
be administered; (b) when ordered to inject a harmless bolus of saline into a
prisoner who fears he is receiving a lethal injection; (c) when ordered to inject
a lethal drug into a prisoner; (d) all of the above; (e) none of the above. Only
52.1 percent correctly answered all of the above.
Many respondents were not fully informed about the APAs stance on psy-
chologists participation in interrogation as outlined in the 2005 PENS report
(whose implications only 24.8% correctly understood), as outlined by the 2008
referendum (55.2% answered correctly) or as outlined in a 2009 APA official
statement (66.5% answered correctly).
620 / Boyd et al.
Table 1
Characteristics of psychology graduate student respondents
(N = 185)
Characteristics Percent
Gender
Male
Female
Present, past, or future obligation for military service
Member of the APA
Hours of training in military ethics in graduate school
Less than 1
15
Greater than 5
Candidate supported in the last U.S. president election
McCain
Obama
Other candidate
Did not vote
18.9%
81.1%
6.0%
82.1%
73.6%
23.0%
3.4%
7.4%
75.4%
1.7%
9.7%
Psychologists, U.S. Military, and Human Rights / 621
Table 2. Psychology graduate students knowledge regarding the Geneva Conventions
and the military draft and their likely responses to a medical draft
Measurement item Percent
Aware that the Veterans Administration is the single biggest sponsor of
internships for psychologists?
Aware that 7 percent of APA members work with or for the
U.S. Department of Defense?
Aware of the Health Care Personnel Delivery System?
Aware that psychologists up to age 44 are draft-eligible?
Aware that psychologists in the civilian sector would be presumed fit for
military service without exemption?
Likely response to a medical draft:
Volunteer for service
Await draft notification
Use all legal means to avoid service
Consider emigration
Refuse military induction as an act of civil disobedience
Self-reported famliarity with the Geneva Conventions?
Very familiar
Somewhat familiar
Not at all familiar
Correctly identified physicians obligations under Geneva Conventions:
Situations in which Geneva Conventions apply
Priorities for treatment of wounded individuals
Acceptable interrogation practices
Situations in which orders must be disobeyed
Correctly identified APAs stance on psychologists participation in
interrogation:
As outlined in the 2005 PENS report
As outlined by a 2008 referendum
As outlined in 2009 official statement
57.5%
13.7%
5.1%
5.1%
4.4%
14.4%
43.1%
27.0%
11.5%
4.0%
4.6%
70.1%
24.7%
36.7%
57.2%
49.7%
52.1%
24.8%
55.2%
66.5%
The PENS Task Force included members with strong ties to the military: six out of nine were either
active or former U.S. military or intelligence personnel and the report was adopted by the APA under
unusually hasty, secretive procedures (16).
DISCUSSION
Our results suggest that graduate students in psychology receive little instruc-
tion in military medical ethics and, consequently, know little about the ethical
requirements for professional behavior of psychologists who serve in the U.S.
military. Given that students from 20 institutions consistently reported little
or no teaching about these matters, we suggest that programs reviewthe content of
their ethics courses and significantly bolster teaching about ethics in general
and international standards and guidelines in particular. Further scientific study
is warranted to fully assess the teaching and knowledge about these issues among
graduate students in psychology.
Several limitations in our survey should be noted. The representativeness
of our sample in unknown. In some instances, we could not calculate response
rates from particular schools. In those cases where we could, our response
rates ranged from 2040 percent. We cannot tell how many students never
received the e-mail containing the survey link, nor, among those who did
receive it, how many never opened the e-mail. Therefore, our observed
response rate likely underestimates the true response rate, perhaps dramat-
ically. It is notable that the responses to each survey item varied little between
schools. Wider participation in future incarnations of our survey should provide
us with more reliable data and should be encouraged by graduate programs in
clinical psychology.
Why is there so little teaching about these matters? It may be that these
issues are not on the minds of most psychologists in their daily work. However,
there is a more worrisome possibility. Given the extent of military funding of
psychological researchand, more generally, the extent to which the military
and professional psychology are intertwinedsuch education might be actively
discouraged by some psychologists who fear that wider education about human
rights might lead to more vocal protest of the APAs failure to repeal the PENS
report and condemnation of psychologists participation in interrogations.
More instruction in these matters might also make psychology doctoral students
less likely to join the APA because of its lack of a clear ethical stance on the
permissibility of psychologist participation in interrogations.
The issue of psychologists participating in military interrogation sessions in
contravention of international norms and standards is a specific instance of a
broader ethical concern, namely that of dual loyalties. Conflicts of interest can
arise when a health professional is expected to adhere to good ethical practice,
but is also expected to follow the orders of an institution with goals and
responsibilities beyond health care. Such is potentially the case for military
physicians, nurses, and medics, as well as psychologists. Psychologists and
other health professionals who are not properly educated about their duties in
military settings might fail to navigate their dual loyalties in as ethical a manner
as possible (24).
622 / Boyd et al.
Since a large number of psychologists will be military-involved at some
point in their careers, the issue of dual loyalties should be part of the curriculum in
every psychology training program. Such curricula should address the obligations
imposed by the Geneva Conventions and other international codes, as well as
the likelihood of psychologists being drafted under the HCPDS. In order for this
change to take place, the profession as a whole, and the APA in particular, will
have to confront the issue of psychologist participation in military interrogations.
In light of the clear international guidelines about torture, and the fact that the
Nuremberg defense has been consistently rejected by legal and ethical panels
since it was first offered, psychologists should stand on the right side of history,
annul the PENS report, and issue a clarion call for ethical and humane behavior
by all psychologists. We believe that educating psychologists about these matters
ought to begin in graduate school. Waiting to educate psychologists about these
matters until after they have begun military service is too late.
ADDENDUM
In August, 2013, the APA Council of Representatives adopted a resolution that
rescinds the PENS report and maintains that psychologists may not work in
settings where persons are held outside of, or in violation of, either International
Law or the U.S. Constitution unless they are working on behalf of those being
detained (25).
Although this measure represents a significant advance for the APA, we
maintain our call for significantly increased education about human rights during
psychology training to ensure that psychologists are never again susceptible to
succumbing to public opinion or political pressure and adopting positions that
flout international law, much less basic human decency.
Acknowledgments Each of the authors listed on the manuscript except one
(RA) participated in the original conceptualization of the project and in formu-
lating the online survey. All of the authors had full access to all of the survey
results and participated in analyzing those results, composing and editing drafts
of the manuscript, and approving the final draft. We had no outside funding
for this project and we have no conflicts of interest to declare. We would like
to thank Kaja R. Johnson, MA, Richelle S. Allen, MA, and Twyla Wolfe, MA,
for their assistance in distributing our survey.
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Direct reprint requests to:
J. Wesley Boyd, MD, PhD
26 Central Street
Somerville, MA 02143
jwboyd@cha.harvard.edu
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