Consult: David Nicholl, MBChB FRCP PhD

 

International Health Professional Consultation with David Nicholl

Date:  November 4, 2009

80-minute teleconference

Transcribed by Jean Maria Arrigo

Reviewed by David Nicholl  on  November 12, 2009


David Nicholl, MBChB FRCP PhD, is a consultant neurologist and honorary senior lecturer at City Hospital and Queen Elizabeth Hospital, Birmingham, and the University of Birmingham, England. He grew up in Belfast, Northern Ireland and has been active as a human rights activist on Guantanamo as a supporter of Amnesty International and Reprieve.


Teleconference Participants:  Jean Maria Arrigo, Ray Bennett, Jancis Long, David Nicholl, Stephen Soldz. 


Note:  The transcript has been streamlined a bit. 


International Health Professional Consultation with

Northern Irish Neurologist David Nicholl


[Ray Bennett and Stephen Soldz commiserate and joke until others arrive.]


ARRIGO:  Did anyone else have trouble getting on the line?  I did.


BENNETT:  Not that we know of.  But then maybe they had trouble getting on the line.


ARRIGO:  [Laughing] 

Does anyone know the position of the British Psychological Society [BPS] on torture interrogation?  I just found something from a blog1.


[Jancis Long arrives.]


ARRIGO:  It says that in April 2005 they decided against psychologists condoning torture or providing names or instruments, all that stuff.  But in the [blog] summary it says:  the British Psychological Society says no participating in torture, no advising on or training in methods that could be considered torture, but no comment on whether it is okay to act as a consultant to interrogation.  [See the Appendix for the Declaration of the British Psychological Society Concerning Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment].


SOLDZ:  I’ve never known them to have taken a stand.  I know they’ve covered  the issue in their newsletter, because I had correspondence with the editor of the newsletter when he was working on articles, and it’s always a little bit delicate.  He quotes me, but he’s aware that it’s controversial. 


ARRIGO:  So they really haven’t....


SOLDZ:  I don’t think anyone in the world has.


LONG:  I’d be interested to know what their policy is on the British conducting interrogations as opposed to handing over people to the U.S. or the renditions like Binyam Mohamed2 to another country.


SOLDZ:  The issue with them in the past, of course, was Northern Ireland. 


ARRIGO:  So how was that resolved with the doctors?


SOLDZ:  I don’t know what we know where doctors were on that.  I think it was one of those cases where it wasn’t known but it was presumed.  The European Court of Human Rights, I believe, ruled that it was not torture but that it was cruel, inhuman, and degrading treatment.3  The [anti-]torture attorneys that I had contact with said that that ruling would not be the ruling today, that it would be condemned as torture today by the same court.

I would be surprised if there is much interrogation, because in both Iraq and Afghanistan I’m not sure the British are holding many people for any length of time.  There’s probably tactical interrogation, then I wouldn’t be surprised if they turn them over to the Americans or the Iraqis. 


LONG: And I’m not sure who’s in this huge new prison that’s been built at Bagram.  Do you know, Stephen?  There’s a big new prison. 


SOLDZ:  Well, it’s a fraction of the people that the U.S. captures, I believe.  My guess would be probably NATO [North Atlantic Treat Organization].  Do you know, Ray?


BENNETT:  What I know about this I just heard this weekend actually.  The Afghan policy is now:  96 hours and [then] they have to be turned over to the Afghan authorities, unless the U.S. has a prosecutorial reason for keeping them, that they will prosecute.  Then it has to be pretty good.  It has to pass muster.  It can’t just be, “Well, maybe we will, maybe we won’t.” 


SOLDZ:  What are they doing?  So who is in the Bagram prison?


BENNETT:  I think it would be wrong to call it a prison prison.  That kind of denotes a long-term-stay facility.  You know, you go to prison.  This is a collection point, where people are screened, and they stay their 96 hours there, but, like I say, most of them spend no more than four days there. 


SOLDZ:  Well, we know there are people who have been taken from other places around the world and sent there, like they used to be sent to Guantanamo.


BENNETT:  Yes, exactly, and there will be a long-term detention part of it, but it’s like a pre-trial confinement.


LONG:  That would be pre-trial by US or UK [United Kingdom] authorities? 


BENNETT:  I can’t speak for the UK.  That would be pre-trial for the U.S. 


SOLDZ:  Is this from internal sources, or is this published stuff?


BENNETT:  No, no, informal sources.  Just speaking in conversation.  I just recently returned from Afghanistan. 


NICHOLL:  Hello, it’s David Nicholl.  Sorry, I’ve been busy. 


LONG:  Welcome!


ARRIGO:  We’re very glad that you made it.

The way we usually proceed is we all give short introductions, then we ask our consultant for a longer introduction, then go onto the specific topic of the day.  About 15 minutes before the close of our meeting, I call time and check whether anyone has special questions they haven’t gotten to ask.  So, if that’s okay with you, we’ll start introductions with Stephen, Jancis, whom you know, Ray, me, and then you.


NICHOLL:  Okay.


SOLDZ:  Hi.  I’m Stephen Soldz.  I’m a psychologist in Boston, and I’ve been very active and written a lot about psychologists involved in torture interrogations.


LONG:  I’m Jancis Long.  I’m a clinical psychologist.  I’m the Past President of Psychologists for Social Responsibility, and I might mention that Stephen Soldz is the President Elect.  I, too, have been very involved in the clash between military ethics and medical ethics.  I’m very interested in learning the sensibilities in Britain on these issues.  We really welcome you being here, David.


BENNETT:  Hello.  I’m Ray Bennett.  I’m a retired army warrant officer.  I was an interrogator for over 20 years.  And I’m involved with the group as a subject-matter expert on interrogation policy and that interface between psychologists and the interrogation process — of which there was so much bad press in recent years.  It’s gotten better, but I’m still with the group, like I said, as the subject-matter expert on interrogations.


ARRIGO:  I’m Jean Maria Arrigo, a social psychologist, an independent scholar, also an oral historian.  Since around 1995 I’ve been working with military and intelligence professionals on moral issues and trying to assist their moral voices to the public, which is how I came in contact with Ray.  I’m presently head of this project to develop an ethics casebook for psychologists working in national security settings.  As it turned out, I was a dissident member of the American Psychological Association’s committee to develop guidelines for psychologists in interrogations.


NICHOLL:  Mine’s Dr. David Nicholl.  I’m a consulting neurologist at City Hospital in Queens, Birmingham.  I’m originally from Northern Ireland, which is relevant, and which I should probably say because everyone’s got a political angle there — I’m Protestant, in fact.  But I got involved with the Guantanamo thing just because I was very anxious with the whole War on Terror and detention without  trial, that very similar techniques had been used in Northern Ireland and were actually ineffective.  In fact, you look at the death rates from terrorism essentially trebled during the period of internment.  And I was involved in — There were two specific letters in The Lancet regarding both the involvement of doctors in the forced-feeding regime,4 but also the lack of action from various medical organizations.5 


ARRIGO:  We were discussing, before you came on the line, various issues we want to ask you about.  I think our main interest is in how the health professions came to their positions, or haven’t come to positions [on involvement in abusive interrogations].  In particular, I read about how the British Psychological Society hadn’t taken a position on psychologists giving consultations to interrogations.  This suggests there was a lot of politics behind all this.  If you could help orient us around the politics for health professions in Britain, we would be really pleased.


NICHOLL:  Right.

My area of greatest expertise is what has happened with the hunger strikes and how those were dealt with.  So let me just mention a bit about that. 

I think that if one went back to Northern Ireland around 1980-1981, when the IRA [Irish Republican Army] hunger strikers and Bobby Sands and others died, there’s a misperception that people have that people involved in hunger strike were actually force-fed, which, by and large, wasn’t actually the case.  I think there was one case which went to the High Court, for the family didn’t feel that their relative was competent to make a decision to go on a hunger strike, and I think he was force-fed.  But the other ones certainly weren’t force-fed. 

From a medical-ethical point of view, the Declarations of Tokyo6 and Malta7, the doctors involved with the hunger strike, did actually did follow what happened correctly, which isn’t something a lot of people are aware of.  What is interesting is the history, as I understand it, behind the Declarations of Malta and Tokyo actually goes back to a much earlier hunger strike.  It was 1970-71, when there was an IRA guy [Michael Gaughan, 1974] who was being held in Parkhurst Prison on the Isle of Wight who went on hunger strike.  And the policy then, in the early 1970s, was that prisoners should be force-fed.  He actually died.  The suggestion was that he had some kind of aspiration pneumonia as a consequence of the force-feeding.  There was a lot of anger at that time, both in Britain and also in Ireland, about this.  That really was what let to the British Medical Association and the Irish Medical Association writing the Declaration of Tokyo, which kind of led to this idea that doctors should not be involved in force-feeding of someone who is mentally competent, basically.  So that was the background from the Irish hunger strikes.

Now obviously this can be kind of a fine line.  I’m a little bit unsure what happens in US federal prisons.  But certainly in the UK, if someone goes on a hunger strike now, what would happen is, they would be assessed by a psychiatrist as to whether they’re mentally competent to make that decision.  Perhaps a good example of this would be the Moors murderer who went on hunger strike.  This was a guy who murdered some children in the Northwest, in Manchester, in the 1960s.  I’ll think out his name in a minute —


LONG:  It was Myra Hindley [the accomplice].


NICHOLL:  Myra Hindley, the one with Myra Hindley [Ian Brady] .

Basically, he’s got a psychopathic personality disorder.  He’s been held in prison since the late 1960s.  And in the early 1980s he went on hunger strike because he believed he was going to be moved to a mainstream prison, which wasn’t the case at all.  And the doctors treating him didn’t feel that was really a valid reason to go on a hunger strike.  They actually went to the courts, and the judges backed the doctors that really, under the Mental Health Act [of 1983], he wasn’t competent8, so that his force-feeding was actually treatment under the Mental Health Act.  And he’s been force-fed ever since.

  It doesn’t always work like that.  There was an animal rights protester about three or four years ago who was in prison, I believe, for firebombing some lab that had been involved in animal experiments and decided that he was going to go on a hunger strike.  But it was deemed he was mentally competent.  And he starved and died in prison.9


ARRIGO:  And is it psychiatrists, not psychologists, who generally determine mental competence? 


NICHOLL:  It would generally be psychiatrists, yes. 


ARRIGO:  And you could tell us non-medical people here, are there more or less humane means of forece-feeding?  We hear if Guantanamo Bay of these almost torturous methods of forece-feeding.  But are there humane methods, too?


NICHOLL:  I’m not sure about the Moors murders cases what level of restraint is required.  My impression from having spoken to psychiatrists who were peripherally involved in his case was that he doesn’t make that much of a fuss, although he says he’s on hunger strike, you know, the [chupes _?_] and relatively passively.  I’m not aware of anyone who’s had to use that http://www.restraintchair.com/ type of stuff, that’s been used in Guantanamo.  That’s an unusual situation, to put it mildly.  I should say at this stage that I myself have not been involved with treatment of any hunger strikers as such.  I’m a neurologist.  But I’m basing this on a review of the literature and what other forensic psychiatrists have told me.

Going back to the Irish hunger strikes, it’s quite interesting, the actual neurology behind this.  Of course, none of this was ever published.  But I know from a colleague of mine there was a presentation that was given by one of the pathologists who did the autopsies on the 1980-1981 Irish hunger strikers.  Now they refused everything.  They refused any kind of vitamin supplements or anything else.  And I know from this colleague at that meeting that they all died of Wernicke's encephalopathy.  This is a dementia due to thiamine deficiency that you would get more frequently, say, in alcoholics.  Now I’m sure that if prisoners were being force-fed they would have been given vitamins to avoid that kind of complication.  But it’s quite interesting neurologically that patients would develop Wernicke’s, because the kind of clinical features that you get with Wernicke’s are fascinating— You get patients with increasingly more grandiose delusions, which is kind of odd if they’re being interrogated to get information about terrorism.  They get more and more delusional.

That’s never been published, and that was just a study which the pathologist involved did.  For obvious reasons I’m not going to give the pathologist’s name, but I tracked down the pathologists and e-mailed them to see if they would cooperate.  But they obviously didn’t reply to the e-mail.  You can picture it’s a very, very sensitive issue all around in Northern Ireland. 


ARRIGO:  In this letter that you sent to The Lancet, you had many, many, many medical people who signed on, but the British Medical Association itself didn’t?


NICHOLL:  Ahhhhh, it’s quite an interesting story there as well.


ARRIGO:  Please do tell us that story. 


NICHOLL:  What happened, I knew Clive Stafford Smith, who’s the  legal director of Reprieve, which is a British human rights charity, who act for a number of clients on death row in the States, but also for a number of clients at Guantanamo.


SOLDZ:  Sort of like the British [version of the US] Center for Constitutional Rights.


NICHOLL:  Yep.

Because of my involvement with Amnesty [International] and, somewhat bizarrely, around 2005 I decided to run the London marathon dressed in an orange jumpsuit.  That’s how I got to know Clive, and Clive told me that, first of all, the shackles used in Guantanamo are actually made about two miles away from where I’m currently speaking, which struck me as a little strange.  Then as a consequence, the year before the first Lancet letter, that’s when the hunger strike expanded.  He sent me the affidavits, from prisoners but also from the doctors regarding the treatment of the whole hunger strike situation.  I wasn’t particularly interested in the affidavits from the prisoners, because there’s always the criticism that “prisoners would say that, wouldn’t they?”  The allegations essentially were that large-bore naso-gastric tubes were being used, and the same tube would be used on different prisoners to try to break the hunger strike.  What I was more interested in was the affidavit from Dr. John Edmondson, who was the doctor in charge of Guantanamo at that time.  It was very clear throughout the, I think, 30-page affidavit that the issue of mental competency just hadn’t been discussed.  There was no mention at all of any kind of psychiatric assessment.  Repeatedly, it kept saying, the “involuntary feeding,” as it was called, instead of force-feeding, was justified under he was following orders from higher military authority — which was news to me that a doctor felt forced to do something because he was ordered to do so.... 

Shall I carry on?


Participants:  Yes, yes.  We’re interested in the politics of this.


NICHOLL:  Then what happened was, the affidavit I got from Dr. Edmondson was only about 10 days after it had been written.  So I wrote to Dr. Edmondson, basically quoting him verbatim, and that letter, in effect, was the basis of The Lancet letter.  But I wrote to him, and I didn’t expect he would reply.  I suspect getting a letter from a neurologist in Birmingham [UK] — probably getting a letter from a Martian would be more plausible.  — He wrote back to me, refuting this, saying basically I shouldn’t believe what the press were saying.  So I wrote back say, “Basically I was quoting you in your affidavit.”  He didn’t reply to me since.

At that time I happened to be going to a neurology conference in Australia.  I collared colleagues at the meeting, saying this was what was happening.  “You know, we need to write to an American medical journal about this, to make them aware of the situation.”  And we submitted a letter to the New England Journal of Medicine.  It would have been about November before the first [May 2006] Lancet article, with about 120 signatures on it.  And they then said, “Would you mind holding back because we’re just about to publish an article”10 — this was in the December; I think she’d just been to Guantanamo — a kind of review article about the whole hunger strike and Guantanamo. And literally the second that appeared in the New England Journal of Medicine we submitted — It was certainly well over 150 signatures at that stage.  And it took two months for the New England Journal of Medicine to reject it.  I was pretty infuriated.  In fact, I e-mailed the editor, saying, “I think it’s sad day when the censor’s pen stretches from Camp X-Ray to Massachussets.” 


ARRIGO:  What was their reason for rejecting?


NICHOLL:  They really didn’t have a reason.  They just felt they’d covered the issue sufficiently.  So then I e-mailed Richard Horton, the editor of The Lancet.  It took him about a minute to agree to publish it. 

Now all that time I had Michael Wilkes, who was the Chairman11 of the BMA [British Medical Association], who’d seen the draft, who’d actually helped draft the letter.  And after The Lancet accepted it and after I’d had various lawyers look at it — there’s nothing libelous in it — and at that stage we had 260 people who agreed to submit it — then an e-mail/phone call from Michael Wilkes, saying that the BMA weren’t happy with the wording and they actually tried to reword it, which I wasn’t going to stand for, because I felt every single word in the article was factually correct.  The BMA tried to rewrite it with a kind of medical ethics rubbish, and they weren’t happy to name Dr. Edmondson in the article. 


ARRIGO:  How did this come to the BMA?  What would be their internal structure under which this would come up for consideration?


NICHOLL:  Well, I don’t know.  All I can think of was that Michael Wilks was leaned on by someone else.  Indeed, I wrote another article in the BMJ12 shortly after that pointing out that the BMA had withdrawn basically.  You know, it’s pretty ironic when you think that the BMA has written a textbook about doctors involved in torture.13  I think the exact quote is:  “The role of the national medical association should be to support those doctors who stand up against people using torture.”


ARRIGO:  What I was asking about was the structure of the BMA.  For example, in the American Psychological Association there’s a Council of Representatives, and you go through your representative, or you could write a letter to the president, or there’s a Board, and so on. 


NICHOLL:  Well, it’s very similar.  I haven’t pursued the issue any further, to be honest, in part because there’s a very strong track record of national medical associations making very strong policy statements on torture.  But when it comes to taking an action, they never, ever, ever take any action.  That was the situation in South Africa.  That was the situation with the BMA.  That was the situation with the American Medical Association as well.


SOLDZ:  And the American Psychological Association.


NICHOLL:  Certainly.


LONG:  Yes, indeed.


NICHOLL:  I wasn’t surprised, because that’s what these people do. 


ARRIGO:  In the US these associations, especially the American Psychological Association, have very strong ties with the military, coming out of World War I and World War II, and are heavily funded.  There are a lot of psychologists involved in Homeland Security and entrepreneurial research for national security themes.  Is this also the case in Britain. 


NICHOLL:  I would think much less so.  They just don’t like rocking the boat.  They like writing policy.  They definitely do not like taking action.  I can’t really give you a clear reason for that.  In fact, the Royal College Physicians are actually much more useful in some ways. 

With the first Lancet letter I actually wrote to the American Medical Association.  Well, after the Lancet letter came out, the American Medical Association put out a press release saying how they were opposed to doctors involved in force-feeding and stuff.  So I e-mailed the head of the American Medical Association, pointing out that Dr. Edmondson was actually an AMA member — I knew this because he said so in his affidavit — and what would they do about it.  I never got a reply.  Likewise with the medical board for California and the medical board for Georgia, both of whom didn’t reply. 

And then I was teaching some medical students, in the kind of discussion we’re having now, and I mentioned about the Steve Biko case in South Africa.  And they all looked blank — “Who’s Steve Biko?” — because they’re too young.  I happened to know that this was coming up for the 30th anniversary of Steve Biko’s death.  So we wrote another article for The Lancet, pointing out the comparisons between what happened with Steve Biko and his death, like the medical authorities didn’t do anything basically.  And I wrote to all those bodies pointing out they’d done it, and they all replied.  The American Medical Association said they couldn’t do anything because it was a Board issue.  The medical group for California said they couldn’t investigate a federal prisoner who’s outside their territory.  The medical board for Georgia said they did a full investigation and found that Dr. Edmondson hadn’t done anything unethical.  It took them 11 days to come to this conclusion, from which I estimate they didn’t actually do the investigation.  What they didn’t know was that I had actually shown the same documents to the Royal College of Physicians, who hadn’t been signatories on the original letter.  And their conclusion was — quotes — “If this were to happen in the UK, this would be assault and would be considered a criminal act.”


SOLDZ:  When did you send it to California?  Because they have passed a resolution that would give power to the licensing board now.14

 

NICHOLL:  It was the same year that I sent the original Lancet article.


SOLDZ:  So a couple of years ago. 


NICHOLL:  A couple of years ago. 


SOLDZ:  The situation would be different today.  We might have leverage because we would be to get the legislator who pushed that.  It was passed.  Just to know that there’s been a little bit of progress. 


NICHOLL:  I think that’s terribly important.  If we go back to the Biko analogy, that was an incredibly important case with the way in which South African doctors got viewed.  The whole apartheid era did affect the medical profession as well.  The dean of our medical school at Birmingham was originally from South Africa.  He had to leave.  Otherwise he was going to be arrested basically.  It took several years ultimately before the doctors involved with the initial coverup of Steve Biko’s death got brought to book.  One was struck off and the other one got reprimanded.  And that was actually quite important with the rehabilitation of South African medicine in many ways. 


ARRIGO:  In our medical and psychological associations, we have sections, so there’ll be forensic psychiatrists and this and that.  Is a section of military psychiatrists or military physicians in the British associations?


NICHOLL:  There’s a military division certainly in the BMA, yes.


ARRIGO:  And in our country the military often gives scholarships to medical students and psychology graduate students, and then they owe a certain amount of service.  And if they don’t perform that service properly, they will have to pay back the money and face sanctions.  Do you have that same system?


NICHOLL:  Where I work actually we have the Centre of Defence Medicine, so we have quite a few military doctors that work with us.  Most of the casualties of Afghanistan and Iraq come through my hospital, so we work quite closely with the military on that level.  And we certainly have some students who would be on military scholarships.  It’s much less though than in the US, just because our military’s much smaller.  But certainly that does happen. 

In fact, I was going back to the original Lancet letter.  I was very interested in looking at the medical guidelines that the UK military got and comparing these to the US military.  I haven’t had a chance to look at it more recently, but certainly there was quite a significant difference in terms of the guidelines that were written.  I’d refer you back to [Assistant Secretary of Defense for Health Affairs] William Winkenwerder [Jr, (2001-2007)], who wrote the US guidelines for doctors.15  They don’t make any explicit mention of the Geneva Convention and even suggest that issues of consent depend on issues of trust and national security as well, where the UK guidelines are really explicit the prisoners must  be dealt with according to the Geneva Conventions and international human rights law.  Although I’m sure that there are documented abuses, I don’t think it’s as clear cut, but there are orders from the top.  When you’ve got someone like William Winkenwerder — As far as I can work out, his only association with patients was with the US health insurance industry.  So he’s got a background in medical ethics that’s sketchy, to put it mildly.  [Pause]


LONG:  I would like ask, David, does the UK military do interrogations of people picked up by them in either Iraq or Afghanistan?


NICHOLL:  It’s an interesting question.  The best, worst example was in Iraq, subject to a public inquiry at the moment.  I’m just trying to dig out his name.  If you’ve looked at Steve Miles’s book, Oath Betrayed,16 it looks at some of the UK cases as well.  I think it was Baha Musa17 [in 2003] who had, I think, 76 or 86 separate injuries.  Some very peripheral people were convicted.  But no one at any kind of senior level was convicted with regard to his death.  Presumably there must have been doctors involved with those assessments of his injuries and also his death certificate — why nothing was done in that case.  But that particular case is subject to a public inquiry at the moment.


ARRIGO:  May I shoot out a question to Ray for background information?

Ray, is the tradition of interrogation in the British military different from the tradition in the US?


BENNETT:  Yes, it is.  First important, British military interrogation, at least in the last several decades, has been largely influenced by their experiences in Northern Ireland, say, 30-40 years.  And all those people that I had professional dealings with were shaped, molded by their experiences with Northern Island.  We in the US didn’t have an ongoing operation like that, that would provide us with real-time feedback into effective methods.


LONG:  We’ve had Vietnam!


BENNETT:  I was just getting to that. 

The stuff we did have, such as Vietnam or other various military operations, were significantly different, because the operation in Ireland was characterized as a terrorist operation and a criminal operation versus a military operation, although certainly no one is going to be arguing that the IRA and all the groups didn’t have military capability.  But it was classified as a terrorist or criminal type of interrogation. — I hope our guest will read me the riot act if I’m too far off course here.


NICHOLL:  I think you’re absolutely right.  Many of the same techniques, in terms of hooding of prisoners, sleep deprivation, stress positions, they were all used in Northern Ireland in the early 1970s.  Then the British Government got seriously reprimanded, I think it was by the European Court of Human Rights.18  And Jim Callaghan, who was then Prime Minister (1976-1979), had to apologize in parliament, I think.


BENNETT:  As such, because of those experiences with Northern Ireland and because of the different nature of the interrogations that were being done.  What we were involved in — by “we” I mean myself and my colleagues in the military — we were involved in intelligence interrogations versus criminal interrogations.  There’s a big difference to those two that I’ve always pointed out.19 


NICHOLL:  A couple of quick references I’ve mentioned in terms of the BMA — I’ve just Googled them:  The Medical Profession and Human Rights, which was published in 2006, which covers the issues on national medical associations to support those doctors  that stand up against torture, and the case I mentioned of Baha Mousa [/Musa].  He died on the thirteenth of December of 2003 in Basra.  His death certificate for the Red Cross said the death was due to “cardiorespiratory arrest asphyxia of unknown cause” but did not note other signs of trauma.  That’s currently subject to a public inquiry.20



ARRIGO:  What do you think is the value of texts like this where high principles are proposed but there’s no action.  Is it good to have those texts?


NICHOLL:  That’s a very good point, because I think that the whole process with Guantanamo — not just there but other cases where there’s clearly been abuses by doctors and others — there’s very little teeth to take the people to the courts.  The US, for example, isn’t actually signed up to the International Criminal Court, so there’s no real way in which anyone can take any action against the people involved.  Although the politicians all say, “We’re against torture and won’t do it,” in fact, sadly the whole Geneva Convention is fine words but there isn’t any mechanism to take any action really against the people involved. 


LONG:  The US Supreme Court tried to change some things in Guantanamo by saying they had to follow the Geneva Conventions, although I think there wasn’t that much change following.  But it was one attempt.  I think that having [the declarations] does allow courts sometimes to make some changes. 


ARRIGO:  Well, Ray has spoken forcefully about the value of the Geneva Conventions in his thinking and his colleagues’.  So I was wondering why this wouldn’t have similar effect for the physicians.  [Pause]


NICHOLL:  Is that a question to me? 


ARRIGO:  Uh, no, just a musing.  But here is a question to you.

From the earliest days of psychology [in the US] there was an extreme competition between psychiatrists and psychologists.  In a rough view of history, it was the military that launched psychologists with respect to psychiatrists, because in World War I and World War II, psychologists had theories and techniques for dealing with masses of people and the psychiatrists operated one at a  time.  Right?


NICHOLL:  Ummm.


ARRIGO:  So the military, in a way, you could say, has given the psychologists status and position, as on the BSCT [Behavorial Science Consultation Team] teams in trade for greater compliance — a maybe cynical, way of looking at it.  And I wondered, in the UK historically what is the relation between psychiatrists and psychologists?


NICHOLL:  Because I’m a simple neurologist I’m not sure I can qualify to give an answer on that.  I just think there is always a different view when people are in positions of power.  You get promoted and get medals when you do what you’re told and you get shot down when you don’t.  I haven’t really answered your question.  But one thing I find fascinating is the way a lot of the interrogation techniques, the whole SERE program [Survival, Evasion, Resistance & Escape], seemed to me to be designed in many ways for quite legitimate reasons to help train military troops to protect them, if they’re being captured by the enemy and being tortured.  But to try to use those techniques the wrong way around to interrogate people, I’m surprised almost that some of the psychologists that helped design some of those techniques haven’t been pretty that annoyed that their methodologies are being used in such an abhorrent way.


ARRIGO:  Well, some of the psychologists are [annoyed]. 


NICHOLL:  Well, some of the military psychologists.


ARRIGO:  I’m actually a member of the Division of Military Psychologists in the APA.  One hears murmurs of that very often.  But the fact is the division has voted Larry James, who was one of the principal military psychologists at Guantanamo, as president, made him the spokesperson.  But there are definitely murmurs.  So we have a very complicated problem here.

But the American Psychological Association itself very much promoted the military psychologists who were involved in abusive interrogations in some way.  We don’t know exactly in what way.  The APA put them on the task force to lay out the rules and so on.  So the APA itself was in the position of launching them to the forefront and kind of quieting the other voices.  So if you know anything about how that works in British associations of health professionals, we’d really like to understand some more about the politics over there.


NICHOLL:  I’m not sure we’ve been so directly involved, but I guess this is just what generally happens, a kind of groupthink gets set in and people genuinely believe that they’re doing the right thing.  They feel that supporting the national interest is the right thing to help with these techniques.  That’s what we saw in Germany in the Nazi times.  This is what happens unfortunately.  [Pause]

Also, another thing, “Ian Brady” [the Moors murderer] — that’s what I was trying to remember.  So if you look up Ian Brady and his hunger strike, where he got force-fed — In fact, he’s been on a hunger strike for ten years, I just read in the Liverpool newspaper.  It was the 10th anniversary of his hunger strike last week in the Ashworth Hospital in Merseyside http://www.clickliverpool.com/news/national-news/126659-moors-murderer-ian-brady-marks-10-years-on-hunger-strike.html.


ARRIGO:  Maybe I could turn the conversation in a slightly different direction if we’re talked out on this one. 

We’ve talked to two Israeli psychiatrists and an Israeli psychologist about issues there.  I wondered if you could tell us anything about — The World Medical Association had taken on as its director [president, Dr Yoram Blachar, longstanding President of the Israeli Medical Association]21


NICHOLL:  I know the story, yes, because there’s been a letter.  I have to admit that I’m one of the signatories on that. 


ARRIGO:  Can you tell us about that situation?  Maybe start a little earlier in the story because I think other people on the line aren’t aware of it.


NICHOLL:  I became aware of that about six or seven months ago.  There’s a psychiatrist in London called Derek Summerfield who has been trying to task the situation with patients in Gaza trying to get access to medical treatment but also the allegation regarding the current President of the World Medical Association — I think he’s just changed as of this month.  His name escapes me, even though I signed the letter.  Basically he’s made statements where he’s suggested that physical pressure on prisoners was not torture and that the letter was suggesting that it was completely inappropriate that somebody like the President of the Israeli Medical Association [IMA] to be President of the World Medical Association, given their poor track record of looking at doctors involved in torture.  One of the arguments they [the IMA] made was that they weren’t going to investigate on the basis of the letter because there were a large number of Arab signatures on it.  It seems a little bit ridiculous.


SOLDZ:  In one of the Israeli papers, that was his main defense:  “Look at all the Arabs who are accusing me.”


ARRIGO:  But, in fact, the Israeli Medical Association had not investigated documented problems of torture with doctors?


NICHOLL:  Not at all, had kind of rejected — The Israeli branch of, I think, Physicians for Human Rights or a similar organization just rejected it out of hand. 


ARRIGO:  So he was chairman [President] of the Israeli Medical Association and then went on to be President of the World Medical Association.


NICHOLL:  Correct.


ARRIGO:  This seems, on the face of it, to be astonishing.  Do you have any insight into that?


NICHOLL:  I was one of the 700-plus signatories.  I guess it was similar to what I did with the Lancet letter.  Derek approached me and others, and I saw the letter and the other documentation.  It was interesting because some lawyers were trying to sue Dr Summerfield— He’s been issued with a writ for libel, which I thought was interesting.


LONG:  Who presented this writ?


NICHOLL:  Some lawyers on behalf of the World Medical Association.  It hadn’t gotten to the stage of a writ, but certainly a threatening legal letter to Derek Summerfield, suggesting that unless he retracted this they would be forced to issue a writ for libel.  So I e-mailed the lawyers along the lines of saying, “I don’t know if you remember the lines from Spartacus, but I’m Spartacus too; you’ll have to sue me as well.”  So we haven’t heard anything from them yet.


ARRIGO:  Do you know anything about the World Medical Association?  Are you involved with them at all?


NICHOLL:  Well, I’m a BMA member, and obviously the BMA are members of the World Medical Association.  They’re pretty poor at taking action, as illustrated in the Israeli example, but they haven’t really said much on Guantanamo either, for that matter.


SOLDZ:  Weren’t they originally founded as an organization concerned with human rights in medicine.


NICHOLL:  Yes, all of this.  It goes back to Nuremberg really.  The background of the Geneva Convention can all be traced back to that.  It’s a little bit what I was saying before.  These organizations are extremely good at writing policy but very, very poor at investigating or taking any kind of action.  I guess the difficulty, turning it the other way around, is that there are so many countries which do use torture.  We’ve only just talked about Israel and the US.  But so many countries do use torture, most countries in the Middle East, lots of countries in Asia.  I’m sort of playing devil’s advocate, I guess, because where do you draw the line?  The fact is that they don’t really seem to take any action against any of the —


LONG:  The World Medical Association doesn’t attend to it at all?


NICHOLL:  I would need to do a literature search and see what happens.  The South Africa Medical Association, was it, checked out of the World Medical Association?  I don’t know. I need to look that up.22  I’m trying to think of one instance where a national medical association has been excluded because of its poor record on human rights.


ARRIGO:  In the United States, at least among psychologists, various dissident groups have sprung up.  We’re members of them here, well, except for Ray.  Has that happened in the UK?


NICHOLL:  Well, not particularly.  Although there have been human rights abuses which involved British forces, they have been relatively small.  I’m not convinced that there is evidence of widespread abuse— It’s not as though there’s been a Donald Rumsfeld at the top that’s saying, “I think standing around for six hours is light work,” whatever the quote was that had to do with sleep deprivation.  So I don’t think there’s been the same level of anger.  In fact, in the BMA there’s been policy statements decrying Guantanamo and the polices there.  There’s been very little in the UK about the use of, say, control orders.  And people have been held under house arrest, in effect, in that respect.  There hasn’t been as much coverage in the media, for example.


LONG:  I would be interested in what reactions there have been either supportive or negative to you.  You told us about Michael Wilks, I think, trying to tell you to rewrite your writ.  But like when you ran the marathon or when you’ve been outspoken about the foreced-feeding and things, do you have people trying to recruit you to the humane side of things or saying, “Shut up”?


NICHOLL:  Surprisingly, not really.  When the Lancet article came out, you can get a feel on Google of a kind of lunatic fringe criticizing, but it hasn’t actually been from medics.  It’s been more the lay people who’ve got often fairly extreme right-wing views.  But I haven’t really had any criticism from medical staff. 

One of the funny things, I got approached by Al Jazeera because they wanted to make a documentary about Sami al-Haj, an Al Jazeera cameraman who was held in Guantanamo for a number of years and was force-fed.  I got very irritated when I heard one night some rep from Guantanamo saying that prisoners were being treated humanely, and I had already seen this affidavit.  I just felt that people were being lied to. 

I happened to be in London the following week, and thought we’ll make a day with it.  I’ve got the methodology described in Dr. Edmondson’s affidavit.  I’ll get someone to force-feed me, and then they can see what it looks like.  And I wanted to do that outside of Downing Street [official residence of the Prime Minister].  That would have been an illegal demonstration, so I would have been arrested, which I didn’t particularly want to do.  But the exclusions around Downing Street don’t extend to the US embassy.  I got somebody to put me in a four-point restraint and put a naso-gastric tube down me, which I don’t want to have done again!  Al Jazeera wanted me to do the same thing, but I promised my wife I would never do anything quite so stupid.  And I think the other lesson from this is do a good literature search, because I forgot, of course, that one of the suffragettes actually died from being force-fed.  So don’t try this at home. 

But Al Jazeera came to see me.  We thought that the way to demonstrate this was, I got one of these Resus Annie  dollies that we use to demonstrate CPR23, that we use for doing CPR training on.  And I got it dressed up in an orange jump suit and some handcuffs, and I showed how to put a naso-gastric tube in the throat.

If my boss comes in and sees me with two Arab-looking gentlemen and some KY Jelly and a naso-gastric tube, this isn’t going to look good.  [Laughing]  I haven’t had any problems.


ARRIGO:  Well, I guess we’re about ready for last questions.  Let me take them in this order:  Stephen, Ray, Jancis, and me. 


SOLDZ:  I don’t know that I have any last questions.  I just want to thank you for speaking to us and also for your activism on this issue. 


BENNETT:  I do have a question.  First of all, as a member of group, I’d like to thank you for your participation.  Now, as far as the interrogation aspect of this, and you being a neurologist, as I recall there’s some work being done in the interface of neurology and interrogation, with functional magnetic resonance imaging [fMRI].


NICHOLL:  Yes, a lot of work has been done on fMRI.  Some of it is just looking at different parts of the brain that are involved in how people lie or answer questions.  I’m not really au fait with the literature in terms of military applications of functional MRI, but I can see there could well be an interest in that in terms of looking at interrogations, for example.


BENNETT:  I remember reading a brief article about it — it must have been at least two years ago — into using fMRI as a kind of polygraph machine.  For example, if you did a photo line-up you could tell by certain parts of the brain if that person knew that person or not, or give an indicator towards that.  So, using MRI as an interrogation tool, using neurology and that neurological knowledge, what is the stance of your field on that?  Would it be similar to the problem we’re having with the interface of interrogation and psychology? 


NICHOLL:  I think it would be, except that I think the evidence base for its use in that scenario is probably so weak at the moment. 


BENNETT:  [Overlapping talk] that it would be weak in the public domain.


NICHOLL:  While we were talking I was thinking of other comparisons.  People are also using functional MRI, for example, in looking at people with hysterical limb weakness.  Are they faking it?  There might be a parallel there, if you’re looking at a patient.  Why is it that some patients can apparently fake an injury.  I guess there could be a parallel there.  How do you know if someone is telling the truth using functional MRI.  I just don’t think it’s anywhere near as clear-cut as it might sound to the media. 


BENNETT:  I wouldn’t say it was clear-cut, and I would say it doesn’t need to be clear-cut because — excuse me — half of the crap that was used over the last decade wasn’t clear-cut either. 


NICHOLL:  [overlapping talk]


BENNETT:  Because the only place to nip this stuff is in the bud. 


NICHOLL:  Yes, yes, yes.  It’s a good question.  I haven’t given that much thought, because it’s got a hypothetical.  But I can see, given the amount of money that’s going into interrogation and the war on terror, it wouldn’t surprise me if someone’s putting significant amounts of effort to try to develop those methodologies.


SOLDZ:  They are.  I’m glad Ray raised that.  In the US there’s an initiative under [President Barak] Obama to conduct more research on interrogations, of which this would definitely be part, under the so-called anti-torture people among the intelligence community.  I don’t know if you know Educing Information.24  There was a report from the National Intelligence Council or something [the Intelligence Science Board] that said torture doesn’t work so we need research on what does work, and they’re pushing this kind of thing.  We don’t know about this [fMRI], but we know that there’s evidently pseudoscientific voice analysis systems25 that I know were used in Guantanamo in 2003,26 27 supposedly to detect deception.


NICHOLL:  I’d be very interested in any literature on this.  It’s just not coming up at all, but I’d be glad to look at it further. 


ARRIGO:  As a broad context for this, the psychologists have been trying to find methods to disable, in some way, the detainee, the interrogatee, whereas the tradition of interrogators that Ray represents are basically trying to improve the skills of the interrogators and their capacities, for instance, of self-awareness, self-control, ability to be tolerant and kind of merge minds with the detainee, as needed.  So there are two very, very different approaches.  The research that Stephen was alluding to is all in the direction of undermining the detainee.  What Ray and colleagues would be more in favor of is trying to leave him neurologically intact, or even neurologically in good shape, and use that to the interrogators’ advantage.


SOLDZ:  There is also — this is the more cynical fear — that the reason torture, broadly defined, is effective is that people will say a hell of a lot of things under torture, some of which happen to be true, but you don’t know which ones are true.


NICHOLL:  Absolutely. 


SOLDZ:  With technology that would tell you what was true, then the incentive to get people to say a lot is increased because you could through away the junk.  I’m not sure whether that’s, in fact, an implicit motivation in some of this. 


NICHOLL:  I would be really, really interested to see any references.


SOLDZ: [Overlapping talk] around this because I think this is the wave of the future.  Jonathan Marks wrote a paper on this.28


ARRIGO:  Stephen, can you take responsibility for sending David the references?


SOLDZ:  I’ll make some contacts around this, yes.


LONG:  I’ve got a question.  This would probably have to be for some future time, but I would be very interested if you’ve come across distress from soldiers themselves, either physical, neurological, psychological, in terms of either their training or their experience in the war or the kind of things that they felt were immoral that they were required to do — which seem to be three of the great danger points of the psychology of being a soldier.


NICHOLL:  I work as a general neurologist, so I think those sort of patients would generally come to psychiatry or neuropsychiatry.  I can think of many patients I’ve seen  as a consequence of other conflicts, asylum seekers or refugees, or with tension headaches as part of their post-traumatic stress disorder.  But I haven’t seen the military in that context.


ARRIGO:  My question is, whether you would feel comfortable telling us how you came to these deep concerns and actions, which most of your colleagues haven’t come to.


NICHOLL:  One thing leads to another.  [Laughs]  I think literally there has been a bit of that. 

Well, partially because I’m Christian, and I felt very strongly when Moazzam Begg from Birmingham was being held in Guantanamo, and partially because of being Northern Irish and just being very worried the way people were going down this route of the whole detention without trial, and that they were  being naive that this was actually going to reduce the risk of terrorism, when all the evidence suggests that it would actually increase the likelihood being blown up. 


ARRIGO:  You’re Northern Irish?


NICHOLL:  Yep.  I grew up in Belfast.  I’m from a fairly middle-class area of Belfast.  I find it ironic I’ve relatives who are Orange Men,29  so the fact that I was wearing an orange jumpsuit seems a little bit strange.  And the funniest thing with the whole Lancet thing was that the day it came out there was press release came out from Sein Féin30 in support of the Lancet doctors, which my relatives thought was hysterical....


ARRIGO:  Okay, I guess we’re at the end of our time.  [Description of transcription and confidentiality arrangements.]

And we’re extremely appreciative of this broadening of our perspective.


LONG:  And what you’re doing!  You are making your voice heard where there are not too many voices.


NICHOLL:  In some ways I have been a bit quiet in the last couple of years.  You just get called like this — I mean, I’m not actively doing anything on the Guantanamo situation.  Guantanamo is the tip of the iceberg.  The whole doctors involvement with the black sites, the secret sites, we haven’t covered at all, haven’t had time to talk about that.  That in itself is another worry. 


LONG:  Are our secret sites a worry for the UK military as well?


NICHOLL:  Well, there’s been a lot of controversy about that because there’s a US Air Force base in the middle of the Pacific, that’s actually on British territory....


SOLDZ: Diego Garcia.31


NICHOLL:  There were interrogations that took place on Diego Garcia that were in contravention of multiple UK laws.  Initially the UK denied that this was the case but lawyers from [the human rights organization] Reprieve demonstrated that this had taken place.  It’s got a bit quiet as to what’s happening about that, but I know that Reprieve is doing more work on this to try to work out who knew what when.

This is also specifically relevant to Binyam Mohamed, who was a British resident.  He was on one of these extraordinary rendition flights.  That didn’t land in a UK territory, but certainly British Secret Service were aware of the interrogations and that he was being tortured.


LONG:  And he was aware that some of the questions must have come from the British.


NICHOLL:  Absolutely.  Absolutely, yes.


ARRIGO:  Folks, I’m afraid that we’re overtime.


[Thanks and farewells all around.]


NICHOLL:  Thanks so much.  I think the functional MRI stuff would definitely be worthwhile following up, because it’s just not widely known.


SOLDZ: Yes!


ARRIGO:  Well, I think the interrogators are keeping an eye on it.


NICHOLL:  The neurologists clearly aren’t, and I can think of some functional MRI people who would be interested to do something about that.

Okay.  Thanks very much.



Appendix


Declaration of the British Psychological Society Concerning Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. (2005, March 31).  British Psychological Society Press Releases.  [Available:  http://www.bps.org.uk/media-centre/press-releases/releases$/2005/declar.cfm]

The British Psychological Society regretfully notes that the existence of state-sponsored torture and other cruel, inhuman, or degrading treatment has been documented in many nations around the world. We note that torture victims may suffer from long-term multiple psychological and physical problems.


The British Psychological Society condemns torture wherever it occurs, and supports the United Nations Declaration and Convention Against Torture and Other Cruel, Inhuman, or Degrading Treatment or Punishment. We further condemn the misuse of psychological knowledge and techniques in the design and enactment of torture.


For the purpose of this Declaration, torture is defined as the deliberate, systematic or wanton infliction of physical or mental suffering by one or more persons acting alone or on the orders of any authority, to force another person to yield information, to make a confession, or for any other reason. This definition includes the use of threats, insults, sexual, religious or cultural degradation or degrading treatment of any kind.



DECLARATION


Psychologists shall at all times comply with the standards set out in the British Psychological Society’s Code of Conduct for Psychologists.


Psychologists shall not countenance, condone or participate in the practice of torture or other forms of cruel, inhuman or degrading procedures, whatever the offence of which the victim of such procedures is suspected, accused or guilty, and whatever the victim's beliefs or motives, and in all situations, including armed conflict and civil strife.


Psychologists shall not provide any premises, instruments, substances or knowledge to facilitate the practice of torture or other forms of cruel, inhuman or degrading treatment or to diminish the ability of the victim to resist such treatment.


Psychologists shall not be present during any procedure during which torture or other forms of cruel, inhuman or degrading treatment is used or threatened.


Psychologists must have complete professional independence in deciding upon the care of a person for whom they are responsible.



_____________________________


1 What is a psychologist’s role in interrogation of detainees?  (2006, August 6).  Psychology and Crime News [Available:  http://crimepsychblog.com/?p=1121, November 4, 2009]

2 Biography of plaintiff Binyam Mohamed.  (2007, May 30).  National security, American Civil Liberties Union.  [Available at:  http://www.aclu.org/national-security/biography-plaintiff-binyam-mohamed.]

3 Rodley, N. S. (2003). The definition(s) of tort in international law.  In Current Legal Problems: Vol. 55: 2002. M. Freeman. New York, Oxford University Press. 55: 467-493.

4 Nicholl, D., Atkinson, H., Kalk, J.  Hopkins, W., Elias, E., Siddiqui, A., Cranford, R., & Sacks, O.  (2006, May 10).  Forece-feeding and restraint of Guantanamo Bay hunger strikers.  The Lancet, 367 (9513): 811.

5 Nicholl, D., Jenkins, T., Miles, S.,  Hopkins, W., Siddiqui, A., & Boulton, F.  (2007, September 7).  Biko to Guantanamo: 30 years of medical involvement in torture.  The Lancet, 370 (9590): 823.

6 World Medical Association. Declaration of Tokyo (1975). Adopted by the World Medical Association, Toyko, Japan. October 1975.  [Available:  http://www.cirp.org/library/ethics/tokyo/]. ‑‑—  “Where a prisoner refuses nourishment and is considered by the doctor as capable of forming an unimpaired and rational judgement concerning the consequences of such voluntary refusal of nourishment, he or she shall not be fed artificially. The decision as to the capacity of the prisoner to form such a judgement should be confirmed by at least one other independent doctor. The consequences of the refusal of nourishment shall be explained by the doctor to the prisoner.”

7 World Medical Association. Declaration on Hunger Strikers [Declaration of Malta].  Adopted 1991; revised 2006].  [Available:  http://www.wma.net/e/policy/h31.htm]. — “Forcible feeding is never ethically acceptable. Even if intended to benefit, feeding accompanied by threats, coercion, force or use of physical restraints is a form of inhuman and degrading treatment. Equally unacceptable is the forced-feeding of some detainees in order to intimidate or coerce other hunger strikers to stop fasting.”

8 Dyer, Clare.  (2000, March 18).  Force-feeding of Ian Brady declared unlawful.  British Medical  Journal, 320  (7237): 731. — “The judge accepted the view of James Collins, consultant forensic psychiatrist at the hospital, that Brady's refusal to eat was ‘a florid example of his psychopathology in action.’  Dr Collins described Brady as psychopathic and prone to narcissism, egocentricity, histrionics, obsessionality, need for control, paranoia, litigiousness, lack of remorse, and lack of empathy.... The judge held that the foreced-feeding was treatment for Brady's mental disorder. But even if the act had not applied, he was satisfied that Brady was incompetent, and therefore doctors could lawfully feed him in his best interests.

9 Barry Horne:  The background.  (2003, March 11).  BBC News.  [On-line:  http://news.bbc.co.uk/2/hi/uk_news/england/2839511.stm].

10 Okie S.  (2005).  Glimpses of Guantanamo — Medical ethics and the War on Terror. New England Journal of Medicine, 353 (24):  2529-34.

11 Former Chair of the Representative Body of the AMA; President of the Standing Committee of European Doctors (2008-2010), an umbrella organization for the whole profession in Europe.

12 Nicholl, David.  (2006).  Guantanamo: A call for action: Good men need to do something.  British Medical Journal, 332: 854 – 855.

13 British Medical Association.  (2001).  The medical profession and human rights:  Handbook for a changing agenda.  London:  Zed Books. 

http://www.independent.co.uk/life-style/health-and-families/health-news/how-the-case-of-steve-biko-outraged-medical-opinion-401615.html

14 California State Resolution on Health Professionals’ Participation in Torture (SJR 19).  (2008).  Official California Legislative Information [Available:  http://www.leginfo.ca.gov/cgi-bin/postquery]. 

15 Nicholl, David.  (2008, March 15).  Giving up the ghost:  Detainees, doctors, and torture.  Jurist Legal News & Research, University of Pittsburgh, School of Law. [Available:  http://jurist.law.pitt.edu/forumy/2008/03/giving-up-ghost-detainees-doctors-and.php].

16 Miles, Steven H.  (2005).  Oath betrayed:  Military medicine and the war on terror.  New York:  Random House.

17 Abuse video shown at public inquiry into British Army interrogation of Iraqis.  (2009, July 14).  TimesOnline.  [Available:  http://www.timesonline.co.uk/tol/news/uk/article6699032.ece].

18 Compton Committee’s Report.  (1971).  Northern Ireland.  Hansard, The Official Report of debates in Parliament, Vol. 826, pp. 431-497.

19 Criminal interrogations seek to establish guilt or innocence of the suspect.  Intelligence interrogations seek timely and accurate information from the detainee for tactical or strategic application elsewhere, usually without jeopardy to the detainee. 

20 The Baha Mousa public inquiry.  [Blog;  http://www.bahamousainquiry.org/index.htm, accessed November 19, 2009]. 

21 Boseley, Sarah.  (2009, June 21).  Doctors demand Yoran Blachar resign as ethics chief over Israeli torture.  Guardian.co.uk.  [Available:  http://www.guardian.co.uk/world/2009/jun/21/doctors-israeli-torture-yoram-blachar-resign].

22 Richards, T.  (1994). The World Medical Association: Can hope triumph over experience?  British Medical Association, 308: 262-266.

23 cardio-pulmonary resuscitation. 

24 Intelligence Science Board.  (2006).  Educing information.  Washington, DC.  National Defense Intelligence College.

25 A defense-contract, double-blind study showed near chance rates of accuracy for voice analysis:  42-56% for true positives and 40-65% for false positives, across all conditions. —  Harnsberger, James D; Hollien, Harry; Martin, Camilio A; & Hollien, Kevin A.  (200i). Stress and deception in speech: Evaluating layered voice analysis.  Journal of Forensic Science, 54  (3): 642-650.  [Supported by CIFA contract FA-4814-04-0011].

26 Biography of plaintiff Binyam Mohamed.  (2007, May 30).  National security, American Civil Liberties Union.  [Available at:  http://www.aclu.org/national-security/biography-plaintiff-binyam-mohamed.]

27 Frakt, D. J. R., & K. Doxakis (2008). United States v. Mohammed  Jawad: Defense Fifth Supplemental Filing in Support of D-008 Motion to Dismiss, Redacted Version. O. o. M. C. Office of the Chief Defense Counsel. Washington, DC, Office of the Chief Defense Counsel, Office of Military Commissions.

28 Marks, Jonathan.  (2007).  Interrogational neuroimaging in counterterrorism:  A no-brainer or a human rights hazard.  American Journal of Law and Medicine, 33:  483-500. 

29 Members of the Orange Order, a Protestant fraternal organization.

30 A major left-wing political party, historically associated with the Provisional IRA. 

31 An atoll in the Indian Ocean, 3000 miles South of Iraq, leased by Great Britain to the US as a strategic air base in 1970.