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How Torture Became Part of Health Law
Published online by Cambridge University Press: 24 March 2025
Abstract
Over the past twenty-five years, the Center for Health Law, Ethics, and Human Rights (CLER) has been a leader in torture treatment, advocacy, and education. In 1998, the Boston Center for Refugee Health and Human Rights (BCRHHR) was founded to provide holistic treatment to asylum seekers who have been tortured by their governments and justifiably feared further persecution if they returned to their countries. Seeking justice is an important part of healing for survivors, and BCRHHR clinicians work closely with immigration attorneys to document clinical evidence of torture to support asylum applications. Following the September 11 attacks in 2001, it was revealed that the U.S. government tortured captives and committed other war crimes. CLER scholars examined how doctors and lawyers worked with the Central Intelligence Agency (CIA) to rationalize and sanitize torture, providing legal immunity for perpetrators. My colleagues and I at CLER assumed a national leadership role in opposing practices that constitute torture, as well as cruel, inhumane, and degrading treatment. These practices included the force-feeding of hunger strikers, the Rendition, Detention, and Interrogation (RDI) program (a covert operation involving disappearances, extrajudicial detentions, and torture of suspects in the so-called “War on Terror”), the use of lawyers and physicians to justify these actions, and U.S. policies that authorized torture. We met with military officials of the Department of Defense (DOD) and hosted a meeting with international experts to brainstorm solutions. We evaluated the devastating effects of the U.S. torture program on detainees and testified in the military commission’s pretrial hearings for a detainee accused of terrorism.
Doctors and lawyers at the CLER have focused on understanding contemporary torture and the relevance of the Nuremberg Doctors’ Trial which condemned Nazi doctors for torturing prisoners. The CLER continues to promote the importance of International Human Rights Law.
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- © 2025 The Author(s). Published by Cambridge University Press on behalf of American Society of Law, Medicine & Ethics and Trustees of Boston University
Footnotes
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Thank you to the late Dr. Michael Grodin for his mentorship and inspiration. Thank you to Professor Leonard Glantz for his critical review of this manuscript.
References
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2 G.A. Res. 217 (III) A, Universal Declaration of Human Rights (Dec. 10, 1948).
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7 See S. Treaty Doc. No. 100-20.
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9 See Andrew Milewski et al., Reported Methods, Distributions, and Frequencies of Torture Globally: A Systematic Review and Meta-Analysis, 6 J. Am. Med. Ass’n Network Open art. no. e2336629 (2023).
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12 Id. at 12.
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17 See id. at 1.
18 See Detention, U.N. High Comm’r for Refugees, https://www.unhcr.org/what-we-do/protect-human-rights/asylum-and-migration/detention (last visited Nov. 16, 2024).
19 See, e.g., Kelly Hill, Seeking Asylum at the U.S. Border: Yousif’s Story, World Relief (May 29, 2024), https://worldrelief.org/blog-asylum-seeker-story-yousif/; John Washington, The Dispossessed: A Story of Asylum and the US-Mexican Border and Beyond (2020); Patricia Sutton, Asylum Seekers: Hope and Disappointment on the Border (2022)
20 See Javanbakht & Grasser, supra note 14, at 1242.
21 See, e.g., “I Miss My Mum So Much” – The Pain of Separated Afghan Families, Refugee Council: Blog (Oct. 17, 2023), https://www.refugeecouncil.org.uk/latest/news/i-miss-my-mum-so-much-the-pain-of-separated-afghan-families/ [https://perma.cc/BF5E-XFS4].
22 See Immigration and Nationality Act, 8 U.S.C. § 1101(a)(42) (defining “refugee”); id. § 1158(b)(1)(A) (limiting eligibility for asylum to “refugee[s]”).
23 See generally Off. of the High Comm’r for Hum. Rts., United Nations, Pro. Training Series No. 8/Rev. 2, Istanbul Protocol: Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (2022), https://www.ohchr.org/sites/default/files/documents/publications/2022-06-29/Istanbul-Protocol_Rev2_EN.pdf.
24 Rebecca Gendelman, Correcting the Record: The Reality of U.S. Asylum Process and Outcomes, Hum. Rts. First (Nov. 3, 2023), https://humanrightsfirst.org/library/correcting-the-record-the-reality-of-u-s-asylum-process-and-outcomes/.
25 See Ann M. Simmons, Some Immigrants Meet Harsh Face of Justice, L.A. Times (Feb. 12, 2006, 3:00 AM EST), https://www.latimes.com/archives/la-xpm-2006-feb-12-na-judges12-story.html.
26 A-T-, 24 I. & N. Dec. 296, 296 (B.I.A. 2007).
27 Matter of A-T-, Ctr. for Gender & Refugee Stud., https://cgrs.uclawsf.edu/our-work/matter-t (last visited Oct. 26, 2024); see also Lisa Frydman & Kim Thuy Seelinger, Kasinga’s Protection Undermined? Recent Developments in Female Genital Cutting Jurisprudence, 13 Bender’s Immigr. Bull. 1073, 1073 (2008) (discussing the follow-on effects of A-T-’s case).
28 See William Fisher, RIGHTS-US: Asylum Courts Mishandled Gender Violence Case, Inter Press Serv. (Sept. 15, 2008), https://www.ipsnews.net/2008/09/rights-us-asylum-courts-mishandled-gender-violence-case/ [https://perma.cc/GF86-35CJ].
29 See Brief for Amici Curiae in Support of Petitioner on behalf of Am. Coll. of Obstetricians & Gynecologists et al. at 11–21, Traore v. Mukasey, No. 07-2080 (4th Cir. Nov. 1, 2007), https://www.nesl.edu/docs/default-source/faculty-files/matter-of-a-t-final-medical-amicus-2-7-08.pdf.
30 A-T-, 24 I. & N. Dec. 617, 617 (Att’y Gen. 2008).
31 See Ctr. for Gender & Refugee Stud., supra note 27; A-T-, 25 I. & N. Dec. 4, 10–11 (B.I.A. 2009).
32 Tahirih Wins High-Profile Asylum Case for Young Woman Who Suffered FGM/C, Tahirih Just. Ctr. (Apr. 26, 2011), https://www.tahirih.org/news/breaking-news-tahirih-wins-key-immigration-case/ [https://perma.cc/W9ET-YKT5].
33 Pam Belluck, Federal Ban on Female Genital Mutilation Ruled Unconstitutional by Judge, N.Y. Times (Nov. 21, 2018), https://www.nytimes.com/2018/11/21/health/fgm-female-genital-mutilation-law.html.
34 At the time of this 2018 federal court ruling, Anti-FGM legislation had only been enacted by 27 states. See id. Anti-FGM legislation has now been enacted by 41 states. See FGM Legislation by State, AHA Found., https://www.theahafoundation.org/female-genital-mutilation-fgm-in-the-us/fgm-legislation-by-state/ [https://perma.cc/5CWC-RHQ3] (last visited Oct. 30, 2024).
35 An Act Relative to the Penalties for the Crime of Female Genital Mutilation, ch. 149, 2020 Mass. Acts.; Senate Passes Bill to Criminalize Female Genital Mutilation, Revere J. (Aug. 5, 2020), https://reverejournal.com/2020/08/05/senate-passes-bill-to-criminalize-female-genital-mutilation/ [https://perma.cc/
3BAH-6T7T].
36 COVID-19 Hindering Progress Against Female Genital Mutilation, 6 Lancet Pub. Health 136 (2021).
37 Names on the 9/11 Memorial, 9/11 Mem’l Museum, https://www.911memorial.org/visit/memorial/names-911-memorial [https://perma.cc/F55U-RQTU] (last visited Oct. 30, 2024).
38 Memorandum from George W. Bush, President of the U.S., to the Vice President et al., (Feb. 7, 2002), https://www.aclu.org/legal-document/presidential-memo-feb-7-2002-humane-treatment-al-qaeda-and-taliban-detainees (“Re: Humane Treatment of al Qaeda and Taliban Detainees”); Memorandum from Jay S. Bybee, Assistant Att’y Gen., to Alberto R. Gonzalez, Couns. for the President, and William J. Haynes II, Gen. Couns. of the Dep’t of Def. (Jan. 22, 2002), http://hrlibrary.umn.edu/OathBetrayed/Bybee%201-22-2002.pdf (“Re: Application of Treaties and Laws to Al-Qaeda and Taliban detainees”).
39 Memorandum from Jay S. Bybee, Assistant Att’y Gen., to John Rizzo, Acting Gen. Couns. of the CIA (Aug. 1, 2002), https://www.thetorturedatabase.org/files/foia_subsite/pdfs/DOJOLC000780.pdf (advising that these “interrogation procedures … would not violate Section 2340A [of title 18]”).
40 CIA, Guidelines on Interrogations Conducted Pursuant to the Presidential Memorandum of Notification of 17 September 2001, at 2 (2003), https://www.cia.gov/readingroom/collection/documents-related-former-detention-and-interrogation-program; Oona A. Hathaway, Aileen Nowlan & Julia Spiegel, Tortured Reasoning: The Intent to Torture Under International and Domestic Law, 52 Va. J. Int’l L. 791, 792 (2012).
41 Remarks on the War on Terror, 42 Weekly Comp. Pres. Doc. 1569 (Sept. 6, 2006).
42 Rebecca Leung, Abuse of Iraqi POWs by GIs Probed, CBS (Apr. 27, 2004, 4:37 PM), https://www.cbsnews.com/news/abuse-of-iraqi-pows-by-gis-probed/.
43 See, e.g., Guantánamo Bay: Over 20 Years of Injustice, Amnesty Int’l (Aug. 9, 2023, 11:40 AM), https://www.amnesty.org.uk/guantanamo-bay-human-rights [https://perma.cc/AM9M-N5DZ]; Terry D. Gill & Elies van Sliedregt, Guantánamo Bay: A Reflection on the Legal Status and Rights of ‘Unlawful Enemy Combatants,’ 1 Utrecht L. Rev. 28 (2005).
44 For a collection of testimonies of forced feeding, see Testimonies of Forced Feeding, Ctr. for the Study of Hum. Rts. in the Americas, https://humanrights.ucdavis.edu/projects/the-guantanamo-testimonials-project/testimonies/testimony-of-military-physicians/index.html (last visited Oct. 4, 2024).
45 See, e.g., Tim Golden, The Battle for Guantánamo, N.Y. Times Mag. (Sept. 17, 2006), https://www.nytimes.com/2006/09/17/magazine/17guantanamo.html; More Gitmo Detainees Join Hunger Strike, NBC (June 1, 2006, 6:42 PM), https://www.nbcnews.com/id/wbna13088365; Bioethicist: Support Nurse Who Resisted Force-Feeding at Guantanamo, NBC (Dec. 12, 2014, 3:00 AM), https://www.nbcnews.com/storyline/cia-torture-report/bioethicist-support-nurse-who-resisted-force-feeding-guantanamo-n266716.
46 See George J. Annas, Hunger Strikes at Guantanamo: Medical Ethics and Human Rights in a “Legal Black Hole,” 355 New Eng. J. Med. 1377, 1378–79 (2006).
47 Id.
48 See, e.g., Hernan Reyes, Force-Feeding and Coercion: No Physician Complicity, 9 Virtual Mentor 703, 704 (2007); Sondra Crosby, Not Every Food Refuser is a Hunger Striker, 14 Am. J. Bioethics 47, 47 (2014); but see Joseph H. Obegi, Death by Hunger Strike: Suicide or Not?, 31 Psychiatry Psych. & L. 121, 123 (2024).
49 Sondra S. Crosby, Caroline M. Apovian & Michael A. Grodin, Hunger Strikes, Force-Feeding, and Physicians’ Responsibilities, 298 J. Am. Med. Ass’n 563, 563 (2007).
50 Id.; see also Annas, supra note 46, at 1378.
51 See, e.g., Neil A. Lewis, Guantánamo Prisoners Go on Hunger Strike, N.Y. Times (Sept. 18, 2005), https://www.nytimes.com/2005/09/18/politics/guantanamo-prisoners-go-on-hunger-strike.html.
52 See Ctr. for the Study of Hum. Rts. in the Americas, supra note 44.
53 Crosby, Apovian & Grodin, supra note 49, at 564.
54 World Med. Ass’n, WMA Declaration of Malta on Hunger Strikers (Dec. 5, 2022), https://www.wma.net/policies-post/wma-declaration-of-malta-on-hunger-strikers/ (originally adopted by the 43d World Medical Assembly in 1991 and most recently revised by the 68th WMA General Assembly in 2017).
55 Id. at ¶ 23.
56 See Jason Leopold, The Military Admitted Force-Feeding Gitmo Detainees Violates International Law and Medical Ethics, VICE (Jan. 29, 2015, 1:40 PM), https://www.vice.com/en/article/how-a-military-memo-could-save-the-nurse-who-refused-to-force-feed-guantanamo-detainees/ [https://perma.cc/EEP3-T5MM] (discussing the June 2013 document “Legal Authority and Policy for Enteral Feeding at JTF-GTMO”).
57 See See Closing Guantanamo: The National Security, Fiscal, and Human Rights Implications: Hearing Before the Subcomm. on the Const., C.R., and Hum. Rts. of the Comm. on the Judiciary, 113th Cong. 10 (2013) (statement of Stephen N. Xenakis, M.D., Brigadier General (Retired), U.S. Army) (arguing that the appropriate clinical responses to hunger strikes laid out in the Declaration of Malta “illustrate[] the false choice between saving lives and force-feeding”).
58 Dhiab v. Obama, 74 F. Supp. 3d 16, 29 (D.D.C. 2014).
59 Sondra S. Crosby, Stephen N. Xenakis & Leonard H. Glantz, Force Feeding at Guantanamo in First Case Brought to US Federal Court, 350 BMJ 1270 (2015).
60 Dhiab, 74 F. Supp. 3d at 29–30.
61 Inst. on Med. as a Pro., Ethics Abandoned: Medical Professionalism and Detainee Abuse in the War on Terror, at xxxiii (2013).
63 See Jason Leopold, Gitmo Media Blackout Hopes to Undermine Hunger Strikers, Al Jazeera Am. (Dec. 11, 2013, 1:30 PM), http://america.aljazeera.com/articles/2013/12/11/gitmo-media-blackouthopestounderminehungerstrikers.html [https://perma.cc/G5DY-7LZV].
64 George J. Annas & Sondra S. Crosby, Post-9/11 Torture at CIA “Black Sites” — Physicians and Lawyers Working Together, 372 New Eng. J. Med. 2279 (2015).
65 Id. at 2280; sources cited supra note 32.
66 See Ewen MacAskill, Obama Releases Bush Torture Memos, Guardian (Apr. 16, 2009, 6:05 PM), https://www.theguardian.com/world/2009/apr/16/torture-memos-bush-administration [https://perma.cc/TJV5-SQAV]. For a guide with access to the memos, see Neil A. Lewis, A Guide to the Memos on Torture, N.Y. Times, https://archive.nytimes.com/www.nytimes.com/ref/international/24MEMO-GUIDE.html (last visited Oct. 4, 2024).
67 Annas & Crosby, supra note 64, at 2280.
68 Id.
69 Sarah Dougherty & Christine Mehta, Physicians for Hum. Rts., Truth Matters: Accountability for CIA Psychological Torture 3–4, 14 (2015).
70 See generally S. Select Comm. on Intel., Committee Study of the Central Intelligence Agency’s
Detention and Interrogation Program, S. Rep. No. 113-288 (2014) [hereinafter S. Comm. Study of the CIA]
71 Farnoosh Hashemian et al., Physicians for Hum. Rts., Broken Laws, Broken Lives: Medical Evidence of Torture by US Personnel and Its Impact (2008).
72 Salim v. Mitchell, 268 F. Supp. 3d 1132, 1136–38 (E.D. Wash. 2017).
73 Id. at 1144.
74 Complaint at ¶¶ 73, 112, Salim v. Mitchell, 268 F. Supp. 3d 1132 (E.D. Wash. 2017) (No. 2:15-CV-286), https://www.aclu.org/sites/default/files/field_document/salim_v._mitchell_-_complaint_10-13-15.pdf.
75 Salim v. Mitchell – Lawsuit Against Psychologists Behind CIA Torture Program, ACLU (Aug. 17, 2017), https://www.aclu.org/cases/salim-v-mitchell-lawsuit-against-psychologists-behind-cia-torture-program.
76 Sondra S. Crosby, A Doctor’s Response to Torture, 156 Annals Internal Med. 471 (2012).
77 The case is currently awaiting trial before the Military Commissions Trial Judiciary of Guantanamo Bay. The docket is available through the Office of Military Commissions Website, Office of Military Commissions Cases, Off. of Mil. Comm’ns, https://www.mc.mil/Cases/MC-Cases (last visited Nov. 17, 2024) (navigate to the case USS Cole: Abd al-Rahim Hussein Muhammed Abdu Al-Nashiri (2)).
78 Amnesty Int’l, USA: ‘Heads I Win, Tails You Lose,’ AI Index AMR 51/090/2011, at 1 (Nov. 8, 2011).
79 S. Comm. Study of the CIA, supra note 70, at 66–73.
80 Carol Rosenberg, Expert Testifies Accused USS Cole Bomber Was Tortured, Mia. Herald (Aug. 5, 2014, 6:48 AM), https://www.miamiherald.com/news/nation-world/world/americas/article1963350.html.
81 See 10 U.S.C. § 920(a), (g)(1)(c).
82 Carol Rosenberg, Doctor Describes and Denounces C.I.A. Practice of ‘Rectal Feeding’ of Prisoners, N.Y. Times (Feb. 23, 2024), https://www.nytimes.com/2023/02/24/us/politics/cia-torture-guantanamo-nashiri-doctor.html; Sondra S. Crosby & Leonard H. Glantz, “Rectal Feeding”-Unethical Medical Officer Participation at CIA Secret Interrogation Facilities, 331 J. Am. Med. Ass’n 103 (2024).
83 See MacAskill, supra note 66.
84 Carol Rosenberg, Pentagon Repatriates Malaysian Prisoners Who Pleaded Guilty to War Crimes, N.Y. Times, (Dec. 18, 2024), https://www.nytimes.com/2024/12/18/us/politics/malaysian-prisoners-repatriated-gitmo.html.
85 UN Experts Call for Universal Abolition of the Death Penalty, Off. of the U.N. High Comm’r for Hum. Rts. (Oct. 9, 2023), https://www.ohchr.org/en/press-releases/2023/10/un-experts-call-universal-abolition-death-penalty.
86 Judge Orders Hearing for Idaho Prisoner Who Faced 5 Execution Dates, Claims of Repeated ‘Psychological Torture,’ Death Penalty Info. Ctr. (Sept. 25, 2024), https://deathpenaltyinfo.org/judge-orders-hearing-for-idaho-prisoner-who-faced-5-execution-dates-claims-of-repeated-psychological-torture [https://perma.cc/CM22-MAVN].
87 Gregg v. Georgia, 428 U.S. 153 (1976).
88 Facts About the Death Penalty, Death Penalty Info. Ctr. 3, https://dpic-cdn.org/production/documents/pdf/FactSheet.pdf (last updated Nov. 4, 2024).
89 Deborah W. Denno, Lethal Injection, Britannica, https://www.britannica.com/topic/lethal-injection (last updated Oct. 30, 2024).
90 Death Penalty Info. Ctr., supra note 88, at 3.
91 Nicholas Bogel-Burroughs, Death Penalty Researchers Call 2022 ‘Year of the Botched Execution,’ N.Y. Times (Dec. 16, 2022), https://www.nytimes.com/2022/12/16/us/death-penalty-botched-executions.html.
92 Reprieve, Lethal Injection in the Modern Era: Cruel, Unusual and Racist 8–9 (2024).
93 Letter from Robert Patton, Dir. Dep’t of Corr., to Mary Fallin, Governor of Okla. (May 1, 2014), https://www.documentcloud.org/documents/1151378-5-1-14-doc-letter-re-clayton-lockett.html [https://perma.cc/7MH9-PKNT].
94 Id.
95 Id. at 2 (timestamp of 1830).
96 Id. at 3 (timestamp of 1833).
97 Id. (timestamp of 1844–1856).
98 Id.
99 Id. (death occurred at timestamp of 1906, after administration of Midazolam at 1823).
100 Nicholas Bogel-Burroughs, A Death Row Prisoner Tells of Living Through a Botched Execution, N.Y. Times (June 6, 2024), https://www.nytimes.com/2024/06/06/us/thomas-creech-idaho-botched-execution.html.
101 Id.
102 William J. Curran & Ward Casscells, The Ethics of Medical Participation in Capital Punishment by Intravenous Drug Injection, 302 New Eng. J. Med. 226 (1980).
103 See, e.g., Tanya Albert Henry, AMA to Supreme Court: Doctor Participation in Executions Unethical, Am. Med. Ass’n (Aug. 22, 2018), https://www.ama-assn.org/delivering-care/ethics/ama-supreme-court-doctor-participation-executions-unethical.
104 Atul Gawande, When Law and Ethics Collide — Why Physicians Participate in Executions, 354 New Eng. J. Med. 1221 (2006).
105 Id. at 1223.
106 Id. at 1225.
107 Id.
108 Id. at 1228.
109 State-by-State Execution Protocols, Death Penalty Info. Ctr., https://deathpenaltyinfo.org/executions/methods-of-execution/state-by-state-execution-protocols [https://perma.cc/83DB-AEZX] (last visited Oct. 4, 2024); see also Nathaniel A.W. Crider, What You Don’t Know Will Kill You: A First Amendment Challenge to Lethal Injection Secrecy, 48 Colum. J.L. & Soc. Probs. 1, 21 (2014).
110 Kelly A. Mennemeier, A Right to Know How You’ll Die: A First Amendment Challenge to State Secrecy Statutes Regarding Lethal Injection Drugs, 107 J. Crim. L. & Criminology 443, 485–86 (2017).
111 Neil Singh Bedi, Nisha Mathur & Judy Wang et al., Human Rights in Hospitals: An End to Routine Shackling, 39 J. Gen. Internal Med. 1048 (2024); see also Lawrence A. Haber, Lisa A. Pratt, Hans P. Erickson & Brie A. Williams, Shackling in the Hospital, 37 J. Gen. Internal Med. 1258 (2022).
112 Our Movement, Stop Shackling Patients, https://stopshacklingpatients.org/our-movement/ [https://perma.cc/KME5-H8LF] (last updated Jan. 2024).
113 Id.
114 Bedi, Mathur & Wang et al., supra note 111, at 1049.
115 Stop Shackling Patients, supra note 112.
116 Bedi, Mathur & Wang et al., supra note 111, at 1051.