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2016 Hidden Wounds of War ConferenceThank You to our Sponsors

Military Medical Ethics: Terrorism, Torture, PTSD, and Radicalization

Stephen N. Xenakis, M.D.Brigadier General (Ret)U.S. Army

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AftermathSlide 4 of 16

Profound impact: culture of fear, torture, & politicMusing on impact: Red Scare of 1950s and now a terrorist behind every bushThe impact of the Vietnam War on policy, society, & signs of group think

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they are all terrorists, so different rules apply

Secretary of Defense Donald Rumsfeld

BG Richard W. Thomas/ASG-FP/(703)693-5601/richard.william.thomas@us.army.mil

From the Medics, Unhealthy SilenceAbu Ghraib: torture & the war on terrorismInaction of military medicsHigh standard of medical careObligated to report torture & abuseDoD: Outside of the bounds of doctor-patient relationshipRole of clinicians, pastors, & lawyersImpact of individual & human rightsLeadership must be proactive

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Interview for PD ASD(HA) in 2004 senior health official in DoD- intersection of Abu Ghraib & injury to soldiersNo playbook for this attack on US soilBurden on the senior officer - the buck stops here as GEN Cavazos said all the easy decisions have been made before the problem gets to me

Not a far cry from Guantanamo to legislation:Focus the right spotlight on mental healthOur state of mind anchors or well-being, & anchors or personal & collective securityTorture is wrong & dehumanizingIgnoring the less fortunate & marginalizing in our society is dehumanizingWe have a collective & community responsibility to uphold the fundamental principles of this democracy founded in human rights linking torture & securing our communities in a humane way and speaking up against the violations of human rights.Invited by PHR to assist.6

Guiding PrinciplesMedical EthicsFirst, do no harmBeneficence - duty to maximize benefitJustice - fairness in competing claimsAutonomy respect for the individual

Military EthicsProtect & defend the ConstitutionOath is NOT to the Commander-in-ChiefRule of law prevailsOfficers must disobey illegal orders

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Trends over the next 10 yearsPatrick Kennedy leading changes in mental health predicts chaosIf we dont lead then we will be dragged along military hat of when in charge, take chargeNot a far cry from Guantanamo to legislation:Focus the right spotlight on mental healthOur state of mind anchors or well-being, & anchors or personal & collective securityTorture is wrong & dehumanizingIgnoring the less fortunate & marginalizing in our society is dehumanizingWe have a collective & community responsibility to uphold the fundamental principles of this democracy founded in human rights linking torture & securing our communities in a humane way and speaking up against the violations of human rights.7

General George C. Marshall Slide 8 of 16 Once an army is involved in war, there is a beast in every fighting man, which begins tugging at its chains, and a good officer must learn early on how to keep the beast under control, both in his men and himself (1942).

Memorable quote from GEN MarshallBurden of senior leadership containing the violence.Medics speak truth to power. 8

Human Rights FirstSlide 9 of 16

Burden of senior leadership containing the violence.Medics speak truth to power. 9

Khadr at 15 y/o10

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He grew up in prison from Bagram at 15 y/o to Guantanamo 16-24 y/o.11

CSIS InterrogationSlide 12 of 16

Plead guilty to murder 8 year sentence, with transfer to Canada after 1 year.Faced sentence of 40 years for material support, because of video of his assisting with training of building IEDs.Separate case in Canada arrived in 2012.12

Press ConferenceSlide 13 of 16

Released on bail.13

Ammar Aziz al-BaluchiSlide 14 of 16

Ammars uncle is KSM, & his cousin is Ramzi Yousef.BaluchTradition of first-cousin marriage.14

Zero Dark ThirtySlide 15 of 16

Clip 3First interrogated by the FBI. Ali Soufan Black Banners contends that retrieved all relevant information. Feinstein report corroborates.This is what happened when they got to the CIA.Mark Boal based this character on surreptitious disclosures by the CIA on his interrogation.truth in fiction

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SSCI Report: Dec 2014ShavingDiaperingHoodingIsolationWhite noiseUncomfortably cool environmentRestricted dietWater dousingSleep deprivationAttention graspSlide 16 of 16

SSCI Report: Dec 2014Stress positionsWallingCramped confinementWaterboardingSlide 17 of 16

Impact of ISISSlide 18 of 16

Nave, adventurous, cloistered young men idealistic, lack critical thinking, seduced by FBIHamzah KhanAdel DaoudAnd, in Chattanooga Mohammed Youseff Abdulazeez

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Military Psychiatry & 21st Century WarfareImpact of individual & human rights

Non-nation state actorsInnovative & varied lethal weaponsNon-traditional coalitions & alliancesRevolution, insurgency, & civil disruptionRole of clinicians, pastors, & lawyers

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Trends over the next 10 yearsPatrick Kennedy leading changes in mental health predicts chaosIf we dont lead then we will be dragged along military hat of when in charge, take chargeNot a far cry from Guantanamo to legislation:Focus the right spotlight on mental healthOur state of mind anchors or well-being, & anchors or personal & collective securityTorture is wrong & dehumanizingIgnoring the less fortunate & marginalizing in our society is dehumanizingWe have a collective & community responsibility to uphold the fundamental principles of this democracy founded in human rights linking torture & securing our communities in a humane way and speaking up against the violations of human rights.19

Slide 20 of 16 Sir Edmund Burke:

All that is necessary for the triumph of evil is that good men do nothing.

The psychological and work boundaries of our lives are very permeable. We must stand for our convictions and principles.

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