Review: Oath Betrayed: Torture, Medical Complicity, and the War on Terror by Steven H. Miles

I found a rather terrifying film about the Guildford Four called “In the Name of the Father”. I will write more about them in a separate post. I came to this book because of the topic of torture. Remember Abu Ghraib?

Oath Betrayed by Steven H. Miles is a distressing, well-researched look into one of the most controversial areas of the War on Terror: the treatment of inmates and what role doctors played in the system. The book, which is by a physician and medical ethics expert, does more than just chronicle incidents of abuse. It also speaks to the moral fall that occurs when organizations meant to heal become implicated in damage.

The book is premised on a simple but significant question: where were the doctors and nurses when prisoners were being abused? The question simultaneously questions Miles’s values, and gives him a way to make his argument. He demonstrates that medical workers were often present, knowing and even active participants rather than passive observers. They observed interrogations, advised captives on how much stress or agony they could endure, and in some cases failed to report clear evidence of abuse. This is particularly disturbing as it contravenes fundamental tenets of medicine such as the concept of “do no harm”.

One of the great things about Miles’s strategy is how evidence-based it is. He leans heavily on first-hand sources: declassified government papers, military probes, FBI reports, autopsy data and medical records. As it turns out, the abuse was more systematic and widespread than officials initially believed. The emerging tale is inconsistent with the notion that abuses at facilities such as Abu Ghraib were one-offs by a few "bad apples." “Were they part of a larger institutional failure? Yes. It was a failure at many levels of authority and duty,” Miles adds.

This is the case the book builds over time. The initial chapters explain what torture is and review its legal and historical context. They argue that torture is not simply a set of techniques, but a social institution, sustained by norms, training, and cultural acceptance. Other chapters provide detailed case studies of how detainees were interrogated, how they died, how medical attention was denied and why others who saw these atrocities did not speak up. These case studies are hard to read because they detail physical and mental abuse, but they are vital to demonstrate the effects of the policies being studied on real individuals.

One of the most fascinating aspects about Oath Betrayed is the way it looks at the relationship between science and power. Miles shows how medical information was not used to cure, but to cause further pain. Health workers, for example, occasionally taught interrogators how to inflict pain or discomfort to the level that would cause severe agony or suffering, but would not cause lasting injury. They also kept a watch on some inmates to keep them alive and awake throughout rough questioning. This is an extremely immoral use of medical knowledge since it makes therapists tools of oppression.

Miles also reflects on the idea of silence, in both private and public spaces. Many doctors and nurses and other personnel who knew about abuse did not disclose it because they were terrified, coerced or loyal to their supervisors. This silence allowed the violence to persist and even to escalate. The book suggests that doing nothing is as vital as doing something, which speaks a lot about the importance of moral bravery in the workplace.

Another crucial subject is the larger context of society that permitted these atrocities to happen. The political choices, legal explanations and public attitudes all go into making torture conceivable, Miles adds. He condemns the use of terminology such as “enhanced interrogation” and “detainee” to mask what was really happening. But by discussing torture in technical or logistical terms, officials could steer clear of discussing how moral it was.

It also looks at the standard rationales for torturing people, such as the “ticking time bomb” hypothesis, that harsh measures may be needed to prevent imminent harm. Miles disagrees with this assertion by saying that scenarios like this are generally made up and doesn’t actually happen in the real world. Torture is not only ethically wrong, he believes, but it simply doesn’t work: It leads to faulty knowledge and harms long-term intelligence efforts. The book combines moral thought with practical investigation, and this is how it exposes torture as morally wrong on many levels.

Oath Betrayed is not an easy read, but it is a powerful book. Sometimes the book feels dense and too much, because of how much proof and how detailed it is. Miles writes in a clear, but serious way and the issue is quite heavy on my heart. Readers of this book may wish to pause and reflect on what they have read, particularly when reading about particular instances of abuse and neglect.

Also the book’s position is unremittingly critical. Some readers may expect a more nuanced perspective, given Miles spends little time considering the reasons behind the practices he dislikes. But this concentration is also a strength of the book. It is not supposed to be neutral, but to reveal wrongdoing and make readers think about their morality.

Ultimately, Oath Betrayed is a very significant book that challenges difficult but vital questions about right and evil, obligation, and the boundaries of power. It makes people think about what really happened in the War on Terror and how it was conceivable for people to act like this in a nation that claims to revere human rights and the rule of law. The book is a useful reminder that good work ethics is crucial all the time, but more so in times of crisis.

Miles’s lesson is more than what he’s talking about. He advises people in politics, the medical field and common people they all have a role to play in maintaining moral principles. He hopes that by writing down these blunders in such detail, he might avoid them in the future.

Ultimately, Oath Betrayed is a serious and thought-provoking look at one of the worst periods in recent history. It’s tough to read but it’s vital. The book is thoroughly researched, morally unambiguous and makes people face hard realities and think about what kind of society they want to live in. I don’t think Dr. Miles has grown any better since this was written in 2006.

He wrote The Torture Doctors in 2020. I'll have to add that book to my "to read" list. I read this book and another a few years back.

Robert Jay Lifton, The Nazi Doctors: Medical Killing and the Psychology of Genocide

 
4/13/26 The Balkinization Blog contains a long series of posts and articles on torture and civil liberties in the War on Terror, http://balkin.blogspot.com/2006/12/anti-torture-memos.html