End Torturous Force Feeding

In Saturday night’s GOP debate in New Hampshire, Donald Trump called for a re-introduction of torture in the War on Terror. This campaign statement comes on the heels of the 14th anniversary of the U.S. government bringing “unlawful combatants” to Guantanamo Bay.

Now the U.S. Justice Department is appealing a federal court order to release a disturbing video of Abu We’El Dhiab being force fed at the prison camp. The video is allegedly disturbing and violent. In 2014, a judge ordered the force-feeding of Dhiab because his hunger strike had led him to the edge of death.. Dhiab was on a hunger strike to protest his prolonged deterntion. . He was cleared for transfer to home in 2009 but could not be sent there because of fears he would be in danger and then because of the Syrian civil war.

In early 2002, two detainees were force fed after guards removed turbans that they had made. At its height, 194 people had been part of the strike, though many started eating when turbans became allowed. In 2005, 105 prisoners went on a hunger strike to protest conditions in the prison. At that time, 20 prisoners were force fed. Lacking any power or even rights, some detainees at the camp have gone on hunger strikes to protest their treatment and demand their release. The Red Cross and the World Medical Association have accused the U.S. of to force feeding these individuals.

Force feeding is not a simple process. It requires a trained and skilled health care professional. The patient must be restrained. In the first round of forced feedings sedation was used — essentially paralyzing the patient so that he could not physically prevent the process. In later forced feedings, prisoners have been physically restrained by hand and foot. A flexible tube is lubricated and then forced down the nose and into the esophagus. This has to be done carefully as the tube can easily come out through the mouth or end of up in the trachea. An X-ray is necessary to know if the insertion has gone properly. Then a liquid nutritional supplement is poured into the tube. After feeding, the tube is removed.

Thus, the tube is inserted and removed for every feeding. This is not only an uncomfortable process, it is dangerous as the mouth and pharynx become painfully irritated and the possibility of fluid being poured into the wrong place (such as the lungs) increases as well.

I have been writing and teaching about issues of medical ethics and social justice for 15 years. The participation of health care professionals in force feeding violates codes and policies of ethics of most major national and international medical organizations: The United Nations Human Rights Commission has declared force feeding of prisoners to be a form of torture. The World Medical Association Tokyo Declaration states that a physician should not force feed a prisoner who is of sound mind voluntarily refuses nourishment. The American Medical Association and the American Nurses Association have publicly stated opposition to the practice as well.

On the other hand, force feeding does save detainees from dying by self-imposed malnutrition. One could argue that a health care provider allowing a person to die when action could prevent it is unethical, especially when the detainees are otherwise healthy.

Force feeding goes against patient autonomy — an individual’s right to self determination. The U.S Supreme Court ruled over 100 years ago that adults of sound mind have a right to determine what happens to their own body. The actions at Guantanamo are unethical by any measure.

Physicians are duty bound to refrain from causing harm to patients and bound to prevent harm from happening. This puts the doctor in a catch-22 since force feeding prevents the harm of death, but force feeding against a person’s will harms his/her liberty and autonomy to self determination.

What can we do? First, the government should cease efforts to prevent the release of the video. Hiding the truth does not make it any less true. Second, we should oppose government and military pressure for health care providers to violate their oath. For citizens, this means contacting your representatives. For health care professionals, this means saying “No.” Professional organizations and the public must support those providers who refuse to participate. Those who do participate should have their licensing and credentialing reviewed for any ethical violations. Third, since his initial run for the presidency, President Obama has promised to close the Guantanamo Bay facility. This was reiterated in this State of the Union address. The camp has permitted the U.S. government to detain individuals for an unreasonable amount of time without access to civil rights redress, without charges, and often, without hearings.

We all must pressure our elected officials to ban force feeding at Guantanamo and to close the camp. Our treatment of detainees is a medical wrong, an international embarrassment, and a violation of basic human rights of hundreds of individuals. It’s time for us to apologize and to end our treatment of the detainees.