As U.S. forces vie for control over contested areas across the globe and the Bush administration wrestles with Congress over the rights of prisoners, another battle in the “Global War on Terror” rages just south of our border. This battle is over the bodily integrity of prisoners at the Naval Station prison camp in Guantánamo Bay, Cuba. As early as February 2002, less than two months after the fi rst prisoners arrived at Guantánamo, large-scale hunger strikes erupted in protest when a guard allegedly mishandled the Koran. Prisoners were subjected to force-feeding, a procedure in which food is pumped through a fl exible tube inserted into the nose and pushed down to the stomach. One young hunger striker’s medical records reveal that he was “informed that dying was not permitted.”

Even under proper medical supervision, force-feeding can be extremely painful. The affi davit of one attorney representing a Guantánamo prisoner, who wishes to remain nameless, describes the process of force-feeding and alleged abuse: “Every day, twice a day, for over seven months, the detainee was forcibly removed from his cell and taken to a restraint chair that prevented him from moving any part of his body, including his limbs, torso, and head. The detainee was kept in this restraint chair, incapable of movement, as nurses and corpsman rammed tubes up his nose and pumped 5-10 cans of liquids into his fragile and emaciated body.” After force-feeding, the prisoner was left in restraints “for hours at a time” and further dehumanized when he was denied access to toilet facilities.

The U.S. Department of Defense (DOD) has implemented a force-feeding policy when prisoners use hunger strikes as a form of protest. Military doctors must now choose between the commands of their superiors and the wishes of their patients. Defense offi cials admit to screening physicians who object to force-feeding. They send only those who agree with the practice to Guantánamo. Some critics, including British neurologist Dr. David Nicholl, have claimed that screening “makes sure they don’t have doctors with a conscience.”

Numerous human rights and professional organizations have criticized the involvement of doctors in this procedure. The World Medical Association (WMA), an organization of which the American Medical Association (AMA) is a signatory, holds that the “force-feeding of hunger strikers is unethical, and is never justifi ed.”

In October 2006, the WMA revised its Declaration of Malta to clarify its policy on the duties of physicians in hunger strikes. According to a press release, the revision was necessary to eliminate any possible interpretation that suggested the organization supported force-feeding. The AMA also offi cially opposes the practice, but because the organization is not a “regulatory or licensing agency,” it has renounced the responsibility for prosecuting violators of its policies.

Medical ethics must remain the same during times of peace or war, but medical practice in the military can lead to complex ethical dilemmas. A physician’s duty is fi rst and foremost to their patient, and the practice of force-feeding hunger strikers violates established medical ethics. Critics in and beyond the medical community are increasingly scrutinizing the justifi cations provided by the DOD. Despite outspoken dissent, the DOD continues to stand behind its policy, and military physicians continue to force-feed hunger strikers. The road to accountability is fraught with diffi culties. To date, no formal mechanisms exist to hold doctors responsible for breaching medical ethics at Guantánamo. Continued
1 | 2 | 3 |Next>>