The U.S. has sent Navy nurses and medics to Guantanamo Bay to help keep terror-war suspects alive as they refuse food to protest conditions at the isolated detention center, as well as the legal limbo of its inmates. One hundred of the 166 inmates have reportedly joined the strike, and 23 are being forcibly nourished with liquid transmitted through a tube. President Obama this week said he was renewing a push to close the controversial prison — a 2008 campaign promise he failed to fulfill due to congressional opposition — but he defended the policy of forcibly feeding hunger strikers. "I don't want these individuals to die," he said.
But critics — from the United Nations to the American Civil Liberties Union — say that restraining unwilling prisoners and forcing tubes up their noses amounts to torture. One prisoner who says he underwent the procedure — a Yemeni national named Samir Naji al Hasan Moqbel — said in a New York Times op-ed that it was cruel punishment that made him gag, and feel like he was going to vomit. "I can't describe how painful it is to be force-fed this way," he said. That, according to the U.N.'s main human rights office, makes it unacceptable. "If it's perceived as torture or inhuman treatment — and it's the case, it's painful — then it is prohibited by international law," says Rupert Coville, spokesman for the UN high commissioner for human rights.
Some doctors' groups agree, saying that any patient of sound mind has every right to refuse treatment. Others counter that when a human life is at stake, the moral case isn't that simple. The ethical guidelines of the free world sometimes must be modified to suit the reality inside prisons, says Steven S. Spencer, former medical director of the New Mexico Corrections Department, in The New York Times. "The hunger-striking prisoner may be willing to die in pursuit of his goal. But the stress of incarceration may distort reasonable thinking." The hope is that by showing the hunger striker you're not going to let him die you can get him to snap out of it and resume normal eating, says Spencer:
Incarceration creates not only a loss of freedom of action, but of decision-making. When a person is incarcerated his health care and life are now the responsibility of the prison or jail staff. Institutional policies are directed at preventing self-destructive behavior as well as preventing violence to others.
Despite concerns for patient autonomy, to withhold treatment, or to fail to intervene with forced feeding, to my mind would violate the norms of medical ethics. [New York Times]
The only clear thing about this debate is that there are no winners. "The procedure is, in a word, barbaric," says Kent Sepkowitz at The Daily Beast. Not only is it nearly intolerable to have your head and body strapped down while a tube is pushed through your nose, but being forced to lie on a gurney while doctors willfully violate your wishes must be a "deeper and surely much more brutalizing pain." Still, it "is facile to suggest that refusal to place the feeding tube, as suggested by groups including the [American Medical Association] and the American Civil Liberties Union (of which I am a member), is the single conscionable approach," argues Sepkowitz.
Just as the patient is an individual with rights that must be respected, so too is the doctor a human being with a personal moral code. I actually don't know what I would do if I were one of the 40 medics dispatched to Guantánamo. But I do know I would not read a guideline or listen to the screeching admonishments from across the political spectrum. Perhaps the only lesson from the entire unhappy debacle is this: when a doctor is placed into a fraught situation as the agent of a political action, everyone loses. [Daily Beast]
But not everyone thinks ethical concerns are the heart of this matter. While doctors and human rights activists debate whether it's ever right to force treatment on an unwilling person, the military and the Obama administration are contending with a political dilemma, says Leith Passmore, also in the Times. "The hunger strike is at its core a spectacle," and "the U.S. military is understandably wary of the potential fallout over inmate deaths." President Obama, too, appears determined to limit the backlash. "A member of the Irish Republican Army, Bobby Sands, starved to death in prison in 1981, and his death increased recruitment and sectarian violence. Force-feeding may prevent this type of martyrdom, but it also leaves the United States open to further accusations of state torture," says Passmore. That suggests that this crisis will be a recruiting bonanza for jihadists, whether the U.S. force-feeds the hunger strikers or not.