Monday, May 13, 2013

What does US accomplish by Guantanamo force feeding?

Of the 166 detainees at Guantanamo Bay, about 100 are on a hunger strike. About 20 are being force-fed, according to the New York Times. About 40 medical staff have arrived to ensure that the detainees are fed.

The men want their cases heard before a court. Many of them have been at Guantanamo for 12 years without being charged.

What are the medical ethics of force-feeding? It seems to violate the norms of informed consent and refusing burdensome treatment. The American Medical Association sent a letter to Secretary of Defense Chuck Hagel on April 25. It quoted the 1975 Tokyo Declaration of the World Medical Association which takes an umambiguous stand on the issue: "Where a prisoner refuses nourishment and is considered by the physician as capable of forming an unimpaired and rational judgment concerning the consequences of such a voluntary refusal of nourishment, he or she shall not be fed artificially".

It is not clear how many doctors, if any, are involved in the force-feeding.

However, President Obama has ignored the niceties of medical ethics for the hunger strikers. He simply told the media, "I don't want these individuals to die." Politically it is impossible to release the detainees; legally it is hard to try them. So they remain in limbo, frustrated and angry.

The military has not released much information about the force-feeding regimen. But in The Daily Beast, infectious diseases expert Kent Sepkowitz, of Memorial Sloan-Kettering Cancer Center, makes it sound excruciating:

"Without question, it is the most painful procedure doctors routinely inflict on conscious patients. The nose--as anyone knows who ever has received a stinger from an errant baseball--has countless pain fibers. Some patients may scream and gasp as the tube is introduced; the tear ducts well up and overflow; the urge to sneeze or cough or vomit is often uncontrollable... The procedure is, in a word, barbaric. And that's when we are trying to be nice."

However, he also is unsure what is to be done.

"In this debate individual doctors are stuck at a crossroads of unusual complexity. Sworn to alleviate pain and prevent death where possible, we also are sworn to respect the wishes of the individual. For us, there is no simple way out. Though sharing some similarities, the situation is distinct from respecting the wishes of a patient dying from an untreatable illness--starvation has a remedy."

From here.

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