Guantanamo Medicine

This morning I read a story detailing accusations that doctors at Guantanamo Bay were taking part in practices that violated medical ethics. It seems as if they’re force feeding prisoners with nasal tubes to get them to eat.

The military prison in Guantanamo Bay has always struck me as kinda strange. Sure Jack made it sound real exciting to be around it in A Few Good Men but in our ‘post-9/11 world’ the prison has taken on another image for me personally.

Since 9/11 the US has been holding about 500 ‘suspects’ there, many of whom have not been charged.

The concept of ‘holding’ some of the most serious individual threats to our national security in another country seems more than a bit weird. Even more curious is that other country is Cuba, where we’ve had relationships that have been strained to say the least over the past 50 years or so. I’m guessing that it is much easier to hold people for long periods of time people without charging them in Cuba than say Kentucky.

Last week I saw a pretty pissed off Rumsfeld on TV blasting the UN and Kofi Anan for calling for the US to shut down the military prison. Here’s one of the many articles on the web on this outburst, it made for good TV as he looked close to loosin’ it. He was mad because Kofi had never been to Guantanamo to see the place for himself. Surely Kofi wouldn’t make a strong statement about a facility he’d never been to but had access to.

I googled Rumsfeld UN Guantanamo and most of the stories were about how Rumsfeld has blocked UN access to Guantanamo. (Try it). Strange that my man Rummy would be so upset when he didn’t seem to want the UN there in the first place.

Apparently they’ve worked out their differences because earlier this month a UN human rights team visited the prison and said the treatment they observed there “amounted to torture”. The Defense Department denied this, saying they were just trying to keep the suspects alive. Recently hunger strikers at Guantanamo had been tied down in “restraint chairs” for forced feeding sessions (ouch).

This may have some gray area for me, if you’re trying to kill yourself by not eating then I think it’s OK to force someone to eat. In my mind this is akin to forcibly removing a loaded gun from someone’s head. Suicide by starvation seems weird to me and I’d never really heard of this, there seems to be much more efficient and less painful ways to go. Plus the motivation and patience it would take to starve yourself to death seems so much more difficult than continuing to live, this was eating at me so I did some digging.

As I suspected suicide by starvation is VERY rare, I can’t seem to even find it as a category of suicide techniques, and further the Supreme Court has ruled that the State can in fact intervene in cases of a conscious decision to starve to death:

As a general matter, the States--indeed, all civilized nations--demonstrate their commitment to life by treating homicide as a serious crime. Moreover, the majority of States in this country have laws imposing criminal penalties on one who assists another to commit suicide. We do not think a State is required to remain neutral in the face of an informed and voluntary decision by a physically able adult to starve to death.

So I think I’m cool with forced feeding tubes if someone is trying to kill him/herself. However the UN team found that the hunger strikers were NOT trying to kill themselves but were protesting conditions there.

Capt. John Edmondson, the Chief Medical Officer at Guantanamo has already stated that the detainees’ motivation was to protest their confinement rather than to kill themselves. He justified force feeding as “providing nutritional supplementation on a voluntary basis to detainees who wish to protest their confinement by not taking oral nourishment.” Somehow ‘voluntary’ and ‘restraint chairs’ seems to not go together in my mind.

What do doctors say?
So what does a doctor do when a patient is refusing to eat? The key question to ask would be, “Why?” Here are the guidelines from the American Medical Association on force feeding,

When a patient is capable of forming an unimpaired or rational judgment concerning the consequences of refusing nourishment, a physician should respect such a refusal.

Seems clear to me and this makes sense personally.

History is littered with successful examples of civil disobedience, whether in the form of sit-ins, marches, boycotts, and yes hunger strikes. All can be very useful in effecting change.

Why should we deny this right of anyone?

I wonder how much backlash we’re getting globally for our actions. I’m all for locking up suspected terrorists however I am troubled by examples where our hypocrisy in our role as shepards of human rights can cause extreme backlash.

I fondly recall conversations with Western Europeans just after 9/11. At the time I was working in southern France on a multi-national team, in fact I took the last AA flight from Dallas to Paris on 9/10/2001, and I had to opportunity to discuss with them this horrific event. An easy way to start a provocative discussion was to ask,

Why do they hate us so?

The question of why some hate us is still very relevant, could stuff like this be part of the answer?