Medical ethics and the Gitmo hunger strike

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More than 100 prisoners at Guantanamo Bay are in the 139th day of a hunger strike.  They say they’d rather starve to death than endure continued imprisonment.  Their jailers, with the cooperation of military doctors, are force-feeding them through tubes.  George J. Annas and other Boston University medical professors, writing in the New England Journal of Medicine, say that this is a violation of medical ethics.  So does the American Medical Association.  I think they’re right.

Under the Bush administration, some 779 alleged terrorists from all over the world were brought to Guantanamo Bay for questioning.  Some of them were captured by bounty-hunters in Afghanistan, and the military took the word of the captors that they really were terrorists.  The U.S. military reviewed their cases, and have released all but 166 prisoners.

Of those prisoners, the CIA, FBI and the Justice and Defense departments have determined that 86 have committed no crime, pose no imminent threat and should be released.  The Obama administration says that it has identified only 46 that need to be kept at Guantanamo indefinitely.

So why not at least release the 86?  Why can’t the Obama administration do what the Bush administration did?

If you’re innocent, and you’ve been determined to be “not guilty” by some process, and you still are imprisoned with no hope of release, what are you to do?  The Gitmo prisoners started a hunger strike on Feb. 6.   They said they are willing to starve to death if they are not released.  Guantanamo military spokesmen admitted a few days ago that 104 are still on strike, and 44 are being force-fed by having tubes jammed down their throats.

This is an inherently painful procedure.  Many people with terminal illnesses prefer to go to hospices for the dying rather than prolong their lives a short time by this means.  Reports from Guantanamo indicate that the military authorities are making the process as painful as possible, in order to break the strike.

Hunger strikes are an old tactic by otherwise-helpless prisoners.  Hunger strikes go back at least to lawbreaking women suffragettes in Great Britain at the turn of the last century, and forcible feeding was regarded as a form of torture back then.

It is a powerful tactic because it is embarrassing to authorities.  Although President Obama is willing to kill people he deems terrorists by flying killer drones, letting people die while in his custody is a different matter.

What is the ethical role of physicians in this?  Isn’t it the duty of a physician to intervene to prevent suicide?  The answer to that is that the prisoners are not suicidal, any more than Mahatma Gandhi was suicidal when he began to “fast unto death” in 1932 to protest a new Indian Constitution that separated the electorate by caste.   Gandhi didn’t want to die, but he was willing to risk death rather than accept what he regarded as an injustice.  So it is with the prisoners.

The American Medical Association in an April letter to the Secretary of Defense called forcible feeding unethical and inhumane.  “Every competent patient has the right to refuse medical intervention, including life-sustaining interventions,” the AMA rightly said.

The more important question, which the hunger strike is meant to underline, is what the U.S. government should do about these prisoners.   If some of them are alleged to be criminals, they should be put on trial, punished if convicted and freed are acquitted.  Some of them are enemy combatants captured on the battlefield and are considered still a threat, they should be treated as prisoners of war under the Geneva convention, with access to the Red Cross and human rights organizations.  All others should be freed immediately.  President Obama has authority to do this.

Click on the following links for more information.   Hat tip to Jack Clontz of the Bertrand Russell Society for the first three.

A Medical Ethics-free Zone?  Guantanamo Physicians Urged to Stop Force-Feeding Prisoners, the video and transcript of interviews with George J. Annas, and with Sami al-Hajj, the only journalist ever held at Guantanamo Bay by Amy Goodman of Democracy Now.  Sami al-Hajj was freed after seven years following a 438-day hunger strike that lasted from January 2007 to May 2008.

Guantanamo Bay: a Medical Ethics-free Zone? by George J. Annas, Sondra S. Crosby and Leonard H. Glantz in the New England Journal of Medicine.

Force-feeding prisoners and the role of physicians by George J. Annas in Lancet, the British medical journal.

Starving for Justice at Gitmo by Terry J. Allen in In These Times.

US steps up effort to break Guantanamo hunger strike, a report last Saturday by The Observer in London.

The question of closing the Guantanamo Bay facility is a red herring issue.  Closing is meaningless if the inmates are transferred to some other prison, especially if the other prison is at some inaccessible location outside the United States.

Click on Archives | Matt Bors for more cartoons.

One Response to “Medical ethics and the Gitmo hunger strike”

  1. Mark Adams Says:

    P.E.’s comments represent views of a wise man in modern times. I fail to understand the contrary view of militarism and cruelty to civilians. The actions by our military (as well as guards in our private prison network) will most surely be viewed by other civilized countries as an example of what is wrong with the U.S.A..

    Like

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