A multinational group of doctors, including 50 Americans, has launched a petition to President Obama to protest about the treatment of detainees on hunger strike in Guantánamo Bay. The petition was initiated by Medact, a charity that defends the right to healthcare.
In an open letter published in The Lancet medical journal on Wednesday, they wrote that the detainees no longer trust their military doctors with "very good reason" and that it is imperative that they are seen by independent clinicians. The doctors offer to visit, examine and advise the detainees in any way that is acceptable to all parties.
On 31 May, 13 of the detainees wrote to their military doctors. In their letter, they pointed out that by obeying orders to force feed them, the doctors are putting their duty to their superior military officers before their duty to their patients.
It is estimated that of the 103 Guantánamo detainees currently on hunger strike, a quarter are being force-fed. Four have been hospitalised. A medical team has reportedly been flown to Guantánamo to carry out the task.
British detainee, Shaker Aamer says his fellow inmates resemble famine victims who are ‘vomiting’ and ‘bleeding’ due to pieces of metal on the hard feeding tubes.
During force-feeding, the ‘patient’ is tied to a bed or to a tipped-back chair and his mouth is kept wide open with a metal clamp. A rubber tube is then forced down his throat so that food can be pushed through to his stomach. Sometimes the tube is inserted through the nose. There is a danger that food can enter the windpipe and get into the lungs, endangering the detainee's life.
This degrading and painful procedure has eroded the prisoners’ trust in the doctors to whom they look for protection and medical care. That is why they are asking for independent clinicians to be given access to their medical records so that they can receive appropriate treatment.
Like suffragettes before them, the detainees describe this procedure as ‘torture’. The force-feeding of suffragettes was described as ‘ordinary hospital treatment’. The justification given at the time was that it was carried out to save the women’s lives.
Despite their clear ethical duty not to participate in torture, doctors are still involved in this brutal practice.
Medical complicity in torture can be a result of ‘dual loyalty’ which occurs most often in prisons or detention centres, where clinicians can put the perceived interests of their employers or the state above their duty to their patients. The clinician may come under pressure to comply with - or may even identify with – the objectives of the authorities.
By force-feeding these prisoners, the military doctors are violating the ethics of their profession. This is made clear by both the American Medical Association and the World Medical Association, which has been trying to uphold global medical standards since the grotesque medical experiments carried out by Nazi doctors during World War Two.
According to the World Medical Association, physicians are complicit in torture when they "willingly take part in, facilitate, or allow torture by failing to report clinical evidence of torture to relevant authorities".
This type of torture is also condemned by the UN. The UN Special Rapporteur on Health has stated that it is not acceptable "to use threats of forced feeding or other types of physical or psychological coercion against individuals who have voluntarily decided to go on a hunger strike". Medical professionals who are willingly complicit in torture could be held legally responsible as could states which pressure physicians into complicity.
As explained in a Medact report ‘Preventing torture: the role of physicians and their professional organisations’ doctors have an absolute duty to protect the rights of their patients. They also have a duty to refuse unlawful orders which require them to collude in torture by force feeding competent hunger strikers.
The detainees’ descriptions of force-feeding are strikingly similar to those written by English suffragettes almost exactly 100 years ago.
In 1914 Constance Lytton wrote of her experience while imprisoned,
“He got the gag between my teeth and proceeded to turn it until my jaws were wide apart. Then he put down my throat a tube, which seemed too wide and was about four feet long. Then the food was poured in. It made me sick a few seconds after. The horror of it was more than I can describe.”
That this procedure is still being carried out today is deeply shocking - let alone at the hands of doctors.
This article was amended on 24 June 2013. We originally described the signatories as UK doctors.