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27 September 2013 / Cambridge Journals
United States

Health professionals who participate in force-feeding prisoners on hunger strike at Guantanamo Bay should lose professional licenses

Physicians and other licensed health professionals are force-feeding hunger strikers held prisoner at the US Naval Base at Guantanamo Bay (GTMO), Cuba. These health professionals are violating the medical ethics they swore to uphold and are complicit in torture, according to the authors of an article published today in Prehospital and Disaster Medicine.

Jennifer Leaning, MD, SMH, Director of the FXB Center for Health and Human Rights at Harvard University, and her Harvard colleagues, Sarah Dougherty, JD, MPH, Gregg Greenough, MD, MPH, and Frederick Burkle, MD, MPH, DTM urge the licenses of health professionals who participate in force-feeding be revoked. Leaning and her co-authors also call for the medical profession to demand changes in military medical management protocols and stronger protections for military health professionals who protest unethical orders.

Historically, the treatment of hunger strikers has been difficult for health professionals, particularly those employed in institutional settings, because the practice raises profound clinical, ethical, moral, humanitarian and legal questions. A companion paper, providing historical perspective from the emergency management of refugee camp asylum seekers, is also published in Prehospital and Disaster Medicine today.

Leaning and her co-authors note that hunger strikes are political acts, not medical conditions. Hunger strikers refuse food on a voluntary, informed basis and without suicidal intent. At GTMO and elsewhere, force-feeding involves the use of force and physical restraints to immobilize hunger strikers without their consent and against their express wishes-actions which constitute battery and violate basic human dignity. The US Department of Defense (DoD) force-feeding policy and protocols are a "gross violation" of US and international ethical standards prohibiting force-feeding of hunger strikers.

The DoD has also ratified the practice through a longstanding policy of vetting health professionals assigned to GTMO. Military health care providers have the same medical ethics obligations as civilian providers, but as military personnel are also required to obey lawful orders. Because force-feeding has been found lawful under US civilian and military law, military health professionals at GTMO ordered to force-feed hunger strikers must choose between upholding medical ethics and obeying the law.

"Given the failure of civilian and military law to end force-feeding, the medical profession must exert policy and regulatory pressure to bring DoD policy and operations into compliance with established ethical standards,” says Jennifer Leaning. “We join those medical and ethical authorities who have called for investigations into the force-feeding at GTMO and for sanctions where appropriate. This paper is the first in the medical literature to review the history of exhausting attempts at remedy through US law and presents the tight argument for why only the US medical profession can adequately uphold professional standards of medical ethics through its licensing power. When the law has become deferential to the claims of civilian and military institutions, our only ethical bastion as physicians and health care providers is the national and international guild we have built and belong to. The professional battle to uphold principles of medical ethics and human rights has often in the past proved grossly feeble against prevailing institutional pressures. We turn away from this instance at our collective peril.” 

“Political events and actions are increasingly forcing physicians and other health care professionals to choose between medical ethics and US law,” says Samuel J. Stratton, MD, MPH, Editor-in-Chief of Prehospital and Disaster Medicine. “In both military and civilian contexts, the issues surrounding force-feeding are complex and contentious, and should be subject to rigorous examination and debate. Prehospital and Disaster Medicine intends to publish additional papers adding to the debate on how health professionals should navigate this important ethical dilemma.”

ENDS

Notes to Editors: 

About Prehospital and Disaster Medicine:

Prehospital and Disaster Medicine is an official publication of the World Association for Disaster and Emergency Medicine (WADEM). The peer-reviewed journal focuses on international prehospital, emergency, and disaster health topics.  

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