Cascells: Testimony

(CAS1) The Assistant Secretary of Defense for Health Affairs visited U.S. Naval Station Guantanamo Aug. 8 [2007] to ensure that detainees here are receiving the highest level of care […] He mentioned that a recent article published in the Journal of American Medical Association that challenged the ethics of enteral feeding by Joint Medical Group personnel prompted him to visit Guantanamo Bay and witness the procedure himself. “I got to witness two of the tube feedings done by the nurse. In those instances I witnessed, there was no fighting or resistance,” said Casscells. “Tube feeding is a complicated issue because the detainees are not American citizens, they are not prisoners of war, nor are they criminals in the usual sense. They have this controversial status, which makes the circumstances difficult.” In the future, Casscells said he would like to meet with Islamic physicians and religious leaders to discuss various medical ethics issues. He also hopes to get input from these individuals on controversial issues such as enteral feeding. “Medical ethics is important, and not simple. We routinely seek a broad spectrum of viewpoints. But I have not seen anything that suggests the feeding policy is wrong. No U.S. law or religion approves of suicide. Since some of the strikers are said to have told the doctors they are ordered by detainee leaders to go on hunger strike, the doctors have to feed them when there is a risk of death, since they feel they cannot take at face value the refusal of food from someone who is coerced, or someone who may be depressed.” (DoD Health Affairs Secretary visits Guantanamo).

(CAS2) This month [August 2007] Dr. S. Ward Casscells, the new assistant secretary of Defense for health affairs, went to Guantánamo to "look at it with my own eyes," he told NEWSWEEK. Of the 355 detainees still in Gitmo, about 20 are on hunger strike at any one time, he says. Prisoners who skip nine straight meals go under "observation"; the forced feeding usually begins when they dip 15 percent beneath their ideal weight. […] Casscells watched as a half-dozen Gitmo prisoners went through the 45-minute procedure. They were strapped into "restraint chairs" and a 3/16-inch soft rubber tube was fed through their noses. (Prisoners may request a local anesthetic to ease the discomfort.) The patients ingest a tasteless high-protein mix, and guards watch them for an hour to make sure they do not self-induce vomiting. "Nobody kicked or screamed," Casscells says. The prisoners "complained," he says—not about the feeding but about not getting their day in court. He says some hunger strikers have told guards they would be happy to stop, but fear being "reported back to the detainee chain of command." There are seven doctors at Gitmo, and according to Casscells, none has objected to the forced feedings. "The doctors think they have a duty to keep the patients alive," says Casscells. The forced feeding, like the hunger strikes, will go on (Gitmo: Should Doctors Force-Feed Prisoners?)