Selected from: "Hunger Strikes, Force-feeding, and Physicians' Responsibilities."

In: Journal of the American Medical Association, 298: 563-566.
By: Sondra S. Crosby, MD; Caroline Apovian, MD; and Michael Grodin, MD.

[…] The situation at Guantánamo Bay is unique and has been characterized as a "legal black hole."¹ Nonetheless, it seems reasonable to conclude as has the US Supreme Court that in a detention camp under military control, the provisions of the Geneva Conventions should apply.²⁴ This means, consistent with international humanitarian law, that force-feeding should not be used as punishment and should not be conducted in a manner that amounts to torture or to inhuman or degrading treatment. To the extent that 6-point restraints reportedly have been and continue to be used to immobilize competent prisoners for nasogastric tube insertion or forced feedings,¹² force-feeding at Guantánamo Bay violates the Geneva Conventions, international human rights law, and medical ethics.¹

Physicians caring for patients who are hunger striking may be placed in a position of dual loyalty; for example, fulfilling obligations to the prison or government, which may be in direct conflict with the patient's best interests. The physician's duty to the patient is always the highest priority. Because all legal and ethical rules for treating hunger strikers require the cooperation of physicians, physicians can and should prevent the force-feeding of competent prisoners by refusing to approve or participate. This action will, of course, require medical and legal professional organizations to strongly support prison physicians, including those in the military, who follow the dictates of medical ethics and human rights.

Notes

1. Annas GJ. Hunger strikes at Guantánamo: medical ethics and human rights in a "legal black hole." N Engl J Med. 2006;355(13):1377-1382.

12. Golden T. Guantanamo detainees stage hunger strike despite force-feeding policy. New York Times. April 9, 2007:A12.

24. Hamden v Rumsfeld, 126 SCt 2749 (2006).