Ethics and force-feeding prisoners on hunger strike « Medicine « Cambridge Journals Blog

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Health Professionals Who Participate in Force-feeding Prisoners on Hunger Strike at Guantanamo Bay Should Lose Professional Licenses

Force-feeding Violates Medical Ethics and Amounts to Torture

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 in Prehospital and Disaster Medicine. Dr. Jennifer Leaning, Director of the FXB Center for Health and Human Rights at Harvard University, and her Harvard colleagues, Sarah Dougherty, Dr. Gregg Greenough, and Dr. Frederick Burkle, 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.

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 Dr. Samuel J. Stratton, 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.”

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The paper “Hunger Strikers: Ethical and Legal Dimensions of Medical Complicity in Torture at Guantanamo Bay” can be viewed free of charge for a limited time here.

A companion paper, providing historical perspective from the emergency management of refugee camp asylum seekers, can also be viewed free of charge for a limited time here.

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via Ethics and force-feeding prisoners on hunger strike « Medicine « Cambridge Journals Blog.

What can be done about the poor state of global health?

Blog Post By Solomon Benatar, University of Cape Town & Gillian Brock Department of Philosophy, University of Auckland

What can be done about the poor state of global health? How are global health challenges linked to the global political economy and to issues of social justice? What are our responsibilities and how can we improve global health? These questions are addressed from the perspective of medicine, philosophy and the social sciences. Offering a wealth of empirical data and both practical and theoretical guidance, this is a key resource for bioethicists, public health practitioners, and philosophers. Read more of this post

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