U.S. military doctors should refuse orders to force-feed hunger strikers at the Guantanamo detention camp because it violates their ethical obligations, two doctors and a medical ethics professor wrote in the New England Journal of Medicine on Wednesday.
"Force-feeding a competent person is not the practice of medicine; it is aggravated assault," the trio said in an article posted on the website of the respected medical journal.
"Physicians at Guantanamo cannot permit the military to use them and their medical skills for political purposes and still comply with their ethical obligations," wrote Doctors Sondra Crosby and Leonard Glantz, and George Annas, a lawyer who chairs the Health Law, Bioethics and Human Rights Department at Boston University.
The detention camp at the Guantanamo Bay U.S. Naval Base in Cuba holds 166 men captured in counterterrorism operations, more than half of whom have been cleared for release during U.S. military and intelligence reviews.
At least 104 of them have joined a months-long hunger strike to protest the failure to resolve their fate after a decade of detention, and 43 have lost enough weight that doctors are feeding them liquid meals through tubes inserted in their noses and down into their stomachs, a military spokesman said.
Prisoners who refuse can be strapped into restraint chairs to immobilize them during the procedure.
The journal authors noted that the American Medical Association and the World Medical Association , which represents the medical associations of nearly 100 countries, have long held that force-feeding mentally competent adults who refuse food is a violation of medical ethics.
They urged military doctors to stop the force-feeding, urged the Pentagon to rescind a 2006 instruction permitting the practice and said military doctors should not be disciplined for refusing to force-feed prisoners.
Navy Captain Robert Durand, a spokesman for the detention operation, said the tube-feeding procedure is court-approved and medically sound and is based on procedures used in U.S. prisons, hospitals and nursing homes worldwide.
"It is the policy of the Department of Defense to protect the life and health of detainees by humane and appropriate clinical means, and in accordance with all applicable law and policy," Durand said.
"The policy on treatment of hunger strikers is focused solely on preserving the life and health of detainees in Department of Defense custody, and is consistent with treatment that would be provided for U.S. military personnel under similar circumstances."
The journal authors said that policy mistakenly conflates hunger striking with suicide prevention.
"Hunger strikers are not attempting to commit suicide. Rather, they are willing to risk death if their demands are not met. Their goal is not to die but to have perceived injustices addressed," they wrote.
One of the authors, Crosby, has served as a medical consultant to attorneys representing detainees at Guantanamo Bay, and has examined some of them at the base, including a hunger striker. She is scheduled to examine another prisoner who blames his post-traumatic stress disorder on torture in CIA custody.