CHICAGO -- Military doctors violate medical ethics when they approve the force-feeding of hunger strikers at the US prison camp at Guantanamo Bay, according to a commentary in a prestigious medical journal.
The doctors should attempt to prevent force-feeding by refusing to participate, the commentary's three authors write in today's Journal of the American Medical Association.
"In medicine, you can't force treatment on a person who doesn't give their voluntary, informed consent," said Dr. Sondra Crosby of Boston University, one of the authors. "A military physician needs to be a physician first and a military officer second, in my opinion."
As of yesterday, 20 of 23 fasting detainees at Guantanamo were being fed liquid meals through flexible tubes inserted through their noses and throats, said Navy Commander Rick Haupt, Guantanamo spokesman. The strikers are protesting conditions at the camp and their open-ended confinement.
A few physicians have declined to participate in the force-feeding, although the specific number has not been tracked, Haupt said. The military does not punish doctors who won't participate in force-feeding, Haupt wrote Friday in an e-mail response to questions from the Associated Press.
A mass hunger strike began at Guantanamo in 2005 and reached a peak of 131 detainees. Last year, the military started strapping detainees in restraint chairs during tube feedings to prevent the prisoners from resisting or making themselves vomit.
The restraint chairs constitute excessive force and coercion, Crosby said.
Department of Defense spokeswoman Cynthia Smith said force-feeding is done "in a humane and compassionate manner," using a method that is consistent with procedures used in US federal prisons.
"No patient receives any medical treatment unless medically necessary," Smith said.
Last year, Crosby and a coauthor reviewed the medical records of two detainees who were force-fed, and wrote affidavits filed in federal court. They were not paid for that work, which they did at the request of the prisoners' lawyers.
Reviewing those medical records prompted the commentary, Crosby said.
"We were and still are disturbed by the practices," she said.
The medical records contained no evidence that the hunger strikers received ongoing psychiatric evaluations or had been adequately told about the risks of fasting or tube feeding, Crosby said. If they understand the consequences, the ethical approach is to let them fast without force-feeding, Crosby said. She said it's also unclear whether the strikers have access to independent medical consultation.
Haupt, the Navy spokesman, said mental health professionals see the strikers once a week. The strikers' physical and mental health are closely monitored, he said. They aren't allowed to consult with independent doctors, however, Haupt said.
The commentary calls on professional organizations to back doctors who refuse to participate in force-feeding. Commentaries are the opinions of the authors, not of the journal's editors or of the American Medical Association, but the AMA has endorsed the World Medical Association's policy against force-feeding.
About 360 men are still held at Guantanamo on suspicion of terrorism.