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U.S. Military Document Says Force-Feeding Violates Medical Ethics and International Law

U.S. Navy Should Drop Charges Against Nurse who Refused to Force-Feed Guantánamo Detainees

For Immediate Release

Physicians for Human Rights (PHR) said today that a newly public U.S. military document acknowledging that force-feeding violates medical ethics shows the unlawfulness of hunger strike practices at the detention center at Guantánamo Bay. PHR called on the U.S. government to end all policies requiring clinicians to violate professional ethics and to immediately drop charges against the Navy nurse who refused to force-feed detainees.

“This document exposes the flawed medical and legal reasoning at the heart of Guantánamo’s force-feeding policy,” said Dr. Vincent Iacopino, PHR’s senior medical advisor. “Forcing treatment on mentally competent persons constitutes ill-treatment and possibly torture and is contrary to professional ethics. There is no evidence for the government’s claim that it is diagnosing or treating suicide or self-harm. Yet the command structure orders doctors and nurses to carry out force-feeding anyway, and attempts to justify the practice on the basis of medical necessity. The Navy nurse who stood up against this contradictory and harmful policy should not be discharged.”

PHR rejects the U.S. government’s claim that hunger strikes are a form of suicide or self-harm and that force-feeding is an appropriate therapeutic response. PHR said that this is a mischaracterization, as the hunger strikes at Guantánamo are protests of last resort against indefinite detention and ill-treatment. PHR stated that the government’s policy is inherently contradictory, in that it attempts to justify intervention ostensibly to prevent suicide or self-harm, yet fails to establish a medical foundation for intervention, such as diagnosing and treating self-harm behaviors and investigating other potential causes of weight loss.

Last year, a Navy nurse was transferred out of Guantánamo after refusing to participate in force-feeding. The nurse, who has been charged with misconduct, still awaits a decision on whether he could be discharged after 18 years of service. The American Nurses Association, the International Council of Nurses, and the World Medical Association (WMA) have publicly asserted the nurse’s professional obligation to pursue ethical practice and urged the DOD and the Navy to drop disciplinary proceedings against him.

The internal analysis by a United States Southern Command attorney, which ultimately determines that force-feeding is permitted under U.S. federal law, appears to be the military’s first documented recognition that force-feeding is contrary to professional ethics and international law. The analysis was issued on June 21, 2013 – just two months after the American Medical Association (AMA) sent a letter to U.S. Department of Defense Secretary Chuck Hagel (pdf), stating that “the forced feeding of detainees violates core ethical values of the medical profession.” The AMA endorses (pdf) the WMA Declarations of Tokyo and Malta, which recognize force-feeding as a form of inhuman and degrading treatment.

PHR said that Guantánamo’s force-feeding policy has required clinicians like the Navy nurse to carry out duties prohibited by medical ethics, or risk losing their careers if they refuse.

“Force-feeding requires doctors and nurses to inflict physical and mental pain without any medical justification and violate the most basic professional duty to ‘do no harm,’” Iacopino said. “Current federal policy requires doctors and nurses who serve their country to violate their professional codes and potentially jeopardize their licenses. The government must stop using health professionals as an instrument of punitive and harmful military policies.”

PHR said that force-feeding violates the prohibition against torture and ill-treatment and constitutes medical negligence, and calls on the U.S. government to:

  • Immediately end the practice of force-feeding detainees on hunger strike and institute policies and procedures consistent with the WMA’s Declarations of Tokyo and Malta on hunger strikers;
  • Ensure that no health professionals are compelled to participate in force-feeding, and that those who refuse do not face disciplinary or retaliatory actions for complying with their professional obligations; and
  • Commit to full transparency around hunger strikes at Guantánamo and medical management policies and protocols, including the release of the force-feeding tapes of former detainee Abu Wa’el Dhiab.

Physicians for Human Rights (PHR) is a New York-based advocacy organization that uses science and medicine to prevent mass atrocities and severe human rights violations. Learn more here.

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