The August 1 edition of the Journal of the AMA contains a variety of excellent article and commentaries about the health effects of war and violence. One of these is a commentary written by Drs. Susan S. Crosby, Carlne M. Apovian and Michael A. Grodin about the ethical ramifications of physicians force feeding prisoners without their consent, as doctors are currently doing at the US military base at Guantanemo. They conclude
"To the extent that 6-point human restraints reportedly have been used and continue to be used to immobilize competent prisoners for nasogastric tube insertion , forced feedings at Guantanemo Bay violate the Geneva Conventions, international human rights law and medical ethics.
The article is available at http://jama.ama-assn.org/... for a fee of $15. If you are not a member of the AMA, you can read a copy at the nearest library that subscribes to JAMA (such as a medical school or other health oriented institution). In brief, the authors discuss the history of hunger strikes, the physiology of starvation, the legal reasons why a doctor can step in to force feed a hunger striker---these mainly have to do with mental incompetence or if the hunger striker is being forced by others against his will to participate in the strike. The law does not allow a physician to interfere with a hunger strike carried out by a mentally competent individual and it specifically prohibits the use of any techniques which can be construed at being designed to degrade or punish. They cite a case heard by a European court concerning prisoners in the Ukraine who were restrained and fed by rubber tubes who were ruled to have been tortured through their force feeding.
In case you are picturing a nice, sterile, medically sound procedure, here is this eye witness account from 2005 of how the US military is using force feeding as torture.
http://www.democracynow.org/...
JULIA TARVER: What we found is that the situation at Guantanamo has deteriorated drastically, even since our previous visit at the end of July. The level of hopelessness in the camp has reached a point where our clients are literally vowing they have no other choice but to die. The treatment they are receiving from the guards and the medical staff at Guantanamo is very, very disturbing.
What we've learned is that in some sort of ill-advised attempt to stop the hunger strike, the guards and the medical staff are using intervention, medical intervention, to actually inflict forms of torture on our clients. They claim that in order to preserve life at the base they are inserting tubes into the clients' noses that go down into their stomachs, and they're able to be fed that way.
But the problem is the clients have told us horrific stories repeatedly, from different clients, about how these same tubes are being forcibly inserted in by riot guards, how they're taken from one detainee and inserted into the next detainee with no sanitization, with the bile and the blood still on the tube from the previous detainee.
Coverage of force feeding as torture made Time Magazine last year.
http://www.time.com/...
Al-Shehri's medical records, however, document the use of the larger tubes, which experts say have no medical purpose in this context. Al-Shehri's lawyer has also filed court documents citing lesions and bleeding caused when guards held him by the chin and hair, strapped down, as a medical staffer"forcefully inserted the tube in his nose and down his throat" The lawyer also charges that al-Sherhri was subject to verbal and religious abuse during force-feeding, asserting that the tubes"were viewed by the detainees as objects of torture." The records also show that instead of leaving the tube in place to avoid the possible trauma of repeated insertions, al-Shehri had his introduced and withdrawn at each of his two daily feedings.
And this leads to another problem. According to al-Shehri's records and Gitmo doctors, a typical feeding lasts about two hours, with the inmate left in the restraint chair for roughly 45 minutes afterward. During the feeding period, the prisoner will receive as much as 1.5 liters of formula, which, in the case of hunger strikers, can be more than their stomachs can comfortably hold. This can produce what is euphemistically called "dumping syndrome," an uncomfortable, even painful bout of nausea, vomiting, bloating, diarrhea, and shortness of breath. And those are precisely the symptoms that al-Shehri and many other force-fed prisoners have reported to their lawyers.
In March, as a result of these allegations, more than 250 medical professionals signed an open letter to the British medical journal The Lancet, demanding an end to force-feeding. They cited the code of ethics of the American Medical Association and the World Medical Association, both of which condemn the force-feeding of prisoners as an assault on human dignity — so long as they're capable of making an informed decision not to eat.
Now, the Journal of the American Medical Association has called the practice of force feeding prisoners--which has gone on at Gitmo for two years--a violation of medical ethics. "Because all legal and ethical rules for treating hunger strikers require the cooperations of physicians, physicians can and should prevent the force-feeding of competent prisoners by refusing to 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."
And they are going to need all the support they can get, because the war mongers in the White House are not going to want to give an inch when it comes to torture.