U.S. Naval medics are forcing tubes down the noses of detainees at Guantánamo Bay in order to feed them against their will. The U.N. has said this violates international law. When does “suicide prevention” become torture?
MAY 3 2013: Another hunger strike is happening in the detention camp at the Guantánamo Bay U.S. naval base in Cuba. It currently involves around 100 people, 23 of whom are being force-fed by Naval medics as a matter of “suicide prevention.” Extra medics were flown in earlier this week for this purpose.
The hunger strike led President Obama to bring Guantánamo back into the national spotlight at a press conference on Tuesday. He called the current situation at the base “unnecessary and unsustainable,” but did not lay out a timetable for definitive action. What’s happening now, though, could compel it.
An understanding of what it means to be force-fed is important in the discussion of the morality surrounding this, and why it is unsustainable. Carol Rosenberg at The Miami Herald — where they have a daily Hunger Strike Tracker — described the feedings vividly on Morning Edition yesterday: “Twice a day, if you’re designated for what they call tube-feeding, you are shackled at the wrists and ankles to a chair, and a corpsman, a Navy medic, snakes a tube up your nose, down the back of your throat, into your stomach, and pumps a can of Ensure [a high-protein nutritional supplement] inside.”
In hospitals all over the world, these same tubes are used to feed patients who are unable to eat. It’s very common. I’ve put in hundreds. I’ve had one put into me. It’s uncomfortable while going though the back of your throat and down your esophagus, but tolerable once it’s in. Still the process is not something I would wish on anyone, especially twice every day. Sometimes the tube goes down the person’s airway instead of their esophagus, which can be dangerous. Sometimes it goes into their nose and comes out their mouth, which, in my experience, is disconcerting to the person.
Nasogastric tubes are an appropriate medical intervention for a consenting patient, or for someone whose power of attorney consents on their behalf. It can also be an appropriate measure when a patient is in an altered mental state, prone to self-harm, where the tube might be a temporizing measure to restore them to good mental and physical health. Once in good health, the person could refuse further use of the tube.
Or, could they? Does refusing to eat, in itself, constitute psychopathology — suicidality?
That is the question at Guantánamo. So, let’s step back on the idea of force-feeding for a minute.
Sometimes people force-feed animals benevolently.
Other times, we force-feed animals non-benevolently to make delicious foie gras. People have been doing this to birds for at least 5,000 years.
Force-feeding ducks prompts moral outrage. Force-feeding humans against their will: next-level outrage? It can be medically justified, though, if it is considered suicide prevention. Are 100 detainees suicidal? Even if suicidality is defined as any instance where someone would rather die than endure their current circumstances, when it happens simultaneously in 100 people, it is difficult to diagnose them all as being of mentally ill.
Brian Mishara, Director of the Center for Research and Intervention on Suicide and Euthanasia in the Psychology Department at the University of Quebec, put it succinctly in The New York Times: “In the case of Guantánamo, intervening to save or prolong a person’s life without trying to change the person’s reasons for wanting to die cannot be considered suicide prevention. Suicide prevention would involve intervening to change the person’s desire to die (despite his circumstances) or changing the situation that he feels is intolerable. From the news reports I have seen, those steps are both absent, and therefore the military’s force-feeding does not constitute suicide prevention.”
In India, a woman named Irom Sharmila has been on a hunger strike for 12 years over a law that suspends some human rights protections in areas of conflict. She has been tube-fed through her nose by the Indian government — for 12 years.
Will the United States keep these detainees alive for 12 years against their will? If 12 years sounds too long, then what is an appropriate amount of time to keep a prisoner alive by tube feed? Is this torture? Hundreds of physicians around the world have spoken out on behalf of the World Medical Association — in addition to the American Medical Association — in saying that what the U.S. is doing is inhumane. The U.N. Human Rights Commission has said in the past that forced feeding constitutes torture and violates international law.
Entire public health course syllabi could be structured around Ethics at Guantánamo and the appropriate role of health professionals therein as they try to “first do no harm.” Layering the complexity is the notion that some of the detainees might have information that, should they live to share it, could subvert some future attack against the U.S. and save hundreds, thousands of lives. Would you force-feed one person if it potentially meant saving the lives of thousands? The U.S. has renounced torture, but these notions could influence perspectives on what is torture and what is suicide prevention.
It seems Syria is not the only place President Obama will be fast compelled to discern a red line for human rights. On Tuesday he said Guantánamo “needs to be closed.” Continued discussion around forced feedings as this hunger strike plays out could be what sees these renewed calls realized.