GUANTANAMO BAY NAVY BASE, Cuba -- Some Boston-based medical ethicists are using a commentary in the prestigious New England Journal of Medicine to urge a mutiny by Navy doctors managing a hunger strike at the prison here, and calling on civilian doctors to support them.
Wednesdays article, Guantanamo Bay: A Medical Ethicsfree Zone? argues that doctors who participate in the force-feeding of prisoners violate their ethical obligations.
Force-feeding a competent person is not the practice of medicine; it is aggravated assault, says the article, invoking the World Medical Association position that a competent prisoner can choose to hunger strike.
As of Thursday, the prison said it was administering tube-feedings to 43 of the 104 captives it calls hunger strikers among the 166 detainees. Four were in the hospital, none with life-threatening conditions. Its Department of Defense policy to preserve life through lawful means, said Navy Capt. Robert Durand, detention center spokesman.
The article by Boston University Professor George Annas, a lawyer and medical ethicist, and Sondra Crosby, a physician and professor of medicine at BUs medical school, appeared a week before the war court judge here is being asked to wade into the force-feeding issue at a hearing for the five men accused of engineering the Sept. 11, 2001 terror attacks.
The military wont say whether the alleged 9/11 mastermind, Khalid Sheik Mohammed, or any of the other 13 ex-CIA captives are on a hunger strike.
Those 14 men are under guard in a secret prison compound, Camp 7, as high-value captives of Task Force Platinum.
A Navy medical team uses a calculus of meals missed and weight lost to decide when to recommend a twice-daily tube feeding of a can of Ensure or another nutritional supplement. The camps commander, a Navy admiral who is not a doctor, approves the feeding and orders guards to deliver a specific shackled hunger striker to medical staff.
Guards shackle him into a restraint chair and a nurse inserts a tube up his nose, down the back of his throat and into his stomach for nasogastric feeding. Most captives get this procedure inside designated feeding cells in the detention centers penitentiary-style buildings. A few are fed at the hospital.
The Pentagon calls it a humane practice that prevents a prisoner from starving to death. Defense lawyers say their clients consider it torture.
Physicians at Guantánamo cannot permit the military to use them and their medical skills for political purposes and still comply with their ethical obligations, they wrote.
The Journals commentary writers propose a mutiny by physicians serving on the 137-member prison health staff of doctors, nurses and corpsmen.
We further believe that military physicians should refuse to participate in any act that unambiguously violates medical ethics, they wrote. Civilian physician organizations, future employers, and licensing boards should make it clear that military discipline action in this context will in no way prejudice the civilian standing of the affected physician.
Annas, a well-known, respected bioethicist, is not new to the issue. In 2008, he published a criticism of how the United States used doctors in detention and interrogations. Crosby has conducted medical exams on Guantánamo detainee cases. She has been approved as a consultant on torture in the case of a waterboarded captive, Abd al Rahim al Nashiri, 48, who has pretrial hearings this week in his death-penalty terror case.
The article is being published by the Massachusetts Medical Society journal just weeks after a Navy captain from Massachusetts, Daryl K. Daniels, took charge of medicine at the detention center. Durand, the detention center spokesman, said Wednesday evening he did not know if Capt. Daniels had read it.