Medical staff at Guantánamo should not compromise ethical principles

07/17/2014 7:05 PM

01/21/2015 4:54 PM

The U.S. Navy nurse who has had the courage to object to participating in forced feeding at the military detention facility at Guantánamo Bay should be supported by all professional medical organizations.

As the prison completed its 12th year of operations on Jan. 11, and reflecting upon the medical care for detainees, I am convinced that departures from the clinical and ethical imperatives that we as uniformed medical providers are obliged to uphold has led to an erosion of core medical values.

It is important that clinicians maintain professional ethical behavior in responding to the detainees’ medical and treatment requirements.

The Pentagon claims force feeding is needed to save lives. Military commanders have openly portrayed hunger strikes as acts of asymmetrical warfare that must be stopped with force.

Nonmedical commanders introduced five-point restraint chairs to make force feeding painful and humiliating. They have overruled medical judgments as to whether the detainee was competent and acting voluntarily.

Negotiations over means of taking nutrients were replaced by a uniform policy of force feeding detainees who refused a certain number of meals. Forced cell extractions for force-feeding introduced violence to the process. In 2013, the Department of Defense issued a protocol that even rescinded prior practices that allowed detainees to reduce some of the discomfort of naso-gastric feeding.

Twelve years have gone by without resolution of detainees’ status and fate, and one can understand why they have become even more desperate about their future. In these circumstances, the clinicians’ job is even more difficult in having to address more complex mental and physical health needs and to respond to what have become chronic hunger strikes.

But the duty of clinicians to remain devoted to the patient remains the same, and in the case of hunger strikes, that means determining whether the detainee is competent and un-coerced, and if so counseling him about his options. Domestic and international medical and nursing ethics preclude force-feeding, which are followed in other countries facing terrorism, including Israel and the United Kingdom.

The medical staff should not compromise these ethical principles and become adjuncts to decisions issued by non-medical commanders to break the will of the protesters.

I respect the men and women who serve the Guantánamo detainees. They provide the highest quality care to active duty members and their families and very often share battle space with our warriors.

In Afghanistan, doctors, nurses and medics often perform medical heroics to save life and limb of U.S. and allied forces as well as the enemy. But at Guantánamo, the medical staff is caught up in policies that use them to break protests and breach their ethical obligations.

The United States lost the moral high ground in the world’s eyes when it became apparent that enhanced interrogations were employed at Guantánamo and when forced feeding was administered to hunger strikers by medical professionals.

Restoring respect for our ethics and good medical practice is good for the clinicians, for the detainees, for the operation of Guantanamo, and for our nation.

Albert J. Shimkus, Jr., a professor of national security affairs at the Naval War College, is a retired U.S. Navy captain and the former commanding officer and chief surgeon for both of the Naval Hospital at Guantánamo Bay and Joint Task Force 160, which administered healthcare to detainees.

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