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Wednesday, February 22, 2006

Force-feeding and Guantánamo

The New York Times has a follow-up story about the force-feeding of prisoners at Guantánamo who have refused to eat.  In the first article on Feb. 9, a military spokesperson was quoted as saying that by December 2005, 84 prisoners had started hunger strikes.  That number dropped to 4 after some (35 of 41 rather than 84, from the follow-up) were strapped into restraint chairs for a period of hours, tubes were threaded down their noses and into their stomachs, and forced feedings were begun.

The article offered two reasons for wanting to prevent the prisoners from starving themselves:

Some officials said the new actions reflected concern at Guantánamo and the Pentagon that the protests were becoming difficult to control and that the death of one or more prisoners could intensify international criticism of the detention center.


"There is a moral question," the assistant secretary of defense for health affairs, Dr. William Winkenwerder Jr., said in an interview. "Do you allow a person to commit suicide? Or do you take steps to protect their health and preserve their life?"

Dr. Winkenwerder said that after a review of the policy on involuntary feeding last summer Pentagon officials came to the basic conclusion that it was ethical to stop the inmates from killing themselves.

"The objective in any circumstance is to protect and sustain a person's life," he said.

There is something odd about speaking of this in terms similar to those of the debates around Terry Schiavo or Nancy Cruzan.  While there is no consensus in the U.S. about the circumstances in which committing suicide (or assisting it) is ethical, there seems to be legal consensus that people of sound mind have a right to refuse medical treatment, including nutrition.  For those who are unconscious, the challenge is to determine their wishes and then carry them out -- so for Schiavo, the legal framework (and much of the resulting debate) was around what she would have wanted.  For those convinced that Schiavo would have wanted not to fed in her circumstances, the law is clear that the feeding should stop.  (Thus many of those in favor of continued feeding tried to establish that that's what she would have wanted -- rather than that her wishes were irrelevant, and that she should be fed no matter what.)

So it is odd to see Dr. Winkenwerder speaking of "sustaining" a person's life as if it were not, say, to avoid a public relations problem or to preserve an intelligence asset, but instead as if it's that very person's interests (rights?) at stake.  I understand (but disagree with) the view that those in Guantánamo have no rights at all, but here is a government official appearing to put forward a theory of prisoners' rights as a means of not respecting a prisoner's wishes.  (I'm curious what "regular" prisons do when inmates refuse to eat, and how they justify it.)

More after the jump . . .

The follow-up article seems to be for the purpose of reporting that officials confirmed the use of the restraint chairs.

"It was causing problems because some of these hard-core guys were getting worse," General Craddock said at a breakfast meeting with reporters. Explaining the use of the restraint chairs, he added, "The way around that is you have to make sure that purging doesn't happen."

(Is the journalist signaling irony in noting that the interview took place at a "breakfast meeting"?)

The follow-up offers a third reason for the use of the restraint chairs:

Two other Defense Department officials said a decision had been made to try to break the hunger strikes because they were having a disruptive effect and causing stress for the medical staff.

It suggests that the objections to the use of the chairs center around the pain and discomfort of the procedure -- a threading (and unnecessary rethreading?) of the feeding tube for each feeding; "premature" use of the chair for prisoners who aren't eating but aren't yet starving; and rapid feeding causing a pain like a "knife in the stomach."

I remain confused about forced feeding at all, under circumstances in which the prisoners appear to be on track to be held indefinitely.  While realizing that war is messy and brutal, and that "lawyers on the battlefield" doesn't make sense, and that certain threats have an implacable quality, it seems wrong to me that a group of people has been rounded up by the government, placed in a holding pen, and that the government wishes to reserve the right to prevent any outside scrutiny or any challenge in the legal system that would involve the production of evidence about the threat posed by the prisoners.

Those supporting the indefinite detentions under these circumstances have been granted visits to GB, can offer tales of how well the prisoners are treated, and they offer mini-biographies of some of the prisoners to demonstrate that they are out to violently attack the U.S.  But one wants such matters to be subjected to a genuine truth-finding process rather than claims by officials offered on background -- something that seems right to do under these circumstances without having to believe that the U.S. government is corrupt, or the jailors at GB bad.  (On how well the prisoners are treated -- the follow-up says:

General Craddock suggested that the medical staff had indulged the hunger strikers to the point that they had been allowed to choose the color of their feeding tubes.

Sounds more bizarre than indulgent -- like picking what kind of wood one's cross will be made of.  (And what to make of reports that inmates have had to listen to a loud, repeated loop of the Meow Mix cat food commercial jingle?  A truly Americanized form of torture.)

So I do not share the disdain for lawyers who have stepped forward to try to create some adversarial, in the legal sense, proceedings around this.  The force-feeding stories seem to me to highlight the fact that there is a group of people being held indefinitely, perhaps until they die, for which we are to maintain on faith that they deserve it -- and that any who do not are acceptable collateral damage in the war on terror.

Posted by jz on February 22, 2006 at 06:10 AM in Current Affairs | Permalink


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Cue applause.

Here's my extra-cynical prediction: when it all shakes down, the bottom-line Administration justification for sneering at every moral authority in the world up to and including Archbishop Tutu is going to be that Gitmo makes Gitmo necessary. They've held all these people in a concentration camp for so long that anyone who wasn't a terrorist at the start is certainly going to be one now. (Wouldn't you vow violent revenge if you were held in a squalid cage for five years by brutal soldiers to be chased around with dogs, force-fed, and subjected to meow mix commercials?) Like something Kafka might dream up.

It's hard to decide whether the force-feeding part is totally insignificant in the greater scheme of barbarity that is Gitmo, or the ultimate indignity. I lean to the latter. The last stand against an overwhelming and oppressive power is a defiant self-destruction, and to take that away is to rip away the last shreds of their autonomy.

Posted by: Paul Gowder | Feb 23, 2006 12:20:47 PM

Most discussion on the "doctor assisted torture" front (and in the recent California lethal injection fiasco) focuses on an "all or none" approach: doctors must do all but saw off their own arms in a "duty" to these "patients" OR they need to stay out of Gitmo/the Pen altogether. I've tried to justify a third approach, which acknowledges that there are higher powers than doctors (say it isn't so) that create a world of torture and/or death penalties, and so perhaps a physician's "duty" in this real world is to keep things as humane as possible (in the case of lethal injection, make sure the guy's at least ASLEEP first as per the State's assurance). Tube feedings and torture is a fascinating sub-plot here: I can't wait to see where the partisan cards fall. Say no to Schiavo, say yes to terrorist? I would hope we would have some consistency, although since one party has information and the other had none, perhaps there is room for the old Learned Hand Cost:Benefit analysis.

Posted by: Steve | Feb 22, 2006 8:42:18 PM

Foucault suggested that the special power of the modern state is the power to "make live" and "let die." Seems like this is a textbook illustration -- and note how the idea (one might argue perversion of the idea) of rights simply plays into the government's power.

Posted by: John | Feb 22, 2006 12:09:13 PM

Z, your voice is a welcome addition to blogspace. i've alerted my biotech students to this interesting addition to our ethical doctors-taking-detainees-to-the-brink-of-torture" discussion.


The Nuremberg Code, if left for compliance to agents of institutions and companies that benefit from such experimentation, will be no more effective as a constraint than leaving issues of surveillance and torture to a lawyer chosen by a president who believes such practices are necessary to accomplish his mission. Law and codes, viewed from this perspective, are impediments to doing what must be done, used by an opposition consisting of political opponents, plaintiffs lawyers and rabble-rousing media, collectively seen as “enemy”.

Posted by: eon | Feb 22, 2006 11:31:05 AM

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