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NLM Director’s Comments Transcript
Force Feeding Guantanamo Detainees Criticized: 07/15/2013

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Greetings from the National Library of Medicine and MedlinePlus.gov

Regards to all our listeners!

I'm Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.

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A candid and stimulating editorial, recently published in the New England Journal of Medicine, strongly suggests physicians at the Guantanamo Bay detainment camp in Cuba should not force feed detainees who are on a hunger strike. The editorial’s three authors argue the force feeding of some Guantanamo prisoners is medically unethical — and the practice warrants more criticism from health care professionals.

A news story about the editorial published in the U.K. Guardian reports the Guantanamo Bay camp currently houses about 166 prisoners (most of whom are held for alleged terrorist activities). Many of these detainees or prisoners have been held at Guantanamo Bay (a U.S. military base in Cuba) in an era that began with the destruction of the World Trade Center in New York City on September 11, 2001. At the time the editorial was published, the Guardian reported 104 prisoners were on a hunger strike and 43 detainees received forced feeding.

The editorial’s authors (who are highly respected senior faculty at Boston University’s Schools of Public Health and Medicine) write [and we quote]: ‘Guantanamo is not just going to fade away, and neither is the stain on medical ethics it represents’ (end of quote).

The editorial’s authors explain the ethical principle to not force feed prisoners initially was advanced by the World Medical Association’s Declaration of Helsinki after World War II. The authors cite the declaration that says (and we quote): ‘forcible feeding (of mentally competent hunger strikers) is never ethically acceptable’ (end of quote). The authors add forced feeding (and we quote): ‘is a form of inhumane and degrading treatment’ (end of quote).

The editorial’s authors note a U.S. Department of Defense’s 2006 directive on force feeding detainees says (and we quote): ‘In the case of a hunger strike, attempted suicide, or other attempted serious self-harm, medical treatment or intervention may be directed without the consent of the detainee to prevent death or serious harm’ (end of quote).

However, the authors explain a hunger strike is not an attempt to commit suicide. They discern the goal of the hunger strikers (and we quote): ‘is not to die but to have perceived injustices addressed’ (end of quote).

In addition, the authors suggest physicians abdicate their professional responsibilities to make individual and independent medical assessments when they participate in penological decisions that maintain prison order by force feeding detainees. The authors write (and we quote): ‘physicians who participate in this nonmedical practice become weapons for maintaining prison order’ (end of quote).

The editorial’s authors also imply a sense of frustration with the dearth of criticism among physicians regarding Guantanamo’s forced feeding efforts.

The authors conclude (and we quote): ‘As (Guantanamo) increasingly becomes a medical ethics-free zone, we believe it’s time for the medical profession to take constructive political action to try to heal the damage and ensure that civilian and military physicians follow the same medical ethics principles’ (end of quote).

We should add it is rare to see such a frank and critical editorial in one of the world’s leading medical journals. The editorial is a reminder of the field of medical ethics’ capacity to illuminate health and social issues.

Meanwhile, a helpful overview of the legal and ethical issues in health care (provided by Merck and Co. Inc) is provided in the ‘overviews’ section of MedlinePlus.gov’s medical ethics health topic page.

A link to information about the nutritional needs of end-of-life patients is available within the introduction of MedlinePlus.gov’s medical ethics health topic page. MedlinePlus.gov’s medical ethics health topic page also provides updated, comprehensive, evidence-based information about diverse healthcare ethics issues such as: genetic and prenatal testing, birth control, organ donation, and patient rights.

MedlinePlus.gov’s medical ethics health topic page additionally contains links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. From the medical ethics health topic page, you can sign up to receive email updates with links to new information as it becomes available on MedlinePlus.

To find MedlinePlus.gov’s medical ethics health topic page, just type ‘medical ethics’ in the search box at the top of MedlinePlus.gov’s home page. Then, click on ‘Medical ethics (National Library of Medicine).’ MedlinePlus.gov also has a health topic page devoted to nutrition and health.

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