PHR Library

September 16, 2005

FOR IMMEDIATE RELEASE

Forced Feeding of Gitmo Detainees Violates International Medical Codes of Ethics

The force feeding of hunger strikers by physicians at Guantanamo Bay under the authority of US officials is in direct violation of international codes of medical ethics, Physicians for Human Rights (PHR) said today. Since early August, according to press reports, at least 130 detainees have been on a hunger strike protesting lack of due process and conditions of detention. Ethical principles unequivocally support the autonomy of a hunger striker who is mentally competent and is engaged in this form of expression by his or her own free will -- one of the few forms of expression available to prisoners. Given statements by US officials that US military physicians have force fed some of the hunger strikers, PHR is also concerned that these physicians and other health personnel working at the facility may have been pressured into intervening in ways that contradict their ethical obligations.

Ethical codes endorsed by the American Medical Association (AMA), including the World Medical Association (WMA)’s 1975 Declaration of Tokyo, which was elaborated in the 1991 WMA Declaration of Malta on Hunger Strikers (see links below), state clearly that “where a prisoner refuses nourishment and is considered by the doctor as capable of forming an unimpaired and rational judgment concerning the consequences of such voluntary refusal of nourishment, he or she shall not be fed artificially [emphasis added].”

The WMA is the internationally recognized organization that represents national medical associations around the world. It promotes the highest standards of medical ethics, and provides ethical guidance to physicians through its Declarations, Resolutions and Statements. The American Medical Association is one of the founding members of the WMA.

Internationally-adopted codes of medical ethics provide detailed guidelines for doctors treating hunger strikers. Though physicians in these situations have a duty to respect the sanctity of life, and act in the best interests of their patients, they have a greater duty to respect the autonomy of their patients who freely choose to refuse food and/or fluids and understand the consequences of their actions.

Ethical principles call for health personnel to inform hunger strikers on the clinical consequences of their fasting. Physicians should not apply undue pressure on a hunger striker to end their fasting, and should never accept a decision by a non-medical authority to force-feed them. Hunger strikers require daily assessment by the treating physician of their wishes to continue – or end – their strike and are entitled to have a second medical opinion. Once a patient is no longer able to make an unimpaired decision or has lapsed into a coma, the patient’s physician is responsible for subsequent clinical decisions, taking into account the patient’s preceding decisions regarding fasting when he/she was fully conscious and aware of the consequences of his/her actions.

Hunger strikers should also be protected from coercion by fellow prisoners to participate in this form of protest. It is also the doctor's duty to preserve them from being force fed as a measure of intimidation prescribed by detaining authorities eager to stop the protest. If a doctor cannot accept a patient’s decision to refuse treatment or artificial feeding, the patient would then be entitled to be attended by another physician.

The existing ethical guidelines presume a trusting and confidential relationship between a health professional and the patient. Physicians for Human Rights is concerned that the current situation at Guantanamo, where severe conditions of detention, persistent interrogations using now widely documented coercive methods over the past three years, along with the subsequent hostility generated towards custodial staff, including the physicians, make it impossible for physicians to care for the hunger strikers according to these guidelines. In view of the continued lack of due process and transparency, chronic repressive conditions at Guantanamo, and the ongoing hunger strike crisis among prisoners there, PHR calls on the US Government to:

• permit an independent delegation of qualified physicians to investigate the conditions and circumstances of the hunger strikers in order to help attending military physicians clarify their ethical duties to each patient engaged in the hunger strike
• assure that any intervention with regard to hunger strikers is consistent with WMA standards of medical ethics, as endorsed by the AMA, and that no health personnel are compelled to engage in force feeding. It is imperative that physicians should be allowed to meet privately and confidentially with prisoners to assess the voluntary nature of their strike, as well as to ascertain how and when they have been artificially or force-fed.

PHR also calls upon the American Medical Association to:

• support its members who act in accordance with their ethical duties regarding the health of hunger strikers and to sanction those who violate these duties.

Related Links

Declaration of Tokyo

Declaration of Malta

WMA Course for Prison Doctors  

Physicians for Human Rights Report: Break Them Down

Physicians for Human Rights Report: Dual Loyalty and Human Rights

Physicians for Human Rights (PHR) mobilizes the health professions to advance the health and dignity of all people by protecting human rights. As a founding member of the International Campaign to Ban Landmines, PHR shared the 1997 Nobel Peace Prize.