Doctors Urge U.S. to Stop Force-Feeding Detainees

Reports accuse medical doctors of force-feeding prisoners on hunger strikes at the U.S. detention facility in Guantanamo Bay, Cuba. Madeleine Brand talks with Dr. David Nicholl about a letter he and more than 200 other doctors co-signed, appealing for the U.S. military to stop the practice.

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MADELEINE BRAND, host:

A group of doctors is calling on the U.S. to stop force-feeding hunger strikers at the Guantanamo Bay detention center. In this week's issue of the British medical journal The Lancet, 263 doctors from seven countries signed a letter calling for the feeding to stop. There are currently a handful of hunger strikers at Guantanamo, though there have been more in the past. About three of them are being held in chair restraints and force-fed.

Dr. David Nicholl orchestrated the signing and publication of the letter, and he joins us now by cell phone from London. And Dr. Nicholl, why did you and the others write this letter?

Dr. DAVID NICHOLL (Department of Neurology, Queen Elizabeth Hospital): I'll tell you why. It's because in October, I'm involved with Amnesty International, and I know some of the human rights lawyers for the detainees, and I was given two sets of documents. One was the set of allegations from the detainees about the process of force-feeding, and the other was the set of documents from the doctors and the U.S. government legal sides against those allegations.

I was vaguely interested in the detainee statements, but I was much more interested in what the doctors had to say, as a doctor myself. And to be frank, I was pretty appalled by the statements that were used. Time and time again, the justification for the involuntary feeding process, as they described it, was that they were following the orders of a higher military authority.

Now that wasn't justification at Nuremberg, and I don't believe it should be justification in Guantanamo, because force-feeding is actually banned by the World Medical Association's declarations at Malta and declarations at Tokyo, to which the American Medical Association, as well as numerous other national medical associations are signatories.

BRAND: What are the ethical objections to force-feeding, because aren't doctors supposed to try to save lives and in fact keep people alive?

Dr. NICHOLL: Of course they are, but also they have to respect a patient's autonomy. Just because someone's a prisoner doesn't mean they can not refuse to have treatment. If that's what the patient wants to do, they need to respect that wish.

BRAND: And have there been situations in the past where doctors have had to watch a prisoner decide to starve himself?

Dr. NICHOLL: Well, I think the two most obvious examples would be the Irish hunger strikers, and originally I'm from Northern Ireland. You know, Bobby Sands and the hunger strikers there were left to die, in effect. There were a couple cases in the Irish hunger strikes where they were force-fed, but that only happened after court orders from relatives of some of the people on hunger strike. You know, so in some sense the Irish hunger strikers had the relative luxury of due process and could seek access to the courts, which of course is not the case in Guantanamo.

But perhaps more relevant is the situation in Apartheid South Africa. If one goes back to the 1980s, the South African government felt they were under attack from the African National Congress. They introduced detention without trial. People would be held indefinitely, and the ANC got pretty annoyed at being held for an indefinite period, so dozens of them went on hunger strike. And the government was worried about the political embarrassment of these people starving themselves to death, so they took them to the local hospital to be force-fed.

Now that's where the story changes completely because the doctors involved there, led by Dr. John Caulk(ph), refused to force-feed them because they considered it torture.

BRAND: Do you consider force-feeding torture?

Dr. NICHOLL: Personally, I do. And we quite specifically didn't use the word torture in the lecture because there's this debate about this. And I think the Pentagon and the U.S. Military need to be challenged on this directly. What do they define as torture? You know, are they basing their definition of torture to that now infamous memo to Alberto Gonzales in 2002 where they tried to redefine torture as death or major organ failure?

Now, if that's the definition they're using, I'm prepared to accept that force-feeding isn't torture, but if that's the case, then I believe they're abusing the English language, as well as human rights. If you follow that definition, then the use of the rack from the 14th Century would not be torture, and that's not a definition which anyone else in the world is using, and it's certainly not a definition which I would use.

BRAND: Dr. Nicholl, do you believe the doctors involved should be disciplined?

Dr. NICHOLL: Yes, and I think it's a wake-up call really to the American Medical Association and the state medical boards. Are they going to look the other way? Or are they going to investigate these allegations?

BRAND: Dr. David Nicholl, thank you for talking with us.

Dr. NICHOLL: Thank you.

BRAND: And you can explore both sides of the debate on due process rights for detainees at Guantanamo. There's that and more at our website, NPR.org.

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