At least 106 of the 166 prisoners at Guantanamo Bay detention center are reported to be on hunger strike, with 45 currently being force-fed.
A recently published report by the Constitution Project's Task Force on Detainee Treatment, to which we contributed, found that the practice of forced feeding at Guantanamo was "a form of abuse and must end." A member of the task force, Dr. Gerald Thomson, described the process: "You are forced physically to eat, by being strapped into a specially made chair and having restraints put on your arms, your legs, your body and your head so that you cannot move. [You have] a tube inserted into your throat that extends into your stomach, and you're trying to resist that with the only muscles that are free — in your throat." Detainees have said that it is intensely painful.
When the restraint chairs were first introduced to Guantanamo in December 2005, the force-feeding process was reportedly especially punitive. Several detainees said that guards kept them in a restraint chair for hours after the tube feeding ended — sometimes for as long as six hours. The military says that the restraint chairs prevent assaults on U.S. personnel, but a detainee whose condition has deteriorated such that force-feeding is medically necessary to sustain life is unlikely to have the physical ability to commit assault.
At least two detainees were force-fed in the chair twice a day for close to four years. By 2009, the process was less prolonged and brutal, but the restraint chair was still used for every feeding regardless of a detainee's compliance, according to an independent physician who visited Guantanamo and examined detainees. She found that the force-feeding procedure caused physical pain and psychological harm that in one case became full-blown post-traumatic stress disorder.
Another detainee, Tariq Ba Awdah, has told lawyers that he has been force-fed for six years, and he is still on a hunger strike. Doctors have a duty to preserve life, but they also have a duty to respect patients' autonomy and not to subordinate their medical judgment to prison authorities. As the World Medical Assn.'s Declaration of Malta states: "Fostering trust between physicians and hunger strikers is often the key to achieving a resolution that both respects the rights of the hunger strikers and minimizes harm to them."
Therefore, doctors should be assessing the hunger striker to determine whether he is mentally competent, whether he is suicidal, and whether he is being pressured by other detainees into fasting. Clinicians need to be able to counsel patients about the risk of permanent injury or death, and about measures that can be taken to mitigate those risks.
Above all, as required by their medical ethics, doctors need to be able to act in their individual patient's best interest and exercise their independent clinical judgment.
The International Committee of the Red Cross, the World Medical Assn. and the American Medical Assn. all oppose force-feeding of prisoners as a violation of medical ethics. Pentagon officials are no doubt sincere in wanting to keep detainees alive. But they also view hunger strikes as a means of "asymmetrical warfare," as the Guantanamo commander told task force staff when they visited the prison in February 2012.
That belief probably influenced the response to the current hunger strikes. On April 13, the military placed nearly every captive on lockdown in single cells. Since then, there have been at least two suicide attempts. Fortunately, neither succeeded, but a Muslim advisor to the prison recently told reporters that he expected "more than one death" to result from the current hunger strike.
Putting detainees in lockdown and force-feeding them in restraints can postpone deaths, but it cannot prevent them indefinitely. Prolonged force-feeding carries its own medical risks, and Guantanamo detainees have killed themselves even in the highest security sections of the prison. There have been seven suicides.
In 2010, 86 prisoners at Guantanamo — including several currently being force-fed — were cleared for transfer by an interagency task force convened by the Obama administration. But transfers have been mostly halted in recent years, with Congress and the White House blaming each other. The transfers must restart as soon as possible.
As the president said in a speech on May 23, force-feeding detainees who have been held without charge for more than a decade is unacceptable: "Is that who we are? Is that something our founders foresaw? Is that the America we want to leave our children?"
Unfortunately, the detainees at Guantanamo no longer place much hope in Obama's promise to close the prison. Since the president's speech, the number of detainees being force-fed has increased by at least 13. The administration must move as swiftly as possible to exercise its authority to restart transfers out of Guantanamo, beginning with those detainees previously cleared for transfer. Exercising that authority is the best chance to end the hunger strike.