Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-23T07:03:51.211Z Has data issue: false hasContentIssue false
  • English
  • Français

Hunger Strikers: Ethical and Legal Dimensions of Medical Complicity in Torture at Guantanamo Bay

Published online by Cambridge University Press:  30 September 2013

Sarah M. Dougherty ,
Jennifer Leaning ,
P. Gregg Greenough  and
Frederick M. Burkle Jr.
Sarah M. Dougherty*
Affiliation:
FXB Center for Health and Human Rights, Harvard University, Boston, Massachusetts USA
Jennifer Leaning
Affiliation:
FXB Center for Health and Human Rights, Harvard University, Boston, Massachusetts USA Department of Global Health and Population, Harvard School of Public Health, Harvard University, Boston, MassachusettsUSA Harvard Medical School, Harvard University, Boston, Massachusetts, USA
P. Gregg Greenough
Affiliation:
Department of Global Health and Population, Harvard School of Public Health, Harvard University, Boston, MassachusettsUSA Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts USA Division of International Health and Humanitarian Programs, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts USA
Frederick M. Burkle Jr.
Affiliation:
Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts USA Woodrow Wilson International Center for Scholars, Washington, DCUSA
*
Correspondence: Sarah M. Dougherty, JD, MPH FXB Center for Health and Human Rights Harvard School of Public Health 651 Huntington Ave, 7th Floor Boston, MA 02115 USA E-mail [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Physicians and other licensed health professionals are involved in force-feeding prisoners on hunger strike at the US Naval Base at Guantanamo Bay (GTMO), Cuba, the detention center established to hold individuals captured and suspected of being terrorists in the wake of September 11, 2001. The force-feeding of competent hunger strikers violates medical ethics and constitutes medical complicity in torture. Given the failure of civilian and military law to end the practice, the medical profession must exert policy and regulatory pressure to bring the policy and operations of the US Department of Defense into compliance with established ethical standards. Physicians, other health professionals, and organized medicine must appeal to civilian state oversight bodies and federal regulators of medical science to revoke the licenses of health professionals who have committed prisoner abuses at GTMO.

DoughertySM, LeaningJ, GreenoughPG, BurkleFMJr. Hunger Strikers: Ethical and Legal Dimensions of Medical Complicity in Torture at Guantanamo Bay. Prehosp Disaster Med. 2013;28(6):1-9.

Keywords

dual loyaltyhunger strikemedical ethicsmilitary medicineprisoner
Type
Special Report
Information
Prehospital and Disaster Medicine , Volume 28 , Issue 6 , December 2013 , pp. 616 - 624
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.The Constitution Project. Report of the Constitution Project's Task Force on Detainee Treatment. Washington, DC, USA: The Constitution Project; 2013.Google Scholar
2.Rosenberg, C. Why Obama hasn't closed Guantanamo camps. Miami Herald. January 7, 2012. http://www.miamiherald.com/2012/01/07/v-fullstory/2578082/why-obama-hasnt-closed-guantanamo.html. Accessed August 2, 2013.Google Scholar
3.Shane, S, Landler, M. Obama clears way for Guantanamo trials. New York Times. March 7, 2011. http://www.nytimes.com/2011/03/08/world/americas/08guantanamo.html. Accessed August 2, 2013.Google Scholar
4. A History of the Detainee Population: The Guantanamo Docket. New York Times. July 23, 2013. http://projects.nytimes.com/guantanamo. Accessed August 2, 2013.Google Scholar
5.Crosby, SS, Apovian, CM, Grodin, MA. Hunger strikes, force-feeding and physicians’ responsibilities. JAMA. 2007;298(5):563-566.CrossRefGoogle ScholarPubMed
6. Tracking the Hunger Strike: GITMO Chart. Miami Herald. http://www.miamiherald.com/static/media/projects/gitmo_chart/. Accessed July 25, 2013. .Google Scholar
7. Department of Defense. JTF- GTMO-JMG Standard Operating Procedure: Medical Management of Detainees on Hunger Strike, March 5, 2013. http://www.aljazeera.com/humanrights/2013/05/201358152317954140.html. Accessed July 25, 2013.Google Scholar
8.World Medical Association. Declaration of Tokyo: Guidelines for medical doctors concerning torture and other cruel, inhuman or degrading treatment or punishment in relation to detention and imprisonment. Adopted October 1975, last revised May 2006. http://www.wma.net/en/30publications/10policies/c18/. Accessed July 25, 2013.Google Scholar
9.World Medical Association. Declaration of Malta on Hunger Strikers. Adopted November 1991, last revised October 2006. http://www.wma.net/en/30publications/10policies/h31/. Accessed July 25, 2013.Google Scholar
10.International Committee of the Red Cross. Hunger strikes in prisons: the ICRC's position. January 31, 2013. http://www.icrc.org/eng/resources/documents/faq/hunger-strike-icrc-position.htm. Accessed July 25, 2013.Google Scholar
11.Lazarus, JA. Letter to Secretary of Defense Chuck Hagel. April 25, 2013. http://media.miamiherald.com/smedia/2013/04/30/07/58/FRs25.So.56.pdf. Accessed July 25, 2013.Google Scholar
12.Lazarus, JA. Physicians’ ethical obligations to hunger strikers. BMJ. 2013;346:f3705.CrossRefGoogle ScholarPubMed
13.United Nations. Principles of Medical Ethics Relevant to the Role of Health Personnel, Particularly Physicians, in the Protection of Prisoners and Detainees Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. G.A. Res. 37/194. Adopted December 18, 1982. http://www.ohchr.org/EN/ProfessionalInterest/Pages/MedicalEthics.aspx. Accessed August 2, 2013.Google Scholar
14.Annas, GJ, Crosby, SS, Glantz, LH. Guantanamo Bay: A medical ethics-free zone? N Engl J Med. 2013;369(2):101-103.CrossRefGoogle Scholar
15. IACHR, UN Working Group on Arbitrary Detention, UN Rapporteur on Torture, UN Rapporteur on Human Rights and Counter-Terrorism, and UN Rapporteur on Health reiterate need to end the indefinite detention of individuals at Guantanamo Naval Base in light of current human rights crisis. May 1, 2013. http://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=13278. Accessed July 25, 2013.Google Scholar
16. UN Economic and Social Council, Commission on Human Rights. Situation of Detainees at Guantanamo Bay. UN Doc. E/CN.4/2006/120. February 27, 2006. http://daccess-ods.un.org/TMP/8949787.02068329.html. Accessed July 25, 2013.Google Scholar
17.Dhiab v. Obama, Case No. 05-1457 (GK) (D.C. Cir. 2013).Google Scholar
18. UN General Assembly. International Covenant on Civil and Political Rights. Adopted December 19, 1966. Entered into force March 23, 1976. http://www.ohchr.org/en/professionalinterest/pages/ccpr.aspx. Accessed July 25, 2013.Google Scholar
19. UN General Assembly. Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. Adopted December 10, 1984. Entered into force June 26, 1987. http://www.ohchr.org/EN/ProfessionalInterest/Pages/CAT.aspx. Accessed July 25, 2013.Google Scholar
20.Nevmerzhitsky v Ukraine, App. No. 54825/00, ECHR [5 April 2005].Google Scholar
21.Ciorap v Moldova, App. No. 54825/00, ECHR [19 June 2007].Google Scholar
22.Prosecutor v Seselj, International Tribunal for the Former Yugoslavia, Urgent Order to the Dutch Authorities Regarding Health and Welfare of the Accused, December 6, 2006.Google Scholar
23.Al-Adahi v. Obama, 613 F.3d 1102 (D.C. Cir. 2010).Google Scholar
24.Nicholl, DJ, Jenkins, T, Miles, SH, et al. Biko to Guantanamo: 30 years of medical involvement in torture. Lancet. 2007;370(9590):823.CrossRefGoogle ScholarPubMed
25.Okie, S. Glimpses of Guantanamo: medical ethics and the war on terror. N Engl J Med. 2005;353(24):2529-2534.CrossRefGoogle ScholarPubMed
26.Howe, EG, Kosaraju, A, Laraby, PR, Sasscells, SW. Guantanamo: Ethics, interrogation, and forced feeding. Military Medicine. 2009;174(1):iv-xiii.Google ScholarPubMed
27.Annas, GJ. Hunger strikes at Guantanamo–medical ethics and human rights in a “legal black hole”. N Engl J Med. 2006;355(13):1377-1382.CrossRefGoogle Scholar
28.Xenakis, SN. Testimony presented at: Closing Guantanamo: The National Security, Fiscal, and Human Rights Implications, Hearing before the Senate Judiciary Committee, Subcommittee on the Constitution, Civil Rights and Human Rights; July 24, 2013; Washington, DC, USA. http://judiciary.senate.gov/pdf/7-24-13XenakisTestimony.pdf. Accessed July 25, 2013.Google Scholar
29. Declaration of Malta: A background paper on the ethical management of hunger strikes. World Med J. 2006;52(2):36-43.Google Scholar
30.Wei, M, Brendel, RW. Psychiatry and hunger strikes. Harvard Human Rights Journal. 2010;23(1):75-109.Google Scholar
31.International Council of Nurses. Code of Ethics for Nurses. Adopted 1953, last revised 2012. http://www.icn.ch/about-icn/code-of-ethics-for-nurses. Accessed August 2, 2013.Google Scholar
32.American Nurses Association. Code of Ethics for Nurses With Interpretive Statements. Adopted July 2001. http://www.nursingworld.org/codeofethics. Accessed August 2, 2013.Google Scholar
33.American Nurses Association. Position Statement: Forgoing Nutrition and Hydration. Adopted April 2, 1992, last revised March 11, 2011. http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Ethics-Position-Statements. Accessed August 2, 2013.Google Scholar
34.American Academy of Physician Assistants. Guidelines for Ethical Conduct for the Physician Assistant Profession. Adopted 2000, last revised 2008. http://www.aapa.org/your_pa_career/becoming_a_pa/resources/item.aspx?id=1518. Accessed August 2, 2013.Google Scholar
35.National Association of Emergency Medical Technicians. Code of Ethics for EMS Practitioners. Adopted 1978, last revised June 14, 2013. http://www.naemt.org/about_us/emtoath.aspx. Accessed August 2, 2013.Google Scholar
36. International Council of Nurses, Position Statement, The Nurses’ Role in the Care of Prisoners and Detainees. Adopted 1998, last revised in 2011. http://www.icn.ch/publications/position-statements. Accessed August 2, 2013.Google Scholar
37.Marks, JH. Dual disloyalties: Law and medical ethics at Guantanamo Bay. In: Allhoff F, ed. Physicians at War: The Dual-Loyalties Challenge. New York, NY, USA: Springer; 2008:53-73.CrossRefGoogle Scholar
38.Welsh, J. Responding to food refusal: striking the human rights balance. In: Goodman R, Roseman MJ, eds, Interrogations, Forced Feedings, and the Role of Health Professionals. Cambridge, MA, USA: Harvard University Press; 2009:143-171.Google Scholar
39.Gross, ML. Force-feeding, autonomy, and the public interest. N Engl J Med. 2013;369(2):103-105.CrossRefGoogle ScholarPubMed
40.Beauchamps, TL, Childress, JF. Principles of Biomedical Ethics. 7th ed. New York, NY, USA: Oxford University Press; 2012.Google Scholar
41.Reyes, H, Allen, SA, Annas, GJ. Physicians and hunger strikes in prison: confrontation, manipulation, medicalization and medical ethics (part 1). World Med J. 2013;59(1):27-36.Google Scholar
42.Gillon, R. Medical ethics: four principles plus attention to scope. BMJ. 1994;309(6948):184-188.CrossRefGoogle ScholarPubMed
43.Leopold, J. Physician dismisses force-feeding concerns. Al Jazeera May 21, 2013. http://www.aljazeera.com/humanrights/2013/05/201352071456510564.html. Accessed July 25, 2013.Google Scholar
44.Annas, GJ. The legacy of the Nuremberg Doctors’ Trial to American bioethics and human rights. Minnesota Journal of Law, Science and Technology. 2009;10(19):19-40.Google Scholar
45.Leaning, J. Ethics of research in refugee populations. Lancet. 2001;357(9266):1432-1433.CrossRefGoogle ScholarPubMed
46.Faden, R. ed. Human Radiation Experiments: Final Report of the President's Advisory Committee. New York, NY, USA: Oxford University Press; 1996:122.Google Scholar
47.American Medical Association. Code of medical ethics. Opinion E-8.08, Informed consent. http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion808.page? Accessed August 2, 2013.Google Scholar
48.American Medical Association. Code of medical ethics. Opinion E-10.01, Fundamental elements of the patient-physician relationship. http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion1001.page? Accessed August 2, 2013.Google Scholar
49.Pellegrino, ED. Towards an expanded medical ethics: the Hippocratic ethic revisited. In: Bulger RJ, ed. In Search of the Modern Hippocrates. Iowa City, IA, USA: University of Iowa Press; 1987:45-64.Google Scholar
50.Leaning, J. Human rights and medical education: Why every medical student should learn the Universal Declaration of Human Rights. BMJ. 1997;315(7120):1390-1391.CrossRefGoogle Scholar
51.Snyder, L. American College of Physicians Ethics, Professionalism, and Human Rights Committee. American College of Physicians Ethics Manual. 6th ed. Ann Intern Med. 2012, Jan 3;156(1 Pt 2):73-104.CrossRefGoogle Scholar
52.UN Human Rights Council. Report of the UN Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Anand Grover. UN Doc. A/64/272. 2009. March 31, 2009.Google Scholar
53.Miles, SH. Medical ethics and the interrogation of Guantanamo 063. Am J Bioeth. 2007;7(4):5-11.CrossRefGoogle ScholarPubMed
54.Bloche, MG, Marks, JH. Doctors and interrogators at Guantanamo Bay. N Engl J Med. 2005;353(1):6-8.CrossRefGoogle ScholarPubMed
55.Physicians for Human Rights. Aiding Torture: Health Professionals’ Ethics and Human Rights Violations Revealed in the May 2004 CIA Inspector General's Report. August 2009. http://physiciansforhumanrights.org/library/reports/aiding-torture-2009.html. Accessed July 25, 2013.Google Scholar
56.Physicians for Human Rights. Experiments in Torture: Evidence of Human Subject Research and Experimentation in the “Enhanced” Interrogation Program. June 2010. http://physiciansforhumanrights.org/library/reports/experiments-in-torture-2010.html. Accessed July 25, 2013.Google Scholar
57.Rubenstein, LS, Xenakis, SN. Roles of CIA physicians in enhanced interrogation and torture of detainees. JAMA. 2010;304(5):569-570.CrossRefGoogle ScholarPubMed
58.Annas, GJ. American vertigo: “Dual use,” prison physicians, research, and Guantanamo. In: Grodin M, Tarantola D, Annas GJ, Gruskin S, eds. Health and Human Rights in a Changing World. New York, NY, USA: Routledge; 2013:324-335.Google Scholar
59.Cruzan v. Director, Missouri Department of Health, 497 U.S. 261 (1990).Google Scholar
60.Washington v. Glucksberg, 521 U.S. 702 (1997).Google Scholar
61.Washington v. Harper, 110 S. Ct. 1028 (1990).Google Scholar
62.Huskey, KA, Xenakis, SN. Hunger strikes: challenges to the Guantanamo detainee health care policy. Whittier Law Review. 2009;30(4):783-805.Google Scholar
63.Lantz v. Coleman, 2010 WL 1494985 (Conn. Super. Ct.). Plaintiff's Post-Hearing Brief and Proposed Findings of Fact.2009 WL 6446354, (Conn. Super. Ct.). Jun. 16, 2009.Google Scholar
64.McNabb v. Department of Correction, 163 Wn. 2d 393, 404, 180 P.3d 1257 (2008).Google Scholar
65.Commissioner of Corrections v. Myers, 399 N.E.2d 452, 454 (Mass. 1979).Google Scholar
66.Rubenstein, LS, Annas, GJ. Medical ethics at Guantanamo Bay detention centre and in the US military: a time for reform. Lancet. 2009;374(9686):353-355.CrossRefGoogle ScholarPubMed
67.Koch, T. Weaponizing medicine: “Tutti fratelli,” no more. J Med Ethics. 2006;32(5):249-255.CrossRefGoogle Scholar
68.Lunstroth, J. Torture and the regulation of the health care professions. In: Allhoff F, ed. Physicians at War: The Dual-Loyalties Challenge. New York, NY, USA: Springer; 2008:127-147.CrossRefGoogle Scholar
69.Assistant Secretary of Defense (Health Affairs). Memorandum: Medical Program Principles and Procedures for the Protection and Treatment of Detainees in the Custody of the Armed Forces of the United States. HA Policy 05-009. June 3, 2005.Google Scholar
70.Department of Defense. Medical Program Support for Detainee Operations, Instruction 2310.08E. June 6, 2006.Google Scholar
71.Nicholl, DJ, Atkinson, HG, Kalk, J, et alon behalf of 255 other doctors. Force-feeding and restraint of Guantanamo Bay hunger strikers. Lancet. 2006;367(9513):811.CrossRefGoogle ScholarPubMed
72.Anam et al v. Obama et al., Case No. 04-1194 (TFH) (D.C. Cir. 2013). Declaration of Clive A. Stafford Smith. March 31, 2013. http://www2.ohchr.org/english/bodies/cat/docs/ngos/BirnbergPeircePartners_UK_CAT50_Enclosures.pdf. Accessed July 25, 2013.Google Scholar
73. Doctors Blast Guantanamo Treatment as Unethical. CNN. June 31, 2007. http://humanrights.ucdavis.edu/projects/the-guantanamo-testimonials-project/testimonies/testimony-of-military-physicians/doctors-blast-guantanamo-treatment-as-unethical. Accessed July 25, 2013.Google Scholar
74.Iacopino, V, Xenakis, SN. Neglect of medical evidence of torture in Guantanamo Bay: a case series. PLoS Med. 2011;8(4):e1001027.CrossRefGoogle ScholarPubMed
75. First Geneva Convention for the Amelioration of the Condition of the Wounded and Sick in Armed Forces in the Field (adopted 1864, last revised 1949); Second Geneva Convention for the Amelioration of the Condition of Wounded, Sick and Shipwrecked Members of Armed Forces at Sea (adopted 1949); Third Geneva Convention Relative to the Treatment of Prisoners of War (adopted 1929, last revised 1949); Fourth Geneva Convention Relative to the Protection of Civilian Persons in Time of War (adopted 1949).Google Scholar
76.Nowak, M. What practices constitute torture? US and UN standards. Human Rights Quarterly. 2006;28(4):809-841.CrossRefGoogle Scholar
77.Brennan, D. Torture of Guantanamo detainees with the complicity of medical health personnel: The case for accountability and providing a forum for redress for these international wrongs. University of San Francisco Law Review. 2011;45(11):1005-1072.Google Scholar
78.Lifton, RJ. Doctors and torture. N Engl J Med. 2004;351(5):415-416.CrossRefGoogle ScholarPubMed
79.Burgess, JA. The great slippery-slope argument. J Med Ethics. 1993;19(3):169-174.CrossRefGoogle ScholarPubMed
80.Hanauske-Abel, HM. Not a slippery slope or sudden subversion: German medicine and National Socialism in 1933. BMJ. 1996;313(7070):1453-1463.CrossRefGoogle ScholarPubMed
81.Seidelman, WE. Nuremberg lamentation: for the forgotten victims of medical science. BMJ. 1996;313(7070):1463-1467.CrossRefGoogle ScholarPubMed
82.Protection of Human Subjects. 45 Code of Federal Regulations § 46 (2009). http://www.hhs.gov/ohrp/policy/ohrpregulations.pdf. Accessed August 2, 2013.Google Scholar
83.Reyes, H. Force-feeding and coercion: no physician complicity. Virtual Mentor. 2007;9(10):703-708.Google ScholarPubMed
84.Miles, SH, Freedman, AM. Medical ethics and torture: revising the Declaration of Tokyo. Lancet. 2009;373(9660):344-348.CrossRefGoogle ScholarPubMed
85.Faden, RR, Beauchamp, TL. A history and theory of informed consent. New York, NY, USA: Oxford University Press; 1986.Google Scholar
86.Luce, JM, Bindman, AB, Lee, PR. A brief history of health care quality improvement in the United States. West J Med. 1994;160(3):263-268.Google ScholarPubMed
87.Leopold, J. Revised Guantanamo force-feed policy exposed. Al Jazeera. 2013, May 13. http://www.aljazeera.com/humanrights/2013/05/201358152317954140.html. Accessed July 25, 2013.Google Scholar
88.Barondess, JA. Medicine against society: lessons from the Third Reich. JAMA. 1996;276(20):1657-1661.CrossRefGoogle ScholarPubMed
89.Grodin, MA, Annas, GJ. Legacies of Nuremberg: medical ethics and human rights. JAMA. 1996;276(20):1682-1683.CrossRefGoogle ScholarPubMed
90.Lee, PR, Conant, M, Hellig, S. Participation of health care personnel in torture and interrogation. N Engl J Med. 2005;353(15):1634-1635.CrossRefGoogle ScholarPubMed
91.Spetalnick, M. Red Cross chief presses U.S. on Guantanamo hunger strike. Reuters. April 11, 2013. http://www.reuters.com/article/2013/04/11/us-usa-guantanamo-redcross-idUSBRE93A10J20130411. Accessed August 2, 2013. .Google Scholar
92.Physicians for Human Rights. Force Feeding Violates Medical Ethics, Points to Need to Close Guantanamo. Press release. May 3, 2013. http://physiciansforhumanrights.org/press/press-releases/force-feeding-violates-medical-ethics-points-to-need-to-close-guantanamo.html. Accessed August 2, 2013.Google Scholar
93.McFadden, D. US: More Prisoners End Hunger Strike at Guantanamo. ABC News. July 19. 2013. http://abcnews.go.com/International/wireStory/us-prisoners-end-hunger-strike-guantanamo-19705769. Accessed July 25, 2013.Google Scholar
94.Grodin, ML, Annas, GJ. Physicians and torture: lessons from the Nazi doctors. Rev Int Croix Rouge. 2007;89(867):635-654.Google Scholar
95.Hall, P. Doctors and torture, victims and justice. Lancet. 2011;378(9809):e26.CrossRefGoogle ScholarPubMed
96.Trials of War Criminals before the Nuremberg Military Tribunals under Control Council Law. 1949;10(2): 181-182. Washington, DC, USA: US Government Printing Office, 1949.Google Scholar
97.World Medical Association. Declaration of Geneva. Adopted September 1948, last revised May 2006. http://www.wma.net/en/30publications/10policies/g1/. Accessed July 25, 2013.Google Scholar
98. In remembrance of the victims of Nazi medicine Nuremberg, May 2012. Isr Med Assoc J. 2012;14(9):529-530. Supplement to: Kolb S, Weindling P, Roelcke V, Seithe H. Apologising for Nazi medicine: a constructive starting point. Lancet. 2012;380(9843):722-23. .CrossRefGoogle Scholar