Hunger strikers confront their captors with a dilemma. When women suffragists went on hunger strikes in the early 20th century, authorities pried open their mouths and forced down chunks of food (several women choked to death). During Northern Ireland's Troubles, British authorities allowed IRA and Irish National Liberation Army prisoners to starve themselves to death; 10 did.
Is it ethical for a doctor to force-feed a prisoner on a hunger strike? An opinion piece in the Aug. 1 issue of The Journal of the American Medical Association suggests doctors should refuse to force-feed detainees at Guantánamo Bay as long as the prisoners are capable of making rational choices. This month Dr. S. Ward Casscells, the new assistant secretary of Defense for health affairs, went to Guantánamo to "look at it with my own eyes," he told NEWSWEEK. Of the 355 detainees still in Gitmo, about 20 are on hunger strike at any one time, he says. Prisoners who skip nine straight meals go under "observation"; the forced feeding usually begins when they dip 15 percent beneath their ideal weight. (Overeating is actually a problem at Gitmo; Casscells says many prisoners take drugs for diabetes and high cholesterol.)
A prominent Houston cardiologist before he came to the Pentagon (he also served a four-month tour as a doctor in Iraq), Casscells watched as a half-dozen Gitmo prisoners went through the 45-minute procedure. They were strapped into "restraint chairs" and a L/jo-inch soft rubber tube was fed through their noses. (Prisoners may request a local anesthetic to ease the discomfort.) The patients ingest a tasteless high-protein mix, and guards watch them for an hour to make sure they do not self-induce vomiting. "Nobody kicked or screamed," Casscells says. The prisoners "complained," he says—not about the feeding but about not getting their day in court. He says some hunger strikers have told guards they would be happy to stop, but fear being "reported back to the detainee chain of command." There are seven doctors at Gitmo, and according to Casscells, none has objected to the forced feedings. "The doctors think they have a duty to keep the patients alive," says Casscells. The forced feeding, like the hunger strikes, will go on.