Currently there are about 100 prisoners in Guantanamo Bay Detention on hunger strike (89 of whom have been determined to be innocent of accusations but not released and some of whom have been on hunger strike for more than 106 days) and an estimated “2,493 inmates in 15 state prisons are participating in a mass hunger strike” (Democracy Now 7/17/13). At Gitmo, periodic hunger strikes have been going on for a number of years, prisoners are protesting unlawful imprisonment, cruel treatment and lack of transparency; many prisoners are being force fed. In California, prisoners are protesting the widespread and long term use of solitary confinement; as yet, no prisoners have been force fed. It is unethical and a violation of prisoners human rights to force-feed by Nasal gastric tube. Military and prison doctors who participate in this activity do so in direct violation of medical ethics.
(Note: this blog is structured using the method and format of Thomas Aquinas in the Summa Theologiae. It was originally posted at Catholic Moral Theology.)
Question: Is it ever ethical to force feed hunger strikers to keep them alive?
Objection 1: Hunger Strikers are suicidal; therefore it is wrong to allow them to commit suicide.
Objection 2: The United States government has a responsibility to keep them alive, therefore they must force feed prisoners rather than allow them to possibly die.
Objection 3: As prisoners, the hunger strikers no longer have the freedom to make their own choices; therefore it is within the rights of the government to force feed them.
Objection 4: Feeding by nasal gastric tube is a medical procedure and therefore not “punishment,” “cruel,” or “torture” when administered by competent medical staff.
On the Contrary: According to the World Medical Association, “Forcible feeding is never ethically acceptable. Even if intended to benefit, feeding accompanied by threats, coercion, force or use of physical restraints is a form of inhuman and degrading treatment.”
Response: I answer that it is always unethical to force feed hunger strikers. Based upon the Universal Declaration of Human rights and international decrees on the treatment of prisoners, it is unethical and unjust for the United States government to force feed prisoners in their facilities. Prisoners retain basic autonomy over medical care and the right to refuse food, and medical treatment.
The World Medical Association and the American Medical Association clearly hold that hunger strikers are NOT suicidal. A hunger strike is defined as refusal of food for a period of 9 days as a means of protest. Death is not intended; however, the possibility of death is accepted by those engaging in prolonged hunger strikes.
Hunger strikes are always controversial. And, as history notes, the effectiveness of hunger strikes as a method of protest has been mixed and force feeding comes up as a perennial problem. When women were imprisoned during the Suffrage movement, they used hunger strikes as a means of protecting their unlawful imprisonment and the US government used force feeding as a punishment attempting to break the hunger strike, an episode depicted in the HBO docudrama Iron Jawed Angels. When directed as a means of protest seeking attention of the wider society, hunger strikes have proven to be effective in some cases. Perhaps the 2 most famous modern hunger strikers were Gandhi and Bobby Sands (IRA prisoner).The British authorities responded to the different hunger strikers in radically different ways.
Gandhi used hunger strikes as an effective tool of protest British colonialism. He was not suicidal but demonstrated a clear acceptance of death as a possibility. Gandhi’s resolve was unquestioned and his death was an outcome feared by those against whom he made his demands. “Bombay, 1932. After eight months in prison, Mohandas Karamchand Gandhi begins a hunger strike in protest of British support of a new Indian constitution that would condone separate political representation for India’s lowest social caste — otherwise known as the “untouchables.” British authorities did not want Ghandi to die for fear of broader protests. His hunger strike lasted 21-days. It is not unreasonable to view hunger strikes as a legitimate and effective means of nonviolent protest.
It is also a means of nonviolent protest undertaken with full knowledge of the possibility of death. In 1981 Bobby Sands and eight other Provisional IRA prisoners went on hunger strike demanding to be recognized as political prisoners. Recently a survivor of the IRA hunger strike explained, “Our hunger strike was borne out of desperation. We had spent five years in complete and total isolation, locked up 24 hours a day. During those five years our political representatives had been trying to make a case for the reforms within the prison and, at the end of the process, it wasn’t coming—the brutality was getting worse. We were trying to bring the H Blockto an end “ With Thatcher’s government refusing to give into their demands, after 66 days on hunger strike – Bobby Sands died. The Provisional IRA hunger strike was directed at drawing attention to the prison conditions, as well as political demands within the context of a contested Northern Ireland. The situation in Northern Ireland continued to erupt in violence after Sands’ death.
Each of these highlights an aspect of hunger strikes relevant to today’s context. With Gandhi, we see the use of hunger strikes as an effective tool of civil disobedience and non violent protest. In Bobby Sands, we find an example of wider repercussions which lead governments to fear hunger strikes and engage in force feeding. However, a hunger strike is a legitimate form of nonviolent protest. Similar to civil disobedience, individuals have the right to protest unjust laws in non-violent ways and have their autonomy protected. Just as civil disobedience comes with the possibility of imprisonment; hunger strikes come with the possibility of death. That individuals are in prison and therefore have their freedom of movement restricted does not negate their autonomy over their bodies and medical decisions. International law maintains that prisoners of sound mind retain the autonomy over medical decisions and therefore have the legitimate authority to refuse feeding by NG tube.
Reply to Ad 1: Since prisoners retain authority over medical decisions and by definition, a prisoner on hunger strike is not medically classified as suicidal, it is not ethical to force feed them against their will. Even when death is an imminent possibility, they are not considered suicidal. The question rests upon a medical diagnosis of sound mind upon entering hunger strike, after that their wishes should be respected as any other patients written instructions would be respected.
Reply to Ad 2: While the government is responsible for prisoners within their jurisdiction, this does not authorize the government to force feed prisoners, against their will. In particular, in cases where the protests relate to conditions within the prison itself, the primary responsibility of the state is to just and humane conditions in accordance with domestic and international law within state facilities. Therefore it is unethical to force feed them, even if they may die without it.
Reply to Ad3: As stated above, international agreements recognize that prisoners of sound mind retain autonomy over medical decisions. Therefore it is unethical to force feed them.
Reply to Ad 4: Use of a nasal gastric tube is a medical procedure mandated by a host of medical conditions. Patient’s level of discomfort is dependent upon physical condition, gag reflex, etc. Psychologically, use of this procedure without the consent of the patient creates significantly greater anxiety, fear, pain, and discomfort. The procedure itself is invasive and while administration by competent medical staff determines its safety, it does not negate concerns of “torture.” Recently, rapper Mos Def voluntarily underwent the practice to highlight the plight of hunger strikers at Guantanamo Bay. Therefore calling it a medical procedure does not obliterate questions of cruel and inhumane treatment.