Last week, I was on the phone with my client, Abu Wa’el Dhiab – a detainee of the US government at Guantánamo Bay who has been cleared of any involvement in terrorism – discussing our litigation and whether he had reason to believe he might one day be released. He has been on a hunger strike for over a year and is fighting in court to stop the government from abusively force-feeding him, so he was listless, as is typical. But then he perked up. "I have great news", he said. "Someone at Guantánamo has made a historic stand."
One Navy nurse at Guantánamo had refused to force-feed detainees anymore and declared the practice unethical: I have come to the decision that I refuse to participate in this criminal act, Dhiab told me the nurse said.
It was big news on the prison block.
The nurse, Dhiab tells me, is the first staffer at Guantánamo to choose medical ethics over military logic. Like all staff assigned to force-feed detainees, this Navy nurse was initially a volunteer. But when he arrived on base this spring, he told Dhiab, he encountered something different from what he expected: The story we were told was completely the opposite of what I saw.
As someone who has watched over 10 grim hours of force-feedingfootage, I can well imagine the reasons for the nurse's change of heart. During a typical detainee force-feeding at Gitmo, a hunger-striker is strapped in a multi-point restraint chair (manufacturer's slogan: "it’s like a padded cell on wheels") and a 100cm tube is forced down his nose and into his stomach twice a day: it's not a pretty process.
This methodology causes gratuitous suffering, and deliberately so. General Bantz Craddock, who instituted the restraint chair and twice-daily intubation in 2006, said that he designed it to make hunger-striking less "convenient" – a not terribly subtle euphemism for more painful – and that "pretty soon [after these practices were introduced]…they decided it wasn’t worth it." That was eight years ago.
In addition to the force-feeding itself, if a prisoner on hunger strike refuses to go to the feeding under his own power, the Forcible Cell Extraction (FCE) team in riot gear storms his cell to "subdue" him and haul him to the restraint chair, regardless of any pain it might cause. More recently, camp officials have decided that even "compliant" hunger-strikers should be treated exactly the same … even if they cannot walk to the force-feeding room themselves. For instance, Dhiab has repeatedly told the staff that he is willing to undergo the procedure – although it hurts – if they will allow him to make his way there in the wheelchair that he requires. Camp administrators have refused him even this bit of dignity, and continue to call the FCE team to his cell twice a day.
Of course this would all be appalling to an ethical health professional. By rights, and at a minimum, it ought to bother all health professionals serving at Gitmo because their professions require them to heal, not harm, people – and because they took a solemn vow to put patients first.
By all accounts, this one nurse's disquiet is indeed shared by many of his colleagues. According to Dhiab and others, many nurses at Gitmo have repeatedly exhibited signs that they are discomfited by what they are asked to do. For instance, another client of mine once said that his nurse’s hands shook as she approached his nose with the tube and, when he asked what was wrong, she admitted she had never force-fed anyone before.
This is one of the less-discussed tragedies of the state of affairs at Guantánamo: it damages the prisoners and the young military men and women who are ordered to participate in deeds that go against any human’s basic instincts.
But before this one nurse, nobody was willing to speak the truth from within the military medical corps – and for good reason. Retired Brigadier General Steven Xenakis, a psychiatrist, reported that Defense Department policymakers have said that any service member's refusal to participate in force-feedings is not considered a disciplinary matter. But even if this nurse faces no formal sanctions for adhering tomedical ethics, there are more subtle ways of punishing dissent in the military. That is what other nurses have admitted to Dhiab and others when asked why they go along with force-feeding: they worry, they say, about their rank and their careers.
Since it isn't technically a disciplinary matter – and frankly, even if it were – the rest of the doctors and nurses at Gitmo ought to join their colleague’s boycott. They should return to first principle of medicine, which is patient autonomy. They should insist on using force-feeding only when absolutely necessary and in ways that minimize, not maximize, the suffering it causes – a compromise my client would accept. In so doing, they would have the support of the American medical community, which has already condemned force-feeding andurged health professionals not to participate.
Sometimes all it takes is for one brave soul to break ranks to bring an unjust system crumbling down. In the early 1980s, Dr John Kalk shamedSouth Africa’s apartheid regime by refusing to force-feed hunger-striking activists who were detained without trial. This nurse is now walking in his footsteps, and his colleagues should feel obligated to join them.
