"We write regarding the forcefeeding and restraint of Guantanamo Bay detainees currently on hunger strike.1,2 The World Medical Association specifically prohibits forcefeeding in the Declarations of Tokyo and Malta, to which the American Medical Association is a signatory.

Fundamental to doctors’ responsibilities in attending a hunger striker is the recognition that prisoners have a right to refuse treatment. The UK government has respected this right even under very difficult circumstances and allowed Irish hunger strikers to die. Physicians do not have to agree with the prisoner, but they must respect their informed decision. Those breaching such guidelines should be held to account by their professional bodies. John Edmondson (former commander of the hospital at Guantanamo) instigated this practice, and we have seen no evidence that procedures have changed under the current physician in charge, Ronald Sollock.3

Edmondson, in a signed affidavit, stated that “the involuntary feeding was authorized through a lawful order of a higher military authority.”4 This defence, which has previously been described as the Nuremberg defence,5 is not defensible in law. In a reply to an earlier draft of this letter, Edmondson said that he was not forcefeeding but “providing nutritional supplementation on a voluntary basis to detainees who wish to protest their confinement by not taking oral nourishment”.

Recently, it was confirmed that health-care staff are screened to ensure that they agree with the policy of forcefeeding before working in Guantanamo Bay.1 On his departure, Edmondson was awarded a medal for his “inspiring leadership and exemplary performance [which] significantly improved the quality of health care for residents of Guantanamo Bay” and “scored an unprecedented 100% on both the Hospital and the Home Health surveys.”3 The New York Times, however, reports that hunger striking detainees are strapped into restraint chairs in uncomfortably cold isolation cells to force them off their hunger strike.2

We urge the US government to ensure that detainees are assessed by independent physicians and that techniques such as forcefeeding and restraint chairs are abandoned forthwith in accordance with internationally agreed standards.

We declare that we have no conflict of interest."

David J Nicholl, Holly G Atkinson, John Kalk, William Hopkins, Elwyn Elias, Adnan Siddiqui, Ronald E Cranford, Oliver Sacks, on behalf of 255 other doctors

1 Okie S. Glimpses of Guantanamo: medical ethics and the war on terror. N Engl J Med 2005; 353: 2529–34.
2 Golden T. Tough US steps in hunger strike at Camp in Cuba. New York Times Feb 9, 2006 (accessed Feb 22, 2006).
3 Byrington S. Sollock takes command of Naval Hospital. Guantanamo Bay Gazette 2006; 63: 3. (accessed Feb 22,2006).
4 Al Joudi et al vs George Bush in the US District Court for the District of Columbia. Case1: 05-cv-00301-GK. Document 48, Exhibit A. Filed Oct 19, 2005.
5 Spitz V. Doctors from hell: the horrific account of Nazi experiments on humans. Boulder: First Sentinent, 2005. >from *Forcefeeding and restraint of Guantanamo Bay hunger strikers* March 10, 2006. Lancet 2006; 367: 811

related context
> jtf-gtmo. 'joint task force guantanamo conducts detention and interrogation operations to collect and exploit intelligence in support of the global war on terrorism, coordinates and implements detainee screening operations,and supports law enforcement and war crimes investigations.'
> guantánamo bay - a human rights scandal. 'the unlawful detention of 'enemy combatants' has now entered its fifth year... guantánamo bay has become a symbol of injustice and abuse in the u.s administration’s 'war on terror'. it must be closed down.' amnesty international
> black sites. 'a military term that has been used by intelligence agencies to refer to secret prisons, generally outside of the mainland territory and legal jurisdiction, and with little or no political or public oversight.'
> the national security strategy. 'america is at war.' u.s national security council. march, 2006
> situation of detainees at guantánamo bay. united nations, commission on human rights. february 16, 2006
> mortality before and after the 2003 invasion of iraq. november 19, 2004
> deadly medicine. 'how could science be co-opted in such a way that doctors as healers evolved into killers and medical research became torture?' november 5, 2004
> art and war: the role of artists and scientists in times of war. 'what can artists and scientists do when there is a war? how can we be useful? how can we help to find solutions? how can we avoid the use of the military while at the same time protecting the lives of innocent civilians? what educational work can we do to avoid violence and war?'

imago
> guantanamo ethos: the place of living ?

sonic flow
> involuntary feeding [stream]
involuntary feeding [download]