More than 260 doctors from around the world have called on the U.S. military to stop force-feeding detainees at the Guantanamo detention center who are on a hunger strike. The doctors signed a letter published Friday in the respected British medical journal "Lancet." But at the Pentagon, a spokesman says there is no plan to review what he calls the "involuntary" feeding, which he says is done only when "appropriate or medically necessary."
The doctors' letter says force-feeding is a violation of declarations by the World Medical Association, documents it says the American Medical Association has signed.
The American Medical Association is the largest association of physicians in the United States, and it is generally recognized as the arbiter of medical ethics issues for American doctors. The association's own ethical guidelines say doctors should respect a person's decision to refuse to eat, as long as that person is mentally competent and understands the consequences of the decision.
"The law is that prisoners have a right to refuse any treatment, and physicians have to respect that informed decision that those individuals have consented to," said Richard Horton, editor of the Lancet journal. "So anything that breaches that informed decision is not defensible in law."
The letter in Lancet calls on the U.S. government to end force-feeding and allow independent physicians to assess the condition of the Guantanamo detainees. Defense Department spokesman Bryan Whitman says there is no plan to review the policy.
"The policy of the department is unchanged," he said. "And it is to support the preservation of life by appropriate clinical means, and to do that in a humane manner."
Lawyers for detainees say the few remaining on hunger strike have been subjected to inhumane treatment. The lawyers say their clients have been strapped to chairs and had feeding tubes forced through their noses and down their throats. The lawyers claim that the doctors at Guantanamo changed their approach earlier this year, removing and re-inserting the tubes for each feeding, making the process much more painful for the detainees, and causing many of them to abandon the hunger strike. A senior U.S. general acknowledged last month that chairs are used to restrain detainees who resist the tube feeding.
According to the U.S. military, the hunger strike began last August and reached a high of 84 detainees in December. Detainees were demanding freedom, or at least some indication of when and under what circumstances they might be released. Officials say there is a review process for that, but lawyers for the detainees say it is not a legal process.
By January, officials said the number of detainees on hunger strike was down to 15. Spokesman Bryan Whitman says there are now six men on hunger strike, and three of them are being fed against their will. Officials say only those whose health deteriorates significantly are force fed.
Still, Whitman acknowledges the issue of force-feeding is a difficult one.
"I think it's fair to say that these are difficult issues," he said. "They're difficult moral, ethical, legal issues. And one would not expect that everyone would come to a consensus on this. The department has not come by this policy without a lot of deliberate consideration, deliberation and has determined that this is the appropriate way forward at this time."
But the Lancet editor, Richard Horton, says if the U.S. government ignores calls to end the force-feeding, it is violating international law.
"They have an international legal obligation to take notice of this," he said. "If they choose not to, they're breaking international law."
The letter in Lancet says the appropriate medical governing bodies should discipline U.S. doctors who participate in force-feeding. U.S. military doctors at Guantanamo say they provide "compassionate and consistent" care to the detainees, and that resistance to the tube feeding has eased as a result.