Guantanamo medics accused of abusive force-feeding

WASHINGTON -- US military medics have attempted to dissuade Guantanamo Bay detainees from continuing a hunger strike by forcing finger-thick feeding tubes through their noses without painkillers, lawyers for the detainees told a federal judge yesterday.

Military medics have also recycled dirty feeding tubes used on other prisoners, the lawyers claimed, relaying what they were told by their clients. Calling the alleged practices abusive, the attorneys asked US District Judge Gladys Kessler to order the military to turn over their clients' medical records and to allow an outside doctor to examine the detainees.

Terry Henry, an attorney for the Bush administration, called the allegations ''outrageous." He argued that the doctors at the base provide excellent care to the prisoners, saying the allegations ''should be seen as story-telling, exaggerations, misunderstandings, or miscomprehensions of what is going on."

But Kessler was skeptical, saying she found the accounts ''extraordinarily disturbing."

''The allegations are very serious and certainly describe treatment that is needlessly painful, abusive, and extremely inappropriate in terms of needlessly causing further deterioration to the mental condition of the detainees," the judge said, ordering the government to respond in writing to the allegations by the middle of next week.

The abusive force-feeding claims revived attention to the issue of the medical ethics of US military doctors serving in the war on terrorism. The New England Journal of Medicine has run articles criticizing military doctors for allegedly having allowed interrogators to read prisoners' medical records and for helping interrogators determine the detainees' physical and psychological vulnerabilities.

Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, said yesterday that, if it is true that Guantanamo medics have used unnecessarily harsh feeding tube techniques to punish prisoners on the hunger strike, then they have committed ''a grave violation of medical ethics."

''Medicine is supposed to remain neutral," Caplan said. ''When you start to become complicit in efforts to break resistance using medical expertise that should be there simply to protect the health of people, you're headed down the wrong track."

Henry said 24 prisoners at Guantanamo remain on a hunger strike, down from 107 at its height. Seven are hospitalized, and many of the rest, who are being held in a special cellblock, are also being forcibly fed to keep them alive. The detainees have been refusing to eat or drink since Aug. 8 in order to protest their continued detention without trials.

Their hunger strike had prompted renewed interest in the military's medical practices at Guantanamo. The International Committee for the Red Cross sent an investigative team with a doctor from Switzerland to the base this week, Red Cross spokesman Simon Schorno said yesterday. He declined to disclose their findings, citing Red Cross policy.

In addition, the American Medical Association said yesterday that it is working with the military to send representatives to the base in the next few weeks.

Other groups, including Physicians for Human Rights, have argued that it is unethical for a doctor to force-feed a Guantanamo detainee who has chosen not to eat, citing international medical standards that call for respecting a patient's autonomy. The antiforce-feeding standard is endorsed by the American Medical Association.

But lawyers for the detainees said yesterday that they have no quarrel with force-feeding prisoners ''in a humane and a medically appropriate manner" because their clients are in a deep depression.

''We do not believe that, in the situation they're in, they're competent to make the decision to terminate their lives," said attorney Julia Tarver, who recently visited several Saudi detainees who are refusing to eat or drink.

Lawyers for the government and the detainees also sparred over whether it is standard medical practice for a doctor to administer a painkiller in order to reduce the trauma of forcibly inserting the feeding tube. Both sides indicated that the medics gave no such treatment to the detainees.

Zahid Bajwa, a Harvard Medical School professor who directs clinical pain research at Beth Israel Deaconess Medical Center, said the detainee lawyers are correct. Even under the best of conditions, he said, physicians would always use a local anesthetic or a sedative to reduce the pain of inserting a feeding tube.

''It is painful," Bajwa said. ''The standard of care is pretty clear in this scenario. . . . They have to use painkillers or sedatives."

Detainee lawyers also asked Kessler yesterday to order the military to allow more frequent attorney visits, as well as phone calls with family members who would urge them to resume eating.

Henry argued that granting special privileges to the hunger strikers would be logistically difficult and would only create a perverse incentive for more hunger strikes.