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Jan 11, 2018 · (CNN)Few things could more appropriately commemorate Thursday's 16th anniversary of the opening of the Guantanamo Bay …

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American physicians have not widely criticized medical policies at the Guantanamo Bay detainment camp that violate medical ethics. We believe they should. Actions violating medical ethics, taken on behalf of the government, devalue medical ethics for all physicians. The ongoing hunger strike at Guantanamo by as many as 100 of the 166 remaining prisoners presents a stark challenge to the U.S. Department of Defense (DOD) to resist the temptation to use military physicians to “break” the strike through force-feeding.

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President Obama vowed in January 2009 to close the prison camp at Guantanamo Bay
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And even among the detainees still at Guantanamo more than a decade after their capture -- the worst of the worst, as they were often caricatured -- have ruled for more detainees than they have ruled against.

 

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This poses a number of policy issues in the war on terror. The rules for invoking the national will are embedded in Article I, Section 8 of the United States Constitution, which gives to Congress – the elected representatives of the American people – the power to declare war. A declaration of war – to establish the national will – therefore becomes a shared responsibility between the political will of the government and the popular will of its constituents. This is more than just a formality. Failure by Congress to declare war in Vietnam led to a failure to mobilize the second element of the national will, the popular will of the public, and ultimately contributed to the United States’ defeat. A declaration of war gives the President clear-cut military authority, as well as non-military options, including internment of armed combatants and seizure of foreign funds and assets. A formal declaration of war in the war on terror might have precluded the Supreme Court’s decision to grant detainees at Guantanamo Bay access to the protections of the judicial system. Further, according to William F. Buckley:

Jan 11, 2018 · (CNN)Few things could more appropriately commemorate Thursday's 16th anniversary of the opening of the Guantanamo Bay detention facility than a …
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No new detainees have been sent to Guantanamo (despite repeated pledges by Trump on the campaign trail that he would reinvigorate the detention program), and no detainees have been released, either.


Omar Khadr, a Canadian, is seen in this undated family portrait

It's hardly revolutionary to state that physicians should act only in the best interests of their patients, with their patients' consent. At Guantanamo, this principle is seriously threatened because constant physician turnover makes continuity of care impossible. Detainee trust has also been irrevocably damaged by physicians' historical involvement in “enhanced interrogation,” as well as by the use of “restraint chairs” to break a 2006 mass hunger strike. Physicians may not ethically force-feed any competent person, but they must continue to provide beneficial medical care to consenting hunger strikers. That care could include not only treating specific medical conditions but also determining the mental competence of the strikers, determining whether there has been any coercion involved, and even determining whether the strikers want to accept voluntary feedings to continue their protest without becoming malnourished or risking death.

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Hunger strikers are not attempting to commit suicide. Rather, they are willing to risk death if their demands are not met. Their goal is not to die but to have perceived injustices addressed. The motivation resembles that of a person who finds kidney dialysis intolerable and discontinues it, knowing that he will die. Refusal of treatment with the awareness that death will soon follow is not suicide, according to both the U.S. Supreme Court and international medical ethics. The March 2013 guard-force–centered Guantanamo policy on “Medical Management of Detainees on Hunger Strike” seems to concede this point, since it makes no references to suicide. (Available at is the text and a summary of a meeting on physician participation in hunger strikes.)

detention facility at Guantánamo Bay, Cuba — a U.S

Guantanamo is not just going to fade away, and neither is the stain on medical ethics it represents. U.S. military physicians require help from their civilian counterparts to meet their ethical obligations and maintain professional ethics. In April the American Medical Association appropriately wrote the secretary of defense that “forced feeding of [competent] detainees violates core ethical values of the medical profession.” But more should be done. We believe that individual physicians and professional groups should use their political power to stop the force-feeding, primarily for the prisoners' sake but also for that of their colleagues. They should approach congressional leaders, petition the DOD to rescind its 2006 instruction permitting force-feeding, and state clearly that no military physician should ever be required to violate medical ethics. We further believe that military physicians should refuse to participate in any act that unambiguously violates medical ethics.