Letter to the WMA: Address complicity of doctors in force-feeding of detainees on hunger strike

June 18, 2014

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Today, 18 June 2014, Physicians for Human Rights – Israel sent a letter to the World Medical Association, urging this worldwide body of doctors to take action against doctors’ complicity in force-feeding practices around the world. The letter is supported by numerous other organizations, including IFHHRO and several of our members.

For PHR-Israel the topic of force-feeding is a pressing concern, since the Israeli parliament is currently debating a law change that will allow the forced feeding of Palestinian detainees currently on hungerstrike.

The text reads:

We, the undersigned national medical association and health and human rights organizations, call on the World Medical Association (WMA) to publicly voice its objection to different attempts around the world to allow for, urge, or pressure, physicians to participate in force-feeding. We feel that in face of this onslaught on medical integrity and ethics it is crucial that the leadership of the medical community – the WMA – take a clear and immediate position, and publicly denounce those attempts.

Attempts to force-feed hunger striking prisoners and detainees or asylum seekers are not unique to one country, but rather a universal challenge. For example:

  • Israel: The hunger strike of Palestinian prisoners and detainees began on April 24th as a protest against Israel’s policy of administrative detention (without charges or trial). Despite the objection of the Israeli Medical Community, the Israeli Medical Association and the National Bioethics Institute, Israel’s Prime Minister Netanyahu has instructed to expedite a legislation that will enable force-feeding of Palestinian prisoners and detainees currently undergoing hunger strike in protest of their administrative detention. The proposed Amendment to the Prisons Act (Preventing Damages due to Hunger Strikes), 5773-2013 – Legalizing Forced Feeding of Hunger Striking Prisoners – has passed first reading and is brought for second and third eadings within days or weeks.
  • US: Detainees at Guantánamo Bay have engaged in numerous hunger strikes since 2002 to protest their indefinite detention and abusive treatment by prison authorities. The latest wave dates to February 2013, although some detainees are long-term hunger strikers and have been on continuous strike for several years. While precise numbers are no longer being made public, the commander of Joint Task Force Guantánamo confirms that “up to a couple dozen detainees” are refusing food or being force-fed. The U.S. military has responded to these protests by subjecting hunger strikers to force-feeding, which involves strapping detainees into restraint chairs and inserting a tube through their nose into their stomach, sometimes more than once a day. This coercive procedure, which can amount to torture, is undertaken at the direction of the Guantánamo commander with the participation of physicians and nurses.
    While authorities claim that force-feeding is necessary to save the detainees’ lives, evidence suggests it is used to punish them and to break the hunger strikes. Detainees have been routinely placed in isolation units, “forcibly extracted” from their cells by military riot police, and subjected to physical and psychological threats and abuse. Force-feeding competent hunger strikers at Guantánamo has been condemned by the UN Special Rapporteur on Torture, as well as other UN bodies, human rights groups, and medical authorities around the world. To date, the U.S. government has refused to end force-feeding, to provide detainees with access to independent medical assessment and care, and to require medical personnel to abide by their professional ethics.
  • Turkey had an immense experience with hunger strikes and attempts of force feeding requests from the government throughout history. There was even a lawsuit against the High Disciplinary Committee members for calling physicians to refuse force feeding hunger strikers during 2000-2001. The HDC members were acquitted at the end. The Human Rights Foundation of Turkey provided healthcare for more than 500 hunger strikers who suffered Wernicke-Korsakoff syndrome (WKS) and were released from prisons due to their health condition. Some suffered WKS because of forced and inadequate feeding without Thiamine, by physicians who did not follow the call by the Turkish Medical Association to refuse forced feeding and they lacked the knowledge of how to handle hunger strikers health problems thus causing serious health consequences.

The force-feeding process is inherently cruel, inhuman, and degrading. Because of force-feeding’s invasive nature, the WMA, the preeminent international organization in the field of medical ethics and practice, has repeatedly condemned force-feeding of competent prisoners. The WMA’s Tokyo Declaration, adopted in 1975, states that doctors shall respect a competent prisoner’s right to refuse artificial feeding. And, in its Declaration of Malta on Hunger Strikers, adopted in 1991 and revised in 2006 in large part due to developments in Guantánamo, the WMA states that “[f]orcible feeding is never ethically acceptable. Even if intended to benefit, feeding accompanied by threats, coercion, force or use of physical restraints is a form of inhuman and degrading treatment.” The American Medical Association, a member of the WMA, has endorsed these unequivocal principles, as evidenced by its April 25, 2013 letter to you. The International Committee of the Red Cross has similarly stated: “The ICRC is opposed to forced feeding or forced treatment; it is essential that the detainees’ choices be respected and their human dignity preserved.”

Attempts to prevent such measures by referring governments and authorities to the different declarations and treaties mentioned are no longer enough to constrain the practice of force-feeding. We therefore urge the WMA to directly confront the issue and to publicly address relevant governments and authorities, demanding that they respect medical autonomy and ethics and refrain from allowing, condoning, legalizing or urging for force-feeding. The practice is and should be unequivocally recognized as torture or cruel, inhuman or degrading treatment.

Respectfully yours,

Association of Democratic Doctors in Germany, Germany
Belgian Unions of Medical Association, Belgium
Center for Constitutional Rights, United States
Centro di Salute Internazionale (CSI – Centre for International Health), Italy
Doctors for Human Rights, United Kingdom
Health and Human Rights Programme, University of Cape Town, South Africa
Human Rights Foundation of Turkey (HRFT), Turkey
IFHHRO (International Federation of Health and Human Rights Organizations), The Netherlands
Johannes Wier Foundation for Health and Human Rights, The Netherlands
Osservatorio Italiano sulla Salute Globale (OISG – Italian Global Health Watch), Italy
Rete Italiana per l’Insegnamento della Salute Globale (RIISG – Italian Network for Global Health Education), Italy
MEDACT, United Kingdom
Medico international, Germany
National Lawyers Guild, United States
People’s Health Movement (Europe)
Physicians for Human Rights, United States
Physicians for Human Rights – Israel, Israel
T’ruah: The Rabbinic Call for Human Rights, United States

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