But pointedly, it was never recognized as such by the WMA or AMA until 2005. Like I said, I think this was a political gesture aimed at a particular situation rather than a general practice.
I have no problem with their belief. I’m on record as saying the Guantanamo detainees should be released. But saying I agree with their political position on this issue doesn’t mean I agree with the principle of politicizing the practice of medicine.
It could have effects beyond merely advisory. A medical professional could lose his or her license for defying what the AMA or WMA defines as reasonable standards. Just as the armed forces can take away this woman’s military career for refusing to comply with military orders, the state nursing board can take away this woman’s medical career for refusing to comply with ANA standards.
Well, it depends on what you mean by “political gesture”. The AMA doesn’t need a position on force-feeding unless and until its members are in a position where they are being invited to assist in force-feeding sufficiently often to require an institutional response. That situation had arisen in 2005. Any response by the AMA - including a decision to do nothing, or to affirm the legitimacy of force-feeding - would be seen as “political” since the circumstances that call for a response are themselves political, but I don’t see that that in any way invalidates or devalues the AMA position.
What does the AMA say about allowing someone to kill himself while in custody? What is the military supposed to do once this prisoner becomes unconscious due to hunger?
Realized I should have included a disclaimer. My opinions are strictly my own. Largely it was understanding of the current UCMJ issues as opposed to opinion anyway… and IANAL.
Surely if the prisoner is incapacitated, the right to make medical decisions on his behalf passes to his next of kin?
Yes, this.
It was taught, and repeated, ad nauseum, in nursing school that a competent patient has the right to refuse any and all procedures. And not only can I lose my nursing license for doing a procedure against their will, but I can be charged with assault (if I threaten to do it) and battery (if I touch a patient to do it.) So for me, this is a clear cut case of nursing ethics *and *the law being in favor of the nurse refusing.
On the other hand, legally speaking, aren’t prisoners considered under the custody of the state, like a school acting in loco parentis for a minor? That is, a Type I diabetic prisoner will be forced to take his insulin in most (all?) prisons, even if he doesn’t want to. Their legal right to informed refusal is limited when it is a refusal that will be fatal as a result. It’s just one more right they lose when they are sentenced, like the right to wear the clothing they want or eat the food they like.
So when the prison officials make a determination against the patient’s wishes, we have a clear conflict between ethics+law and law. In my universe, that means I break the law and take the consequences.
On the third hand, this guy hasn’t actually been charged and found guilty on anything has he? Isn’t that the whole controversy about the prisoners at Gitmo? I admit, I’m a little fuzzy on that point. But if he hasn’t been found guilty and sentenced, then has he lost those rights (yet)?
If he has lost his right to informed refusal, then it means we’re back to my professional ethics+law on a&b being on conflict with the law in favor of forced treatment. Court martial me.
Does it? Or does it pass to the prison authorities?
Here is a little history of the treatment of hunger strikers. The issue has been around since at least the IRA and Red Army Faction hunger strikes in the early 80s. Many doctors and medical organizations have always resisted the practice as to a competent person (the situation is murkier for an anorexia nervosa patient). The WMA issued a statement in 1982 that barred “artificial feeding” but did not refer specifically to forced feeding. The 2006 clarification was clearly in response to hunger strikes at Gitmo.
According to the article linked above, the WMA permits artificial feeding after the patient becomes unconscious, unless the patient has left prior instructions forbidding it. Also, any such instructions may be disregarded if they were the coercive product of peer pressure by other prisoners. Basically, in such situations, the feeding is artificial but no longer forced.
Much longer than that; it was used as a torture technique against suffragettes for example. So we’re talking at least back to the late 1800s.
delete post
I admit it. I threw everything in the fridge into this pot to cook. Thank-you for draining it pulling out the grizzle, bone and bay leaves. I appreciate it.
As others have noted, this is not a new issue. People in prison have been going on hunger strikes for decades. And prison medical officials have been participating in force feeding hunger strikers throughout this period.
The principle is that the state has an obligation to the well-being of people it’s holding in custody. It has to protect them from harm as much as practicable - and this includes self-inflicted harm. Starving yourself is obviously harmful. So forced feeding is not really a form of torture - it’s preventing harm rather than causing it.
A nitpick but not quite that far. From what I can find, the first suffragette hunger strike started in 1909.
I don’t know how correct the first claim is. I suspect that force feeding has been going on as long as hunger striking, but I also suspect it hasn’t always been performed by medics. Prison officers may have administered it commonly in the past.
As for preventing harm rather than causing it, people haved died as a result of force feeding or its complications (and this may be related to my first point).
A hospital will not force-feed you (unless they diagnose a mental illness which vitiates your capacity to make your own decision about whether to eat). The issue is whether, in prison, you lose the right you would have outside prison to make this decision for yourself. I don’t see a slam-dunk that says you do - since the 1970s, the British government no longer force-feeds prisoners who refuse food and, if they die, they die. (And there are notable examples.) And, whatever about the argument that a convicted felon loses rights including the right to choose not to eat, it’s hard to construct an argument that someone who hasn’t been convicted of any crime loses this right.
She will be metaphorically crucified. That is what happens to people who insist on following their conscience against the banal bureaucrats and has been throughout history.
…her superior officers who she swore a legally binding oath to obey?
And she’s free to not re-up when her term is over. Until then, if she wants to violate orders, she gets to to face the consequences of that.
This is cut and dry. The military has an obligation to not let prisoners die while in their custody, even if those prisoners are set on killing themselves, and she’s refusing a lawful order to that end.
Putting aside the question of whether those orders really are lawful… You go from saying what the law is in one sentence to saying what should happen in the next. I don’t think one necessarily follows from the other. The current state of the law can sometimes be morally in the wrong, don’t you think? If the act of force feeding is immoral, then should people be punished for refusing to commit an immoral act when ordered to do so?
You might not agree that there is anything immoral about force feeding, but my point is that the morality of force feeding is relevant to the question.
If the nurse had instead been ordered to do something that you consider torture, and if the state of the law made that a legal order, then would your opinion by different?
It sounds like you feel the military is morally in the right in keeping the prisoners alive by force feeding.
Let me ask you basically the same question I asked Martin Hyde:
If the nurse had been ordered to torture the prisoners (that is, to do something that you personally consider torture, but which in this scenario is nevertheless within their legal – if not moral – authority to order), would you still feel (1) that the nurse should have complied with the order, and (2) that she should be punished for failing to comply with the order?
Yes and yes. When one swears an oath to obey the lawful orders of their superiors, they forfeit the right to object on moral grounds. If it is possible that taking such an oath would obligate you to do things you find morally reprehensible, then you should not take that oath.