Letter re the 2017 Guantanamo hunger strike and the new change in policy

We are an ad hoc group of medical professions who feel an ethical obligation to bring attention to the plight of the hunger strikers in Guantanámo Bay.

The history of the peaceful protest there is not an edifying one. For some years, the Obama Administration force fed the strikers which raises profound questions under the 1975 Declaration of Tokyo. However, it appears that the Trump Administration implemented a new policy on September 20, 2017, with the detainees being coerced into dropping their strike. If the detainees’ complaints are true – and they merit an urgent and independent investigation – then medical care is being withheld as part of this new program. Medical supervision of the strike has apparently been ended, along with a daily evaluation of the prisoners’ inexorably declining health.

Some of the detainees have been on strike for four years and, despite being force fed, had already lost more than 20 percent of their body weight before the new policy took effect three weeks ago. It is accepted then that “[a]fter more than a month of fasting, or when more than 18 percent of body weight is lost, severe and permanent medical complications can occur. It can become very difficult to swallow water, hearing and vision loss can occur, breathing can become laboured and organ failure can start to set in.” As the strike progresses, death becomes a very real risk due to cardiovascular collapse or severe infection.

The detainees’ actions cannot be seen as free and voluntary – even if they had no complaint about mistreatment in Guantanámo Bay. Aside from the physical damage suffered by hunger strikers, we expect to see psychological changes causing impulsive behavior. The Journal of Medical Ethics reports that these effects can “enhance the likelihood that [hunger strikers] will starve themselves to death.”

We should not lose sight of the wood for the trees. The moral and ethical issues may readily be resolved. Where, as here, a prisoner has been denied liberty or a fair trial for 15 years or more, most people would agree that he has a valid cause for complaint. The simple solution would be to give him justice. Failing this, the Trump Administration should permit independent medical oversight of the on-going protest.