Should Military Care Providers Force-Feed Detainees?

Abstract

INTRODUCTION Forced feeding has been a controversial ethical issue at the military prison at Guantanamo Bay in Cuba, which recently resurfaced when a military nurse decided that he was not willing to participate in forced feeding on the ground that this violated his moral conscience. The question whether the U.S. captors should force-feed prisoners who seek to starve themselves to death is one with strong arguments on both sides. On one side is the argument of individual autonomy. While prisoners may have lost their freedom, based on respect still owed them as human beings they ethically should have some right to make some decisions themselves. Thus, some international health organizations have asserted that prisoners have a right to stop eating, even if the result is starvation. They hold that under the principle of autonomy, prisoners have a right to die as a protest. Similar rulings have been enunciated and legally upheld in other previous contexts. On the other hand, even if this position is the highest moral road, then, it still may be open to question whether autonomy should also apply in this particular case. Why might it not, here? The consequences of allowing detainees at Guantanamo to starve themselves to death may be exponentially greater than for prisoners in other circumstances. Their death, for example, could be seen as a strategic “suicide weapon,” which may trigger violent repercussions throughout the world resulting in inordinate numbers of people’s deaths. All arguments regarding this topic, as all difficult ethical issues, must be carefully scrutinized within their particular contexts. Thus, we shall consider here other major arguments for and against forced feeding, with the goal of discerning what if any arguments may still be sufficient to make the moral case that detainees at this facility should be force-fed. DETAINEES ARE TOO DEPRESSED TO BE DEEMED COMPETENT TO CHOOSE TO STARVE TO DEATH A first argument is that detainees become depressed as a predictable result of their imprisonment and, thus, like severely depressed patients who are acutely suicidal, are not competent to choose to die by fasting. Competence legally refers to having the cognitive capacity to make a rational decision, and the criteria depend on the kind of decision being made. Thus, the criteria for being competent to make a medical decision for one’s self differ from the criteria required to write a will. In this case, these criteria may not matter, unless it can be shown that these detainees are severely depressed. For example, civilians in the United States can refuse even lifesaving care even if moderately depressed. So, unless a different standard is applied to detainees, it would be ethically inconsistent to deny them their autonomy to choose not to eat. Allowing mildly depressed civilians to refuse food and water, but not detainees, would be inconsistent, ethically arbitrary, and, thus unsound.