Wednesday, July 16, 2014

Medical Mutiny: The Power of One

A Navy nurse refused early this month to force-feed Guantanamo hunger-striking detainees on grounds of conscientious objection, and has since been "reassigned" to other duties. From Carol Rosenberg of the Miami Herald:
A prison camp spokesman, Navy Capt. Tom Gresback, would not provide precise details but said Monday night that the episode had “no impact to medical support operations at the base.”
“There was a recent instance of a medical provider not willing to carry out the enteral feeding of a detainee,” he said in an email. “The matter is in the hands of the individual’s leadership.” 
The unnamed medic is the first known Gitmo staffer to refuse to partake in what the United Nations describes as torture and a breach of international law, and the brass euphemizes as "medical support operations." Detainees, many of whom have been cleared for release but remain indefinitely imprisoned because of "instability" in their home or potential host countries, began their hunger strike 18 months ago.

 A team of ethicists had urged a "medical mutiny" at the facility. And one brave soul finally heard the message. One person decided to ignore President Obama's plaintive excuse that "I don't want these individuals to die."

As Rupert Coville, spokesman for the UN High Commission on Human Rights, explains, force-feeding was formally deemed cruel and unacceptable punishment by a panel of international medical ethicists in 1975.

"Even if intended to benefit, feeding accompanied with threats, coercion, force or use of physical restraints is a form of inhuman and degrading treatment. Equally unacceptable is the force feeding of some detainees in order to intimidate or coerce other hunger strikers to stop fasting," it (the panel) said.

And as one detainee wrote in a memorable New York Times op-ed last year, forced feeding is degrading and extremely painful. He described the ordeal this way:
A team from the E.R.F. (Extreme Reaction Force), a squad of eight military police officers in riot gear, burst in. They tied my hands and feet to the bed. They forcibly inserted an IV into my hand. I spent 26 hours in this state, tied to the bed. During this time I was not permitted to go to the toilet. They inserted a catheter, which was painful, degrading and unnecessary. I was not even permitted to pray.
I will never forget the first time they passed the feeding tube up my nose. I can’t describe how painful it is to be force-fed this way. As it was thrust in, it made me feel like throwing up. I wanted to vomit, but I couldn’t. There was agony in my chest, throat and stomach. I had never experienced such pain before. I would not wish this cruel punishment upon anyone. 
It took over a year, but at least one would-be torturer was humane enough to crack. I wonder where this guy was "reassigned." Hopefully he's not in a prison cell with Chelsea Manning, that other famous conscientious objector, while awaiting his court martial. But whoever he is, he is a hero.

Meanwhile, it seems the torturers themselves have been stupid and sadistic enough to actually film their grotesqueries. And the Obama administration is, not surprisingly, mightily resisting FOIA demands for the release of the tapes for public viewing. I guess it's just one of those uncomfortable photo-ops that might place the president in a bad light. It would be a grotesquerie too far.


Will said...

I heard about the conscientious objector nurse this morning. Chalk one up for the good guys!

Here's a video I posted last year of rapper Mos Def voluntarily being force-fed Gitmo-style. It ain't pretty:

Denis Neville said...

The World Medical Association Declaration of Tokyo (1975) prohibits medical complicity in torture.

In 2004, Robert Jay Lifton, M.D. wrote, “There is increasing evidence that U.S. doctors, nurses, and medics have been complicit in torture and other illegal procedures in Iraq, Afghanistan, and Guantanamo Bay.”

As a medical professional I ask myself, what produces this behavior?

Lifton spoke of psychologically and militarily structured “atrocity-producing situations” in which military medical personnel, even without direct participation, often become socialized to an environment of torture because of the pressures of the military structure, and by virtue of their medical authority confer its legitimacy.

While living in Germany, I asked the same question about the military German doctors and nurses, the vast majority of whom were ordinary people and not fanatics, directly involved in Nazi cruel medical experiments and killings. What produced that behavior?

I later read Lifton’s The Nazi Doctors: Medical Killing and the Psychology of Genocide, which is the most extreme example of becoming socialized to atrocity. They became murderers mainly in atrocity-producing settings.

However, “atrocity-producing situations” are not powerful enough to override all of our humane instincts.

Bravo to the male Navy nurse for refusing to force-feed that Guantánamo prisoner.

“There are people who resist these situations. But it takes a special amount of autonomy and courage," said Lifton.

Elizabeth Adams said...

Nasogastric tubes are quite painful. As a nursing student, I volunteered to have one put in me in front of my nursing class. It was more painful than I could have imagined. And out of all the procedures I have had to do, it is my LEAST favorite to perform.

The license (which has a strong basis in ethics) comes first -- it certainly comes before the employer, even if one is "outranked" by the person giving orders.

This is why my all-time nurse heroes are the nurses of St. Vincent. They risked their jobs by standing up to the status quo and being the last line of defense for their patients:

Denis Neville said...

@ Elizabeth Adams

It was my experience also that of all the procedures I have ever done, passing a feeding tube was one of my least favorite to perform. What was it like on the other side of the tube? That Mos Def film is a cringe inducing reminder.

Re: your all-time nurse heroes

A group of nurses from St. Vincent Hospital in Santa Fe, New Mexico, refused to assist with infant circumcisions on ethical grounds.

Googling further, at some hospitals, Jewish medical personnel are leading the charge in refusing to assist in circumcisions.

We rightly decry female genital mutilation. Why, then, are so many happy to condone the male equivalent?

“Nothing excites Monster Mohel more than cutting into the infantile penile flesh of an eight day old boy.” - Matthew Hess, Foreskin Man comic book, San Francisco anti-circumcision movement

Study recommends circumcision, to avoid diseases; Norwegian nurses push to ban ritual circumcision; Denmark, Norway resist calls to ban circumcision; European Jewish officials defend ritual circumcision; Council of Europe motion backs circumcision; US envoy warns circumcision bans will create Jew-free Europe; @

Oy vey! Another war - Circumcision Wars - I have been totally unaware of in my blissful state of ignorance as an older circumcised male. Since I was born to Catholic parents, I was obviously circumcised for nonreligious reasons. I never asked my mother “why?” having never been aware of any negative impact of my circumcision on our mother-son bond.

Our two boys were circumcised in the 80’s. It was never an issue between my wife and I. As healthcare professionals, we were likely following the American Association of Pediatrics (AAP) recommendation for circumcision at the time. My being circumcised never entered that decision, although I was surprised to learn that there is a golden rule of penises (a father’s desire to have his son’s penis resemble his own). Good Grief!!!

I still find myself curiously ambiguous about this. While I have no doubts at all about the evils of female genital mutilation, I am neither passionately for nor against circumcision based on my experiences with it I guess. So why don’t I join the chorus of disapproval? My liberal conscience in a classic dither, I fear.

But bravo to those nurses!

“We only labor to stuff the memory, and leave the conscience and the understanding unfurnished and void.” - Michel de Montaigne