“Where a prisoner refuses nourishment and is considered by the physician as capable of forming an unimpaired and rational judgment concerning the consequences of such a voluntary refusal of nourishment, he or she shall not be fed artificially.” [Declaration of Tokyo]
A recently viralized video of Yassin Bey (the musician/actor formerly known as Mos Def) undergoing force-feeding to highlight what Guantanamo Bay detainees experience daily has shed light on a matter wrought with multiple ethical implications. In the video, Bey is shackled to a chair as a team utilizes a standard procedure to insert a nasogastric (NG) tube through his nostril, down the oropharynx and esophagus, and into the stomach.
NG tubes are used for a variety of indications and are commonly employed. The most obvious indication is to feed a person who is unable to swallow but needs nutritional support. For example, someone who has recently suffered a stroke and cannot swallow safely (for risk of aspiration into the lungs), or someone who is intubated and sedated in the ICU and cannot feed themselves may have an NG tube placed to allow for feeding. If an NG tube cannot be passed (for various reasons such as mechanical obstruction in the upper GI tract), or if a more long-term method of tube feeding is desired, a tube can be inserted through the skin directly into the stomach. Feeding by way of the GI tract is always preferred over parenteral nutrition (i.e. nutrition through an IV line). It promotes healthy cells stomach and intestines, and it also has a much lower risk of infection than feeding through an IV.
The ethics of tube feeding in the medical community is mostly discussed in terms of end of life care. When patients are suffering from a terminal illness with no hope for cure, palliative care is recommended to alleviate the person’ s suffering in the last days, months, or even years of their life. Rather than enduring uncomfortable, painful procedures and treatments that do not improve quality of life, palliation serves to treat pain and improve symptoms such as shortness of breath. When patients are no longer able to feed themselves, tube feeding may be offered to or even demanded by family members who feel that not feeding their loved one is akin to starvation. However, it has been shown that tube feeding does not improve quality of life; the pleasure of eating food is not replaced by a tube in the stomach. Also, it can do harm, for there is a risk of aspiration gastric contents into the lungs as well as other complications. The tube may even cause more discomfort than support, countering the very point of palliative care.Tube feeding may even artificially prolong a person’s life when they are ready to die naturally, thus prolonging their suffering.
As this instructional video shows, inserting an NG tube can be mildly uncomfortable, but for the most part it is bearable in a patient who is willing and cooperative. In Yassim Bey’s video, the procedure is so uncomfortable that he breaks into tears and begs the team to stop. The focus of this demonstration is not only on the discomfort of the person undergoing the procedure, but also on the fact that the detainees who are forced to have an NG tube inserted for force feeding are on hunger strike.
Hunger strikes have been utilized throughout history and has been recorded even centuries ago as a means of non-violent protest. Mohandas Gandhi employed a hunger strike to protest British rule in India. Irish political prisoners went on hunger strike in 1981, also against the British. Suffragettes for women’s rights were imprisoned and also force-fed during their hunger strikes. Many debate the effectiveness of hunger striking and whether it is a plausible means of protest. As one article points out, there are other methods of non-violent protest that have been more equally or more effective. However, political prisoners are limited in what they can do. The Guantanamo Bay detainees who have been cleared for release but have not yet been released (some of them waiting years) are, understandably, turning to hunger strikes in desperation.
The issue goes even further, as it currently the month of Ramadan in the Islamic calendar, and fasting from sunrise to sunset is one of the Five Pillars of Islam. Forcing prisoners who observe Ramadan to be fed goes against their very core values and beliefs, for they are not able to partake in a major aspect of their faith and spirituality. This, to me, is another form of disrespectful disregard for human beings. Religious leaders, including Catholic Bishop Richard Pates, have been urging President Obama to halt force-feeding, especially during this month of religious observation.
I cannot begin to imagine being forced to stay imprisoned despite not being charged with any crimes. I cannot imagine being cleared for release but having no way out.I cannot imagine watching years of my life pass by in unfair confinement. I empathize with these human beings who have very limited means of getting their message out to the world. I see hunger striking as a last resort of sorts, and the decision to forego food is not an easy or flippant one. If a person chooses to refuse feeding and has the psychological wherewithal to make their own decisions, then force-feeding against their will is wrong. As shown above, if a patient is willing and cooperative, placing an NG tube can be fairly simple. But if a person is unwilling to eat and does not want an NG tube placed, forcing this upon them is cruel.
Many, including our president, may feel it is unethical to allow hunger strikers to die from starvation. These strikers are exerting their only method of non-violent protest, but they are not being allowed to do so. Just as a soldier risks death for his or her country, just as a Freedom Rider risked imprisonment or death by silently sitting on a bus, just as a young girl named Malala risked death by promoting the education of girls in a society poisoned by the Taliban, just as the Salt Marchers risked death by beginning a nationwide civil disobedience movement, so do hunger strikers risk death to protest an unjust reality. Removing the method of their protest by force feeding is like removing buses for Freedom Riders to ride, removing schools for girls, removing salt from the face of the earth. What a slap in the face of humanity to disallow civil disobedience while ignoring the very issue being protested.
It is my hope that the voices of the innocent are heard and that freedom, the value we claim to value the most, if granted to those who are risking everything, even life, to attain it.