February 25, 2006
The United States and Iran share an expression of public opinion, one
that still causes considerable distress to the majority of British:
[In 1997] the people of Hartford, Connecticut, dedicated a monument to
Bobby Sands and the other Irish Republican Army hunger strikers…. The
monument stands in a traffic circle known as "Bobby Sands Circle," at
the bottom of Maple Avenue near Goodwin Park. The Iranian government
named a street in Tehran after Bobby Sands. (It was formerly Winston
Churchill Street.) It runs alongside the British embassy.
Readers may or may not be familiar with this part of Northern Ireland’s
history, involving the death through a hunger strike of the IRA
detainee. Bobby Sands was 27 years old when he died, 5 May 1981, after
66 days without food. Nine other IRA prisoners died following him in
the same strike. Sands and his fellow strikers were protesting their
reassignment from political prisoner status back to criminal status;
poltical status was won the previous year through a hunger strike.
Sands was elected to Parliament several days after he began his
protest. The British government's unwillingness to concede to the
prisoner's demands during the second strike, which led to the death of
Bobby Sands and the other detainees, resulted in much greater sympathy
for the IRA from Irish nationalists and greatly strengthened the
movement as well as earned recognition from people around the world. A
further brief summary is given by the Cain Institute.
Before discussing the aspect of force-feeding that is taking place now
in U.S. prisons, I want to step back a bit further into British
history. I first became aware of the question of force-feeding through
an excellent BBC docudrama many years ago about suffragettes, who
employed civil disobedience in the UK from 1900 to 1920 in order to
achieve the vote for women.
Many
were imprisoned and used hunger strikes to further their cause. The
authorities could not let these women, many of whom were connected to
leading families in the country, die and become martyrs. They were
forcibly fed.
The BBC did not hide what this meant in their dramatization of the
events. They showed the women being bound to chairs, their heads pulled
back by their hair, and the rough-handed prison warders thrusting
large-diameter rubber tubes down their throats and pouring in a food
mixture through a funnel.
So that you take what follows as seriously as you take all other acts
now being done in our name, I ask you to sense the ugliness of the
abuse, your mouth being forced open, the taste of that tube, and the
abomination of the act. For surely we have become so accustomed to
these atrocities that our newspapers can discuss them calmly and
objectively. But you can no more be objective about these horrors than
you can calmly debate in Congress where and when torture might be
acceptable.
Yet what follows is classified not as torture
but as "prisoner welfare." Constance Lytton was force-fed in October
1909. Her book Prison and Prisoners included an account of her
experiences:
Two of the wardresses took hold of
my arms, one held my head and one my feet. The doctor leant on my knees
as he stooped over my chest to get at my mouth. I shut my mouth and
clenched my teeth…. The doctor seemed annoyed at my resistance and he
broke into a temper as he pried my teeth with the steel implement. The
pain was intense and at last I must have given way, for he got the gap
between my teeth, when he proceeded to turn it until my jaws were
fastened wide apart. Then he put down my throat a tube, which seemed to
me much too wide and something like four feet in length. I choked the
moment it touched my throat. Then the food was poured in quickly; it
made me sick a few seconds after it was down. I was sick all over the
doctor and wardresses. As the doctor left he gave me a slap on the
cheek. Presently the wardresses left me. Before long I heard the sounds
of the forced feeding in the next cell to mine. It was almost more than
I could bear, it was Elsie Howley. When the ghastly process was over
and all quiet. I tapped on the wall and called out at the top of my
voice, "No Surrender," and then came the answer in Elsie’s voice, "No
Surrender."
As is happening now in Guantánamo Bay, nasal
insertion was also employed. Mary Leigh, a member of the WSPU, was
forced-fed in September 1909:
On Saturday
afternoon the wardress forced me onto the bed and two doctors came in.
While I was held down a nasal tube was inserted. It is two yards long,
with a funnel at the end; there is a glass junction in the middle to
see if the liquid is passing. The end is put up the right and left
nostril on alternative days. The sensation is most painful — the drums
of the ears seem to be bursting and there is a horrible pain in the
throat and the breast. The tube is pushed down 20 inches. I am on the
bed pinned down by wardresses, one doctor holds the funnel end, and the
other doctor forces the other end up the nostrils. The one holding the
funnel end pours the liquid down — about a pint of milk… egg and milk
is sometimes used.
Emmeline Pankhurst, who was then in her
fifties, endured 10 hunger strikes. Kitty Marion underwent at least 200
force-feedings in prison while on hunger strike. Emmeline Pankhurst’s
sister, Mary Clarke, was taken ill at her home in Brighton soon after
release from prison and died of a broken blood vessel, probably as a
result of being forced-fed in Holloway Prison.
In Parliament James Keir Hardie, one of the founders of the Labour Party, said:
In reply to a question of mine today, Mr. Masterman, speaking on behalf
of the Home Secretary, admitted that some of the nine prisoners now in
Winston Green Gaol, Birmingham, had been subjected to "hospital
treatment," and admitted that this euphemism meant administering food
by force. The process employed was the insertion of a tube down the
throat into the stomach and pumping the food down. To do this, I am
advised, a gag has to be used to keep the mouth open.
That there is difference of opinion concerning the horrible brutality
of this proceeding! Women worn and weak by hunger, are seized upon,
held down by brute force, gagged, a tube inserted down the throat, and
food poured or pumped into the stomach. Let British men think over the
spectacle.
In 1913 the British Government sought a better
way to treat such prisoners. The Prisoner’s (Temporary Discharge of Ill
Health) Act came into force. Suffragettes were now allowed to go on
hunger strike, but as soon as they became ill they were released. Once
the women had recovered, the police rearrested them and returned them
to prison where they completed their sentences. This successful means
of dealing with hunger strikes became known as the Cat and Mouse Act.
Now step forward in time to the 1970s and ’80s. Prisoners detained for
terrorism in Northern Ireland undertook hunger strikes in support of
demands that were unacceptable to British public opinion. In words so
terribly familiar today, the Cat and Mouse Act could not be employed,
on the grounds that alleged IRA gunmen could not be let loose on the
streets. At the same time, the British government could not countenance
creating martyrs by letting them die.
Debate on
force-feeding came to a head in the UK in the 1970s when two Irish
prisoners, Dolours and Marian Price, legally challenged the Home
Office’s right to force-feed in any case other than where refusal of
food arose from a medical or psychiatric condition. It caused a furor,
and the prison policy of involuntary feeding that earlier IRA prisoners
had experienced was overturned. In 1981 the wishes of hunger strikers
were respected and doctors supervised death-fasts in Northern Ireland.
The death of Bobby Sands came as a result. The policy was subsequently
refined, so that when prisoners became too weak to communicate
effectively, the prisoner’s priest met with family members so that a
final decision on intervention could be taken.
The hunger
strikes came to an end, in part because of the realization that each of
the families of the strikers would ask for medical intervention
whenever the strikers lapsed into unconsciousness. At the same time, on
6 October 1981 James Prior, then Secretary of State for Northern
Ireland, announced a series of measures that went a long way toward
meeting many aspects of the prisoners’ five demands.
The relevance of this history to Guantánamo Bay will become clear.
The New York Times of February 9, 2006, includes this information:
United States military authorities have taken tougher measures to
force-feed detainees engaged in hunger strikes at Guantánamo Bay, Cuba,
after concluding that some were determined to commit suicide to protest
their indefinite confinement, military officials have said.
In recent weeks, the officials said, guards have begun strapping
recalcitrant detainees into "restraint chairs," sometimes for hours a
day, to feed them through tubes and prevent them from deliberately
vomiting afterward.
Some officials said the new
actions reflected concern at Guantánamo and the Pentagon that the
protests were becoming difficult to control and that the death of one
or more prisoners could intensify international criticism of the
detention center.
Colonel Martin said
force-feeding was carried out "in a humane and compassionate manner"
and only when necessary to keep the prisoners alive. He said in a
statement that "a restraint system to aid detainee feeding" was being
used but refused to answer questions about the restraint chairs.
The Times quotes lawyers representing six of the prisoners:
"It is clear that the government has ended the hunger strike through
the use of force and through the most brutal and inhumane types of
treatment," said Thomas B. Wilner, a lawyer at Shearman & Sterling
in Washington, who last week visited the six Kuwaiti detainees he
represents. "It is a disgrace."
The extent of this disgrace is indicated in the article:
The Guantánamo prison, which is holding some 500 detainees, has been
beset by periodic hunger strikes almost since it was established in
January 2002 to hold foreign terror suspects. At least one detainee who
went on a prolonged hunger strike was involuntarily fed through a nasal
tube in 2002, military officials said.
Since
last year, the protests have intensified, a sign of what defense
lawyers say is the growing desperation of the detainees. In a study
released yesterday, two of those lawyers said Pentagon documents
indicated that the military had determined that only 45 percent of the
detainees had committed some hostile act against the United States or
its allies and that only 8 percent were fighters for Al Qaeda.
These words are chilling: "'This is just a reality of long-term
detention,’ a Pentagon official said. 'It doesn’t matter whether you’re
at Leavenworth or some other military prison. You are going to have to
deal with this kind of thing.’"
We do not know the exact
methods adopted to force-feed these prisoners, not least because the
Pentagon is reluctant to go into details and some of its statements
conflict:
Until yesterday, Guantánamo officials
had acknowledged only having forcibly restrained detainees to feed them
a handful of times. In those cases, the officials said, doctors had
restrained detainees on hospital beds using Velcro straps.
Two military officials, who insisted on anonymity because they were not
authorized to discuss the question, said that the use of restraint
chairs started after it was found that some hunger strikers were
deliberately vomiting in their cells after having been tube-fed and
that their health was growing precarious.
In a
telephone interview yesterday, the manufacturer of the so-called
Emergency Restraint Chair, Tom Hogan, said his small Iowa company
shipped five $1,150 chairs to Guantánamo on Dec. 5 and 20 additional
chairs on Jan. 10, using a military postal address in Virginia. Mr.
Hogan said the chairs were typically used in jails, prisons and
psychiatric hospitals to deal with violent inmates or patients.
In the absence of more information, our sources can only be those quoted in The Times:
…a Kuwaiti detainee, Fawzi al-Odah, told [his lawyer] last week that
around Dec. 20, guards began taking away items like shoes, towels and
blankets from the hunger strikers.
Mr. Odah
also said that lozenges that had been distributed to soothe the hunger
strikers’ throats had disappeared and that the liquid formula they were
given was mixed with other ingredients to cause diarrhea, Mr. Wilner
said.
On Jan. 9, Mr. Odah told his lawyers, an
officer read him what he described as an order from the Guantánamo
commander, Brig. Gen. Jay W. Hood of the Army, saying hunger strikers
who refused to drink their liquid formula voluntarily would be strapped
into metal chairs and tube-fed.
Mr. Odah said
he heard "screams of pain" from a hunger striker in the next cell as a
thick tube was inserted into his nose. At the other detainee’s urging,
Mr. Odah told his lawyers that he planned to end his hunger strike the
next day.
This description echoes the words of one of those
IRA prisoners in Northern Ireland, before the British government was
made to face its inhumanity in 1981. Sinn Féin’s Gerry Kelly, in an
interview with the North Belfast News in 2004, said:
"They press their knuckles into your jaws and press in hard. The way
they finally did force feed me was getting forceps and running them up
and down my gums," he said.
"I opened my mouth, but I was able to resist after that," said the Sinn Féin man in the interview.
"Then they tried — there’s a part of your nose, like a membrane and
it’s very tender — and they started on that. It’s hard to describe the
pain. It’s like someone pushing a knitting needle into the side of your
eye. As soon as I opened my mouth they put in this wooden bit with a
hole in the middle for the tube. They rammed it between my teeth and
then tied it with cord around my head.
"Then
they got paraffin and forced it down the tube. The danger is that every
time it happens you think you’re going to die. The only things that
move are your eyes.
"They get a funnel and put the stuff down."
The New York Times quotes a government official:
"There is a moral question," the assistant secretary of defense for
health affairs, Dr. William Winkenwerder Jr., said in an interview. "Do
you allow a person to commit suicide? Or do you take steps to protect
their health and preserve their life?"
There is indeed a
moral question — one that the international community has answered, and
it reaches very different conclusions from those apparently reached by
the United States.
The World Medical Association, which
includes support from the British Medical Association, has deemed the
involuntary feeding of hunger strikers as coercive and provides an
alternative route. Its statement, adopted by the 43rd World Medical
Assembly in Malta in November 1991 and editorially revised at the
44th World Medical Assembly at Marbella, Spain, in September 1992 can
be read here. The preamble is below:
- The doctor treating hunger strikers is faced with the following conflicting values:
- There
is a moral obligation on every human being to respect the sanctity of
life. This is especially evident in the case of a doctor, who exercises
his skills to save life and also acts in the best interests of his
patients (Beneficence).
- It is the duty of the doctor to
respect the autonomy which the patient has over his person. A doctor
requires informed consent from his patients before applying any of his
skills to assist them, unless emergency circumstances have arisen in
which case the doctor has to act in what is perceived to be the
patient’s best interests.
- This conflict is apparent where a hunger striker who has issued
clear instructions not to be resuscitated lapses into a coma and is
about to die. Moral obligation urges the doctor to resuscitate the
patient even though it is against the patient’s wishes. On the other
hand, duty urges the doctor to respect the autonomy of the patient.
- Ruling in favour of intervention may undermine the autonomy which the patient has over himself.
- Ruling in favour of non-intervention may result in a doctor having to face the tragedy of an avoidable death.
- A
doctor/patient relationship is said to be in existence whenever a
doctor is duty bound, by virtue of his obligation to the patient, to
apply his skills to any person, be it in the form of advice or
treatment.
This relationship can exist in spite of the fact that
the patient might not consent to certain forms of treatment or
intervention.
Once the doctor agrees to attend to a hunger
striker, that person becomes the doctor’s patient. This has all the
implication and responsibilities inherent in the doctor/patient
relationship, including consent and confidentiality.
- The
ultimate decision on intervention or non-intervention should be left
with the individual doctor without the intervention of third parties
whose primary interest is not the patient’s welfare. However, the
doctor should clearly state to the patient whether or not he is able to
accept the patient’s decision to refuse treatment or, in case of coma,
artificial feeding, thereby risking death. If the doctor cannot accept
the patient’s decision to refuse such aid, the patient would then be
entitled to be attended by another physician.
The excellent New York Times
report came and went with little remark in the mainstream press. The
treatment of prisoners on hunger strike by forcible feeding continues.
"Saving" prisoners from their hunger strike is a deceptive distortion
of a cruel and unacceptable coercion that needs our urgent attention to
bring to an immediate end. If we dare not allow prisoners to seek death
as a means of escaping their circumstance or because they want to make
martyrs of themselves, and yet we cannot meet any of their demands for
the promise of a fair trial or some relief from their seemingly endless
imprisonment, why cannot we follow the procedures demanded by the World
Medical Association? If this is not acceptable, why cannot we adopt the
British measures in Northern Ireland, which respected prisoners’ wishes
until the point when imams and families can be involved in the
decision-making regarding medical intervention?
Our answer at the moment is to revert to a practice that was discredited as cruel and barbaric a hundred years ago.
Please show the mercy to these people that seems absent in our
lawmakers and bring this issue to the attention of Congress through
your representatives. I shall be doing so in the United Kingdom.
Perhaps our Canadian and European friends can also raise questions on
this treatment of detainees with representatives of their own
government to increase international pressure.
Note: I do
not want to reawaken the deep hurt of such recent events that is still
keenly felt on both sides of the Atlantic. The deaths of Bobby Sands
and his nine colleagues were some of the many, many tragic consequences
of the troubles. I pay my respect to him and his dedication to his
convictions now, although I cannot accept his support of violence
in response to the wrongdoings he saw as being perpetrated by the
British government.