Legal / Ethics

Viewpoint: Nurse’s refusal to force feed Gitmo prisoners triggers debate

Few Americans know that a U.S. Navy nurse may lose his 18-year career because he decided he could no longer in good conscience continue force-feeding hunger striking detainees at Guantanamo Bay detention camp this past summer.

Lawyers for the nurse say his decision was guided by the ethical and moral principles of the nursing profession to put patients’ welfare above all else. The military says the nurse disobeyed orders. A military Board of Inquiry will decide the nurse’s fate sometime next year.

In the meantime, the American Nurses Association and Physicians for Human Rights are raising awareness and support for the Navy nurse. The ANA, along with PHR and the nurse’s attorney, held a press conference for the media in November to answer questions and explain their support for the nurse. The nurse’s identity is being withheld by his attorney.

As I listened to the press conference, the discussion triggered ambivalent recollections of my 2007 trip to the Guantanamo Bay detention camp, which is located on the southeastern tip of Cuba. At the time, I was an editor for a Chicago-based magazine for RNs. Photographer Andrew Campbell and I flew to Guantanamo Bay to interview Navy medical personnel assigned at the time to care for suspected terrorists captured in Afghanistan and other countries after 9/11.

For 3 days, Andrew and I were given extraordinary access inside the camp, unprecedented at the time for anyone but major media outlets. We saw detainees receiving medical care from Navy nurses and corpsmen at the small hospital built for the prisoners inside the camp. We observed and photographed a low-risk, unshackled detainee undergoing physical therapy for low-back pain. We also interviewed mental health professionals who worked with detainees overcome with hopelessness over their indeterminate stay at Gitmo.

One day as we walked to cell blocks deep in the camp, we heard the Islamic call to prayer, the adhān, over the camp’s speaker system. I remember thinking at the time it was one of the most beautiful sounds I had ever heard, but incongruent to be playing on a U.S. military compound given the global war on radical Islam that is being waged.


Later, we also watched camp guards distribute lunch prepared in accordance with Halal requirements under Islamic law to detainees in their cells. We continued to observe from a short distance, until one of the detainees noticed the glint of Andrew’s camera and started yelling. Detainees don’t like being photographed. We left when the other detainees quickly joined in.

But primarily I was at Gitmo to talk to medical personnel, like Comdr. Jane French, the senior nurse executive at the time. She told me the primary responsibility for Navy RNs at Gitmo is supervising and training the corpsmen, not providing hands-on nursing care. Corpsmen have similar training to civilian licensed practical nurses. The RNs have limited contact with detainees. Any direct nursing care usually takes place when a detainee is admitted to the hospital – that is except for the force-feedings.

The Navy denied my request to watch a detainee being force-fed, but we were allowed to talk with French and other nurses about the feeding. Only RNs placed the feeding tubes, after an order from a Navy physician with final approval from higher command. These nurses were called nutritional support nurses. Force-feeding requires strapping a detainee in the restraint chair and inserting a soft, flexible catheter down his nasal passage, through the throat and into the stomach. Nurses know that even with a cooperative patient, this is an uncomfortable procedure. There is a risk that the tube will go into the lungs instead of the stomach. Once inserted, a nutritionally balanced liquid supplement such as Ensure is then carefully instilled into the tube. When the feeding is finished, the tube is removed.

Most controversial then and now is the use of the specially made five-point restraint chairs. Detainees are strapped by their arms, legs and head into the chairs for the feedings. The chair is also used to forcibly extract uncooperative detainees from their cells.

While we were at the detention camp in 2007, I was told that 11 out of 13 hunger strikers were being force-fed. Even then, the Department of Defense was being criticized in the United States and around the world for force-feeding detainees who were on hunger strikes, which began in August 2002.

I asked French what would happen if a nurse did not want to do the feedings because he or she believed it went against nursing ethics. French said the nurse would not be forced to do the feeding and someone else would do it instead. I do not recall if this option was an unwritten rule or an established policy.

So I was surprised when I heard that a Navy nurse at Gitmo was being disciplined for making such a choice. Certainly there have been numerous commanders at the detention camp and changes in policies since 2007. But still, why make an example of a nurse? One who is caught in a no-win, no-man’s land between military orders and accepted nursing ethics, both of which he has agreed to enforce.

The issue was apparently forced when a detainee’s lawyer from Reprieve, an international nonprofit that legally advocates for prisoners, leaked the news that a nurse had refused to force-feed detainees this past summer. Once the news was out, the military had to enforce its argument that the feedings are necessary to keep hunger-striking detainees alive. Force-feeding is a question of life and death, not ethics, says the military. Military medicine is not bound by codes of ethics for civilian nurses and physicians, I was told.

Despite the access we had at Guantanamo Bay, Andrew and I both quickly recognized that we were being shown only what the military’s public affairs officers (PAOs) wanted us to see and hear. Some medical personnel were reluctant to talk and used only their first names for fear of retribution from detainees. Andrew’s pictures were screened every evening by a PAO. We knew the detention camp was built on a foundation of secrets.

The Navy nurse in question is now back at his home station of Naval Health Clinic New England. According to the Miami Herald, his supervisor, Capt. Maureen Pennington, says in order for the nurse to stay in the Navy, he must prove why he should remain in service. In 2 more years, the nurse can retire with full benefits, depending on the outcome of a Navy Board of Inquiry.

A court martial of the Navy nurse could have revealed secrets the Navy and government want kept quiet and bring more unwanted attention to the procedure. But more attention may be coming anyway. A Federal court judge ruled in October that the U.S. government must release videotapes of force feedings to the public. This is being delayed by the Department of Justice.

If the tapes are released to the public, they will open a crack for the outside world to see into Gitmo’s dark hole. And the nurse who chose personal and nursing ethics over military duty? Today, his career remains trapped in the purgatory of Gitmo’s sticky political web.

Janet Boivin, RN, BSN, BSJ, is a freelance writer and a staff nurse for a free clinic in Illinois.

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