Adrian Mora

Date of Award

January 2011

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

John H. Warner

Subject Area(s)

Ethics, Law, History

Abstract

HYPOTHESIS/AIMS: In the Global War on Terror (GWOT), hunger strikes by detainees in Guantanamo Bay, Cuba have been managed by military physicians through force feedings. This thesis answers the question of how did the United States justify its current practice of force feeding prisoners against prevailing medical ethics? The author hypothesizes that U.S. case law history of approximately 1979 to 1997 enabled the current military doctrine to force feed international detainees in GWOT.

METHODS: A qualitative and comprehensive review of the relevant literature was undertaken. The sources used for conclusive analysis included press releases, ethics commentary, law reviews, medical association declarations, military law, international law, domestic law, court cases, judicial reviews, military manuals, and federal prison manuals.

RESULTS: The majority of decided United States court cases from the late 1970's through the mid 1990's upheld that the State may force feed a competent prisoner on a hunger strike and override the patient's right to refuse treatment and right to privacy. The U.S. military's current hunger strike policy follows similar opinion and procedural language established from the aforementioned case law history.

CONCLUSION: The preponderance of established rulings suggests that approximately 20 years prior to the hunger strikes of Guantanamo Bay in GWOT, the United States justified force feeding fasting prisoners. This national acceptance influenced the Department of Defense's stance on detainee hunger strikes. The military's procedural guidelines follow current federal prison regulations. Also, the official opinions by the military cite the federal prison system, federal law, and court language applied by consenting rulings. Key international jurisdictions and the bioethics community, including the United Nations, have ruled to uphold a hunger striker's right to refuse nutrition. The U.S. military's refusal to align with prevailing ethics also demonstrates the larger significance of U.S. case law to validate today's U.S. military doctrine. As such, the author suggests avenues of bioethics reform for military medicine.

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