Philosophical commentary on contemporary political issues in the tradition of Charles Taylor, Alasdair MacIntyre, and Michael Sandel.

Wednesday, May 1, 2013

Guantanamo's Decision to Force-Feed Prisoners Recalls Age-Old Questions of Ethics

At this very moment, 100 prisoners at Guantanamo Bay are participating in a mass hunger strike. Of those 100 prisoners, 21 are so badly starved that medical authorities at the base have approved their force-feeding through nutritional supplement tubes that are run through the prisoners' noses.

This decision to force-feed Guantanamo Bay prisoners has not been made without controversy, however. In particular, many American medical professionals are taking issue with the military's decision. Most prominent of these is Jeremy Lazarus, president of the American Medical Association, who wrote a letter to Secretary of Defense Chuck Hegel on the matter.

In the letter, he spelled out that the decision to force-feed Guantanamo Bay inmates "violates the core ethical values of the medical profession." He then quoted the World Medical Association Declaration of Tokyo:
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. The decision as to the capacity of the prisoner to form such a judgment should be confirmed by at least one other independent physician.
Lazarus and the professional medical community argue that force-feeding the prisoners in Guantanamo is a violation of their right to self-determine by refusing treatment.

While some may see this situation as a question of law and some may see it as a question of medicine, what it really does is force us to engage in a philosophical exercise. In particular, the situation poses a serious question to us: Is inaction equivalent to action if consequences remain the same?

This question reinvigorates a classic philosophical disagreement: that between Immanuel Kant's categorical imperative and Jeremy Bentham's consequentialism. To spare the details, Kant tends to focus on the content of an action, while Bentham tends to focus on the result of an action. We see this dilemma every day. When a car backs out and accidentally bumps into someone else, the person hit will say "look at what you did to my car!" He is upset about the result or consequence of the action. The person who backs out says "I didn't see you there, I did not mean to hit your car!" The content of the action is innocent. In our legal system, we have to take some side, so the person who pulled out would be held legally responsible, but the pull of the importance of content of an action is still strong. The law can only be justified by saying the consequence was negative (the car was damaged) and the content was negative (the driver must have been neglectful, so he must be at fault).

To bring this back to the force-feeding decision, mainstream medical practice allows doctors to restrain patients from inflicting self-harm. If a patient wants to take a knife to his own throat, then both the content and the consequence of the action is negative. Mainstream medical practice does not, however, permit doctors to force medical assistance on patients who refuse treatment, even if it results in dire health problems or death of the patient. In this way, mainstream medical practice is Kantian. It maintains that inaction and action with the same consequences should be treated differently. The military, on the other hand, makes no distinction between inaction and action if they result in the same health problems for the patients. Slitting my own throat has the same ultimate result as refusing medical attention if my juglar spontaneously ruptured. Thus, a hunger strike is the same thing morally as suicide. In this respect, the military is utilitarian in their appraisal.

Now if mainstream medical practice condoned active self-harm (such as suicide), then a different debate emerges, but it is one that is no less philosophical. There is further conversation to be had about what it means to make an "unimpaired and rational judgment" as well. Only by engaging with philosophy can we get a handle on what rationality looks like and how it could be impaired.

In the words of Michael Sandel, "to engage in...practice is already to stand in relation to theory." How we act depends on whether we decide to be rigorous about that theory or to to be blind to how it affects our every decision as individuals and as a society.

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