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.

The Origin of Ethics

On Wednesday, my good friend Peter Hurford wrote a short post on his excellent blog titled "Questions for Moral Realists." In this post, Hurford asserts that there are three categories of moral realism, with each category assuming the last. The first category, "success theory," holds that moral statements point towards a real moral standard. Success theorists who believe that there is only one "true" moral standard fall into the second category: "unitary theory." And the unitary theorist who argues that the one true moral standard is the only path for a rational human being partakes in the third category, "absolutism theory."

As someone who sympathizes with claims of moral realism, I decided it would be valuable to shed my perspective on this discussion. In particular, I will try to answer Hurford's three questions from his post:

(1) Why is there only one particular morality?

(2) Where does morality come from?

(3) Why should we care about morality?

I will begin with (3). Ethics is the science of choice. The fundamental question of ethics is "what should one do?" This is what grounds ethics as both the most practical and also the most fundamental philosophical field. While Descartes saw "do I exist?" as the fundamental philosophical question, the question that precedes his epistemological foundation is "should I concern myself with existence?"

The skeptic could take a step backwards and say "do I not need to know if I exist in order to ask myself what I should do in the first place?" One can see how the reasoning can get circular at this point. So the question that presents itself after this is "which is a more important question for me to consider, 'what should I do?' or 'do I exist?'" I tend to think that the pragmatic method needs to be turned to here.  I can go on for years worrying about my own existence, but if I do in fact exist then that is time wasted and if I don't exist then there was not much to gain from discovering such a fact in the first place.

In short, my answer to (3) is that morality is something that we have to concern ourselves with first if we are to take part in our lives as human beings.

I will now backtrack to hit (1) and (2). Since I am now asking the question "what should I do?" The question of who "I" am becomes essential. Ruling out metaphysically interesting but practically irrelevant "brain in the vat" theories, I am fairly certain to say that I am a man, but that I am also different from other men. So the question arises: what do I owe to that of myself that is like others and what do I owe to that of myself that is unlike others?

When I think of how I am like other men, a lot of things come to mind. I share 99.9% of the genetic code of all other men. I need to eat, drink water, stay healthy, and I have a desire to flourish. This last piece is probably the most important of them all.

While I may like different sports and spend my free time differently than others, I share that desire to make my life worthwhile. While I was strongly resistant to this strand of moral philosophy until less than a year ago, I find it hard to deny that morality has an evolutionary basis.

If there is anything that has given human beings the ability to persist as a species, it is our complex system of collaboration. The ability of language and our capacity to develop society and hierarchy has given us a leg up on evolutionary competition that expanded the species from 2,000 individuals in western Africa to over 7 billion people across the world. This has occurred because human beings have rules that allow them to collaborate with one another and to respect one another within cultural systems. The ability to work together through problem solving to hunt, to specialize between architects, engineers, managers, and electricians to build a house, to replicate a system of agriculture from Europe in America, these are the social tools that have fueled our survival, and they are built on an evolved sense of duty, respect, and collaboration. Thus, this is my answer to (2): morality is an evolved concept that occurs within a species.

The reason I think this does not qualify as a case of the Is-Ought Fallacy will also provide an answer to (1). The question "What should I do?" has a specifically transcendental nature to it. This is because no one can ask the question "what should I do?" besides a human being, so who we are has a necessary bearing on what we should do. This is why Nussbaum's capabilities approach makes so much sense. As a human being, I have certain human needs. Those provide a constraint on my menu of actions that can allow me to flourish.

As for the categories of realism listed above, I would have to say that the above take on the origins and nature of morality take part in all three: success, unitary, and absolutism. Morality is a real concept that applies to all human beings and are a rational end to human flourishing. Is it a real concept outside of human existence? No. Does that fact have any bearing on that fundamental question "what should I do?" The answer to this is also "no."  Morality is not "absolute" in a way that transcends humanity, but man cannot transcend humanity, and therefore morality is practically absolute. And in the realm of practice, that is the only thing that matters.