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A US doctor and two lawyers Wednesday called for an end to force-feeding prisoners on hunger strike at Guantanamo Bay, saying the practice goes against medical ethics and is a form of assault.
"Force-feeding a competent person is not the practice of medicine; it is aggravated assault," wrote the experts from the Department of Health Law, Bioethics, and Human Rights at Boston University.
"Physicians may not ethically force-feed any competent person, but they must continue to provide beneficial medical care to consenting hunger strikers," said the commentary in the New England Journal of Medicine.
The authors called for more doctors to speak out against the policies at the US war on terror prison camp at the US naval base at Guantanamo Bay, Cuba, where the number of detainees on hunger strike has ballooned in the past three months.
There were 14 men on hunger strike and eight receiving nourishment via nasal tube on March 15, according to figures distributed by the US military.
As of June 12, almost two-thirds -- 104 of the 166 detainees at the prison camp -- were on hunger strike, and 43 were being force-fed.
"Hunger striking is a peaceful political activity to protest terms of detention or prison conditions; it is not a medical condition," the doctors wrote, finding fault with the military's assertion that force-feeding was needed to save lives.
In 2006, the US Department of Defense issued instructions that said medical intervention without consent of the detainee was permitted in cases of hunger strike, attempted suicide or other serious self-harm.
"This policy mistakenly conflates hunger striking with suicide. Hunger strikers are not attempting to commit suicide. Rather, they are willing to risk death if their demands are not met," the article said.
"Their goal is not to die but to have perceived injustices addressed," wrote doctor Sondra Crosby of the Boston University Department of Medicine and legal experts George Annas and Leonard Glantz.
The US Supreme Court and standards of international medical ethics hold that a decision to refuse treatment, with the knowledge that death will follow, is not the same as suicide, they argued.
The trio said the World Medical Association's Declaration of Malta is considered the authoritative standard on hunger striking and hold that force-feeding the mentally competent is "never ethically acceptable" and "is a form of inhuman and degrading treatment."
As the hunger strike has grown, the US Department of Defense has sent more medical personnel -- about 40 additional people -- to assist the force-feeding operation.
The situation drew the consternation of the American Medical Association, which wrote to the defense secretary in April that force-feeding "violates core ethical values of the medical profession."
But the authors said more political lobbying is needed to stop the force-feeding, and noted that Guantanamo represents a "stain on medical ethics" that will not fade away.
"American physicians have not widely criticized medical policies at the Guantanamo Bay detainment camp that violate medical ethics. We believe they should," the experts wrote in their piece, titled "Guantanamo Bay: A Medical Ethics-Free Zone?"
"Physicians at Guantanamo cannot permit the military to use them and their medical skills for political purposes and still comply with their ethical obligations."
A separate commentary in the same journal by Israeli scholar Michael Gross of the University of Haifa argued that hunger strikes by security detainees "pose an excruciating dilemma."
Hunger strikes set forth just three choices to prison authorities: let them die, accede to their demands, or force-feed, he said.
"It is unimaginable that any decent society today would leave 10 Irish Republican Army hunger strikers to die of starvation as the British did in Northern Ireland in 1981," he wrote.
"Instead, we should think about how to feed hunger strikers humanely."