Clueless Bioethicists at JAMA

Sometimes I think that to some bioethicists, it’s all a mind game. The latest example is an article published in the Journal of the American Medical Association. Prisoners at Guantanamo Bay are on a hunger strike, and the authors are upset because army doctors are helping to force feed them. From the story:

Military doctors violate medical ethics when they approve the force-feeding of hunger strikers at the U.S. prison camp at Guantanamo Bay, says a commentary in a prestigious medical journal. The doctors should try to prevent force-feeding by refusing to participate, the three authors write in today’s Journal of the American Medical Association.

“In medicine, you can’t force treatment on a person who doesn’t give their voluntary informed consent,” said one of the authors, Dr. Sondra Crosby of Boston University. “A military physician needs to be a physician first and a military officer second, in my opinion.”

Let’s not make this about the propriety of Guantanamo, but about the rights of prisoners and the duties of the government toward the imprisoned, generally. Prisoners are not fully autonomous deciders—to borrow a memorable Bush phrase—they are under the authority of the state. Moreover, the government has a duty to prevent suicide by prisoners. (Can you imagine the screaming if a Guantanamo prisoner succeeded in starving himself to death?) Thus, just as doctors should strive to revive a patient after a suicide attempt by hanging—which is medical treatment—the government has the duty to use the least intrusive methods available to keep inmates sufficiently nourished so that their lives are not at risk; thus nasal tubes but not surgically inserted abdominal tubes. And yes, doctors should help to make sure it is done correctly. And I would say this should apply to any prisoner who seeks to take his or her own life in any context.

This isn’t to say that a patient should be required to have a heart bypass procedure, for example. But prisoners autonomy is not the same as those who are free. And they do not have the right to commit suicide. These bioethicists need to get out of their abstract ideals and into the real world.