Science, religion, public funding and force feeding in modern medicine

Responding to Bronca, T. “A conflict of conscience: What place do physicians’ religious beliefs have in modern medicine.” Canadian Health Care Network, 26 May, 2015.

Sean Murphy*

Tristan Bronca writes, “Belief without evidence is becoming incompatible with scientific sensibilities.”1

This notion might be exemplified by Dr. James Downar. Advocating for physician assisted suicide and euthanasia in Canadian Family Practice, he described himself as “a secular North American who supports individual autonomy, subject only to limitations that are justifiable on the basis of empirically provable facts.”2

Dr. Downar’s “Yes” was opposed by Dr. Edward St. Godard’s “No.”3 Since both are palliative care specialists, their differences on the acceptability of physician assisted suicide and euthanasia are not explained by differences in their clinical experience, but by their different moral or ethical beliefs.

However, neither Dr. Downar’s beliefs nor Dr. St. Godard’s can be justified “on the basis of empirically provable facts.” Nor can Dr. Downar’s support for individual autonomy, since empirical evidence demonstrates the primacy of human dependence and interdependence – not autonomy. Empirical evidence can provide raw material needed for adequate answers to moral or ethical questions, but it cannot answer them. As Dr. McCabe told Tristan Bronca, science is necessary – but not sufficient. Moral decision-making requires more than facts.

And the practice of medicine is an inescapably moral enterprise. Every time they provide a treatment, physicians implicitly concede its goodness; they would not otherwise offer it. This is usually unnoticed because physicians habitually conform to standards of medical practice without adverting to the beliefs underpinning them. Hence, the demand that physicians must not be allowed to act upon beliefs is unacceptable because it is impossible; one cannot act morally without reference to beliefs.

But Tristan Bronca asks specifically about whether or not religious beliefs belong in medical practice in a secular society. On this point, the Supreme Court of Canada is unanimous: “Yes.”

“Everyone has ‘belief’ or ‘faith’ in something, be it atheistic, agnostic or religious,” Mr. Justice Gonthier wrote in Chamberlain v. Surrey School District No. 36. “To construe the ‘secular’ as the realm of the ‘unbelief’ is therefore erroneous.”

“Why,” he asked, “should the religiously informed conscience be placed at a public disadvantage or disqualification? To do so would be to distort liberal principles in an illiberal fashion and would provide only a feeble notion of pluralism.”4

Thus, to argue that a “secular” society excludes religious belief perpetuates an error that contributes significantly to climate of anti-religious intolerance.

Public funding of services is beneficial for patients, but quite distinct from physician obligations. After all, physicians provide many kinds of elective surgery and health services that are not publicly funded, and physicians are not paid for publicly funded services that they do not provide. Besides, our secular society taxes both religious and non-religious believers, so both have equal claims on “public dollars.”

Most important, public funding does not prove that a procedure is morally or ethically acceptable, any more than public funding proves that force-feeding prisoners in Guantanamo Bay is acceptable. Perhaps that point will come up in military proceedings against a navy nurse who refused orders to do so.5

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The Canadian Healthcare Network posted this response in the on-line edition, which is accessible only to health care professionals and managers.


Notes

1.  Bronca, T. “A conflict of conscience: What place do physicians’ religious beliefs have in modern medicine.” Canadian Health Care Network, 26 May, 2015 (Accessed 2018-03-07).

2. Downar J. “Is physician-assisted death in anyone’s best interest? – Yes.” Canadian Family Physician, Vol. 61: April, 2015, p. 314-316 (Accessed 2018-03-07).

3. St. Godard E. “Is physician-assisted death in anyone’s best interest? – No.” Canadian Family Physician, Vol. 61: April, 2015, p. 316-318 (Accessed 2018-03-07).

4. Chamberlain v. Surrey School District No. 36 [2002] 4 S.C.R. 710 (SCC), para. 137 (Accessed 2014-08-03). “Madam Justice McLachlin, who wrote the decision of the majority, accepted the reasoning of Mr. Justice Gonthier on this point thus making his the reasoning of all nine judges in relation to the interpretation of ‘secular.’” Benson I.T., “Seeing Through the Secular Illusion” (July 29, 2013). NGTT Deel 54 Supplementum 4, 2013  (Accessed 2018-03-07).

5. Rosenberg C. “Top nursing group backs Navy nurse who wouldn’t force-feed at Guantánamo.” Miami Herald, 19 November, 2014 (Accessed 2018-03-07)

 

Top nursing group backs Navy nurse who wouldn’t force-feed at Guantánamo

Miami Herald

Carol Rosenberg

GUANTANAMO BAY NAVY BASE, Cuba

One of America’s leading nursing organizations is trying to save the U.S. Navy career of an officer, a nurse like them, who refused to force-feed hunger strikers this summer.

In a private letter, the American Nurses Association wrote Secretary of Defense Chuck Hagel last month arguing that the nurse should not be punished for making an independent ethical decision. The Physicians for Human Rights set up a conference call for Wednesday with the Navy nurse’s attorney and the advocacy group’s president to disclose the letter, which has been obtained by the Miami Herald.

It says: “These actions are resulting from the nurse’s expressing an ethical objection to participating in the force-feeding of detainees who are engaging in a form of protest at Guantánamo Bay Detention Camp.” The Pentagon has not responded.

The Miami Herald disclosed the crisis of conscience over the summer after a Syrian hunger striker heard the lieutenant declare he could no longer force-feed, told his lawyer about it, and the prison confirmed it happened.

Commanders cut short the deployment of the male nurse — who has never been publicly identified — and returned him to his base in New England. His boss ordered that a Board of Inquiry be formed to consider whether to discharge him from military service. . . [Full Text]

Navy Nurse Should Not be Punished for Declining to Force-Feed Guantánamo Detainees

PHR Welcomes American Nurses Association’s (ANA) Statement Supporting Nurses’ Professional Autonomy

Physicians for Human Rights

New York, NY – 11/19/2014

Physicians for Human Rights (PHR) today welcomed the American Nurses Association’s (ANA) statement supporting a nurse who refused to force-feed Guantánamo detainees based on his professional ethical obligations. PHR urged the U.S. Navy to end any disciplinary actions against the nurse, who has been charged with misconduct and faces potential discharge from the military.

“Nurses, like physicians, have professional duties to respect the autonomous decisions of their patients and never participate in ill-treatment or torture,” said Dr. Vincent Iacopino, PHR’s senior medical advisor. “This nurse has shown exemplary commitment to his profession’s ethics by refusing to comply with a military policy that has no clinical justification and is inherently harmful. The Navy should not punish him for refusing to compromise established ethical principles.”

Today’s statement represents the first time the ANA has spoken publicly about force-feeding at Guantánamo, signaling the wider nursing community’s interest in the nurse’s situation and the military’s treatment of medical professionals. The ANA also released communications it had with top defense officials urging them not to punish the nurse for exercising his professional rights and duties. PHR emphasized that the codes of conduct for nurses and physicians mandate respect for patient autonomy and the principle of doing no harm, and that military clinicians are legally and ethically bound to comply.

The Navy is considering holding an administrative trial that could lead to the nurse’s discharge from the Navy, in which he has served for 18 years. His decision not to participate in force-feeding was revealed through Abu Wa’el Dhiab, a Guantánamo detainee challenging his force-feeding in federal court. Dhiab’s case has shed light on the cruel and unnecessary methods used at Guantánamo, including the use of five-point restraint chairs and forced cell extractions.

“All physicians and nurses share a duty to put their patients first and act in their best interests, no matter the circumstances,” said Widney Brown, PHR’s director of programs. “Punishing this nurse for upholding the humane treatment of his patients sends a message that medical professionalism is not respected at Guantánamo.”

The World Medical Association and the American Medical Association are among the leading medical groups that prohibit force-feeding of competent adults. PHR said that health professionals should never take part, and pointed out that the main purpose of the Department of Defense’s force-feeding policy is to keep detainees from protesting over a decade of indefinite detention without charge. In response to criticism of these practices, the U.S. government has applied secrecy rules to any information regarding its treatment of hunger strikers.

PHR calls on the U.S. government to:

  • Immediately end the practice of force-feeding hunger strikers and institute policies and procedures consistent with the World Medical Association’s Declaration of Tokyo and Declaration of Malta on Hunger Strikers;
  • Ensure that no health professionals are compelled to participate in force-feeding, and that those who refuse do not face disciplinary or retaliatory actions for complying with their professional obligations; and
  • Commit to full transparency around hunger strikes at Guantánamo and medical management policies and protocols, including the release of Dhiab’s force-feeding videotapes.

Physicians for Human Rights (PHR) is a New York-based advocacy organization that uses science and medicine to stop mass atrocities and severe human rights violations. Learn more here.

Media Contact:

Vesna Jaksic Lowe, MS
Deputy Director of Communications, New York
vjaksiclowe [at] phrusa [dot] org

American Nurses’ Association supports conscientious objection by U.S. Navy nurse

ANA Statement on the Rights of Navy Nurse to Refuse to Participate in the Force-feeding of Detainees at Guantanamo Bay

Statement attributable to ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN:

ANA has been actively monitoring the force-feeding of detainees at Guantanamo Bay for more than two years, and we support the registered nurses in the military who have to make very difficult decisions related to either moving forward with or questioning any activity within a plan of care.

Professional registered nurses operate under a Code of Ethics that emphasizes the right to make independent, ethical judgments regardless of the setting in which nursing care is provided—even if this causes a nurse to experience conflict arising from competing loyalties.

The rights of registered nurses to honor their professional ethical obligations regarding force-feeding and other sensitive issues are absolutely protected and should be exercised without fear of retaliation.

We urge military leaders and health providers to uphold the ethical code of conduct to which all professional registered nurses are accountable and to be receptive to concerns raised by nurses or any other health care professional who is compelled, by an ethical commitment, to question any activity within the plan of care.

We do not believe this nurse should have to show cause for remaining in the Navy.

Navy nurse faces expulsion after refusing to force feed Gitmo detainees

RT Question More

A Navy nurse who refused to force feed hunger-striking Guantanamo detainees over the summer, once threatened with court-martial, could now lose his career.

The nurse, a Navy lieutenant who has never been publicly identified, refused to force feed hunger strikers shortly before July 4 at Cuba’s Guantanamo Bay prison complex. The decision reportedly followed months of him carrying out the painful procedure.

A Navy commander on Monday said he asked the board to determine whether the nurse should be allowed to stay in the US Navy.

“I can tell you right now that, after reviewing the investigation that was conducted in Guantánamo, I recommended that the officer be required to show cause for retention in the Navy. I chose not to do the court-martial route,” the nurse’s commander, Navy Capt. Maureen Pennington, told the Miami Herald. . . [Full Text]

Navy nurse refuses to force-feed Guantánamo captive

Detainee’s lawyer says her client described the Navy medical officer’s refusal as an act of conscientious objection.

Miami Herald

Carol Rosenberg

In the first known rebellion against Guantánamo’s force-feeding policy, a Navy medical officer recently refused to continue managing tube-feedings of prison hunger strikers and was reassigned to “alternative duties.”

A prison camp spokesman, Navy Capt. Tom Gresback, would not provide precise details but said Monday night that the episode had “no impact to medical support operations at the base.”

“There was a recent instance of a medical provider not willing to carry out the enteral feeding of a detainee,” he said in an email. “The matter is in the hands of the individual’s leadership.”

Word of the refusal reached the outside world last week in a call from prisoner Abu Wael Dhiab to attorney Cori Crider of the London-based legal defense group Reprieve. Dhiab, a hunger striker, described how a nurse in the Navy medical corps abruptly refused to “force-feed us” sometime before the Fourth of July — and disappeared from detention center duty. . . [Full Text]

One Conscientious Objector at Gitmo Is Great – But It’s Not Enough

Vice News

Natasha Lennard

The international medical community has long maintained an ethical line against force-feeding. As infectious disease specialist Kent Sepkowitz has written, “Without question, it is the most painful procedure doctors routinely inflict on conscious patients… The procedure is, in a word, barbaric.”

Yet in Guantanamo Bay, it is daily procedure for a reported 18 hunger striking detainees. Every day medical professionals watch strapped-down inmates gasp, gag, and choke with streaming eyes as rubber tubes are snaked through sensitive nasal passages into empty stomachs. Despite urging from institutions including the American Medical Association and the New England Journal of Medicine, Gitmo prison medical staff continue to participate, all of them just following orders. All but one. [Full text]

Physicians for Human Rights Criticizes Court Decision to Allow Force-Feeding

News Release

Physicians for Human Rights

New York, NY – 02/11/2014 A federal court today declined to stop force-feeding of Guantánamo detainees, allowing the inhuman and degrading practice to continue.

The U.S. Court of Appeals for the District of Columbia Circuit declined to issue a preliminary injunction to halt force-feeding, a type of intervention that violates core medical ethics and constitutes ill-treatment.

“The rights of men being held in Guantánamo are being completely ignored, and the hunger strike is the only option they have left to protest their indefinite detention, which has lasted more than 11 years without charges for some of them,” said Dr. Vincent Iacopino, PHR’s senior medical advisor. “By allowing the cruel and degrading practice of force-feeding to continue, the court has essentially authorized the continuation of an abusive tactic that violates human rights and fundamental medical ethics.”

The detainees being forced-fed are being held in indefinite detention, which is in itself a violation of human rights. A preliminary injunction would have at least stopped force-feeding, which constitutes ill-treatment and could rise to the level of torture. A call for injunctive relief for ill-treatment or torture should be granted under both international standards and the 8th Amendment, which prohibits cruel and unusual punishment.

While the court did not immediately stop force-feeding by issuing an injunction, two of the three judges said the detainees did have a right to challenge the practice in court, paving the way for a continuing legal battle over the issue. The judges also pointed that that “force-feeding is a painful and invasive process that raises serious ethical concerns.” The legal challenge was filed on behalf of three detainees.

Health professionals participated in cruelty and torture

Medical, Military, and Ethics Experts Say Health Professionals Designed and Participated in Cruel, Inhumane, and Degrading Treatment and Torture of Detainees

New York, NY — An independent panel of military, ethics, medical, public health, and legal experts today charged that U.S. military and intelligence agencies directed doctors and psychologists working in U.S. military detention centers to violate standard ethical principles and medical standards to avoid infliction of harm. The Task Force on Preserving Medical Professionalism in National Security Detention Centers (see attached) concludes that since September 11, 2001, the Department of Defense (DoD) and CIA improperly demanded that U.S. military and intelligence agency health professionals collaborate in intelligence gathering and security practices in a way that inflicted severe harm on detainees in U.S. custody.

These practices included “designing, participating in, and enabling torture and cruel, inhumane and degrading treatment” of detainees, according to the report. Although the DoD has taken steps to address some of these practices in recent years, including instituting a committee to review medical ethics concerns at Guantanamo Bay Prison, the Task Force says the changed roles for health professionals and anemic ethical standards adopted within the military remain in place. [Full report]