By David Pittman, Washington Correspondent, MedPage Today CHICAGO -- More than 150 physicians and other healthcare professionals have published an open letter to President Obama asking him to allow independent physicians -- not military doctors -- to visit hunger strikers at Guantanamo Bay.
More than 100 detainees at the American military base in Cuba are believed to be starving themselves to protest their detention without a trial. Saying they don't trust military physicians, the detainees have requested independent doctors be allowed access to their medical records and granted entry to Guantanamo to treat them.
"We endorse their request, and are prepared to visit them under appropriate conditions, to assist in their recovery and release, and certify when we are confident it is medically safe for them to fly," stated the letter to Obama, which was published Tuesday in The Lancet. "We have the deepest sympathy for the hunger strikers, the military doctors, and your predicaments. We offer our services to visit, examine and advise them, and to assist in any way that is acceptable to all parties."
The letter was signed by American and international healthcare providers.
Medical professionals -- including the American Medical Association -- have expressed concern in recent weeks that the detainees aren't receiving the standard of medical care by military physicians.
The British newspaper The Guardian published a letter late last month from 13 of the detainees to their military doctor. In it, they said their doctors in Cuba have force-fed them and treated them against their will.
"As you should know, I am competent to make my own decisions about medical treatment. When I try to refuse the treatments you offer; you force them upon me, sometimes violently," the detainees wrote. "For those reasons, you are in violation of the ethics of your profession, as the American Medical Association and World Medical Association have made clear."
Outgoing AMA President Jeremy Lazarus wrote to Defense Secretary Chuck Hagel in late April to say that force-feeding prisoners against their will violates tenets of medical ethics.
"Every competent patient has the right to refuse medical intervention, including life-sustaining interventions," Lazarus said. "The AMA has long endorsed the World Medical Association Declaration of Tokyo, which is unequivocal on the point: '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 AMA House of Delegates backed patients' right to refuse medical intervention in resolutions passed in 2005 and 2009.
Susan Dorr Goold, MD, incoming chair of the AMA's Council on Ethical and Judicial Affairs, noted that the issue becomes tricky in some situations, such as when detainees go on hunger strikes but then allow others to feed them. In this case, in which the detainees are just asking to allow independent doctors to visit them, "I personally think that's a very reasonable thing to do," Goold told MedPage Today at the AMA annual meeting.
AMA delegate and Air Force physician Paul Friedrichs, MD, said it was difficult for him to comment given he wasn't familiar with letter to Obama published in The Lancet.
That letter noted that since military physicians take orders from Obama -- the same man detaining them in Cuba -- it's natural for detainees not to trust military doctors.
"Without trust, safe and acceptable medical care of mentally competent patients is impossible," the letter in The Lancet stated. "Since the detainees do not trust their military doctors, they are unlikely to comply with current medical advice."
David Pittman
David Pittman is MedPage Today’s Washington Correspondent, following the intersection of policy and healthcare. He covers Congress, FDA, and other health agencies in Washington, as well as major healthcare events. David holds bachelors’ degrees in journalism and chemistry from the University of Georgia and previously worked at the Amarillo Globe-News in Texas, Chemical & Engineering News and most recently FDAnews.
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