Executives from leading U.S. medical associations crafted more than a dozen recommendations Monday regarding doctors' treatment of detainees at Guantanamo Bay.
Conferees focused on the need for the U.S. to adopt the Declaration of Malta, a 1991 accord that protects hunger strikers from force-feeding and calls on doctors to respect the autonomy of the patient.
"Force-feeding is equivalent to torture," said Virginia Hood, a medical professor at the University of Vermont. "Even if it is not considered so in the United States, it should be."
Pentagon spokesman Lt. Col. Todd Breasseale defended the Department of Defense practice of feeding hunger strikers. He said the DoD believes "the preservation of life" supersedes a patient's right to decline treatment.
"Every time that challenge has been brought up, the courts have ruled in favor of the practitioners who have fed people who are trying to starve themselves to death," Breasseale said.
Though the Declaration of Malta would have to be taken up by Congress, the DoD could make some of the structural changes the association executives called for at the conference. The associations want more transparency and accountability of medical practice in Guantanamo, but they also believe the relationship between the military commander and the military physician should not require the doctor to put military goals ahead of patient needs.
"The commander should no more be able to tell a doctor how to practice medicine than he can tell a JAG [Judge Advocate General] officer how to practice law," said George Annas, an ethics and health law professor at Boston University involved in organizing the conference.
The associations considered such ideas as forming a medical ethics committee to review physicians' practices in the military and setting up a hotline for physicians to call if they are uncomfortable with orders and worry about risking their practicing license.
"We have to ask the question of why did [the physicians] not protest?" said Vivienne Nathanson, director of professional activities in the British Medical Association. "We have to make sure that they understand it is their role and duty to protest."
Access to information about military practice in Guantanamo hinders the associations' case for reform and their efforts to institute review boards for the physicians in the field. But they plan to move forward in implementing their recommendations, putting pressure on Congress and the Pentagon to shift military policy toward what the associations called an international consensus about the definition of medical ethics.
"All it takes for the continuation of evil is for us to do nothing," said Stephen Xenakis, retired brigadier general in the U.S. Army.