Opponents of torture have spent the past seven years advocating for a halt to the brutal excesses of the "War on Terror" from the Bush administration's rejection of the Geneva Conventions for detainees in Afghanistan to the waterboarding of prisoners at Guantanamo Bay. Ironically, as progress is finally being made in the international struggle against torture, the state of Connecticut has chosen this moment to launch a radical, pro-torture initiative of its own. In the case of Coleman v. Lantz, now awaiting a ruling by Superior Court Judge James T. Graham, the state's Department of Corrections has argued for the right to force feed a hunger-striking inmate in an excruciatingly painful manner -- although doing so has been condemned by the American Medical Association, the World Medical Association and the nation's leading medical ethicists.
The inmate at the center of the controversy is William B. Coleman, a British citizen convicted of sexually assaulting his wife in 2002 at a trial that has generated considerable controversy. He is currently serving an eight-year sentence at the Osborn Prison in Somers and is eligible for release in 2012. Coleman's guilt or innocence has been debated extensively elsewhere -- and, while the complex case raises many challenging questions regarding criminal justice, the factual dispute that led to his conviction is best left to the legal appeals process. From the prospective of a torture opponent, what matters is that on September 16, 2007, the man stopped eating solid foods. As a result, his weight dropped from 250 to 128 pounds.
Coleman's stated purpose in starving himself was to draw attention to perceived injustices within Connecticut's legal system. He was neither suicidal nor mentally ill -- and, even today, retains his full mental capabilities. On September 16, 2008, he raised the stakes of his protest by refusing liquids. Shortly afterward, the prison's medical director, Dr. Edward Blanchette, had Coleman strapped down and -- without sedation -- tried to force a feeding tube through his nose into his stomach. This first attempt failed. "Success" only came after the inmate was screaming in agony and sneezing up blood. Eventually, Coleman succumbed to this torture and agreed to ingest liquids once again. He is now fighting in court for the right to resume his hunger campaign.
One of the nation's preeminent bioethics scholars, Arthur Caplan of the University of Pennsylvania, testified on Coleman's behalf that the feeding of competent prisoners against their will -- even to save their lives -- violates the most basic tenets of the medical profession. Rational, competent adults have a fundamental right to reject medical care. Force-feeding prisoners is no different than forcibly transfusing Jehovah's Witnesses or providing unwanted chemotherapy to terminally-ill cancer patients. The World Medical Association's 1975 Declaration of Tokyo strictly prohibits physicians from engaging in such practices, which it describes as "contrary to the laws of humanity." The AMA has fully embraced this document. When the United States began force-feeding prisoners at Guantanamo Bay, two hundred fifty prominent physicians signed an open letter to a leading British journal, The Lancet, called for sanctions against the medical professionals involved in these nonconsensual interventions.
Among the reasons for this outcry is that forcible feeding through a naso-gastric tube ranks alongside the most unpleasant and downright horrific experiences that one human being can inflict upon another. The British journalist Djuna Barnes volunteered to be "forcibly" fed for a muckraking exposé in The World Magazine (1914) and later wrote that "it is utterly impossible to describe the anguish of it." Others have compared it to being orally sodomized while paralyzed. Having placed such tubes into the noses of willing patients myself, in order to save their lives, I can assure you that driving one down the throat of an unwilling subject must be unspeakably ghastly.
Another reason that physicians and bioethicists so strongly oppose forcible feeding is that this procedure is intimately tied to the ugliest passages in the history of modern medicine and associated with the worst political and social abuses of the calling. Great Britain inadvertently turned public opinion in favor of women's suffrage by force-feeding hunger-striking suffragists before World War I. Britain used the same tactic, with no more success, against Irish Republicans -- a practice that led to the gruesome death of Tom Ashe at Dublin's Mountjoy Jail in 1917. Finland adopted such tactics to suppress Communists in the 1930s; Turkey allegedly force-fed leftist prisoners as recently as 2001. Most notoriously, the Soviet Union pumped food into the stomachs of prominent dissidents, including Vladimir Bukovsky and Andrei Sakharov, to prevent the negative publicity that might have stemmed from their starvation. In Bukovysky's description of his torment, among the most haunting of all descriptions of human torture, he wrote, "I would have screamed if I could, but I could not with the pipe in my throat. I could breathe neither in nor out....I wheezed like a drowning man -- my lungs felt ready to burst." That is the species of "medical care" that Connecticut now seeks to defend.
The outcome of Coleman's lawsuit, however, should not be the final word on whether or not he may be forcibly fed. Even if the state court finds that he has no Constitutional right to refuse such feedings, this does not mean that his physicians may ethically conduct them. While the Tokyo Declaration has no force of law -- an argument advanced by the state -- its tenets do impose ethical duties upon doctors. The physicians who seek to force-feed William Coleman -- most notably, Blanchette and Suzanne Ducate, the state prison system's chief psychiatrist -- are not operating in a gray zone where medical opinion has yet to reach a meaningful consensus. Instead, they have gone rogue and are flagrantly violating the ethical norms embraced by their profession and their peers (and allegedly being handsomely compensated for doing so). The medical community has an ethical obligation to respond -- by canceling the membership of these physicians in professional organizations, by steering patients away from their offices, and by revoking their licenses, if necessary. Of course, I am hopeful that such drastic steps are not needed. The threat of such action should be more than enough to deter medical professionals from engaging in such blatantly unethical conduct.
Ordinary citizens also have the power to stop this indecency. I certainly would not want to receive my medical or psychiatric care from a doctor, no matter how otherwise competent, who earned extra cash forcing unwanted and invasive medical procedures upon helpless prisoners. If prospective patients refuse the services of doctors like Edward Blanchette and Suzanne Ducate, doing so will send a powerful message that our society does not tolerate torture. While the medical providers who have mistreated inmates at Guantanamo deserve to be pruned from the profession, many of their identities and specific roles remain concealed. In contrast, we do know the names of the doctors who are tormenting prisoners in Connecticut. However Justice Graham rules in Coleman v. Lantz, physicians and patients have an affirmative moral duty to make clear to these rogue doctors that their conduct in this matter is shameful. As barbaric as is the torturing of prisoners, the torture is even more ethically egregious -- if that is even possible -- when the abuse is rationalized under the guise of providing medical care.