Judge orders Guantánamo Bay force-feeding videos to be released

Why through the nose?

And yes, having a tube run through your nose down into your stomach is going to freaking hurt.

I've placed a fair number of nasogastric tubes into patients during my medical student rotations and internship. The discomfort varies depending on the caliber and stiffness of the tube, and the calmness of the patient. In most patients, I wouldn't call it actually painful. There are small caliber, very soft and flexible tubes, which I assume the Guantanamo tubes are, that are capable of providing liquid nutrition such as Ensure (which is what they give the Guantanamo prisoners, if I read the link or wiki entry correctly.)

I never liked (actually, I dreaded) placing the larger caliber ones. I've never seen bleeding occur, but there can be a lot of gagging involved as it passes through the throat. Fortunately, that part is over quickly. (Sometimes the larger ones are necessary for medicine which can only be given in pill form.) I'm thankful that the nurses perform this procedure in our hospital, though I frequently deem them necessary in our stroke patients until they have the alertness and recovery of their swallowing mechanism to make eating by mouth safe. Once the tubes are in, patients who are cognitively fairly intact and not agitated tolerate them very well. Agitated or confused patients often try to pull them out, but patients don't look uncomfortable to me once the tubes are in properly.

The larger, stiffer ones shouldn't stay in for more than a week or two, due to fear of eroding the nasal cartilage. The small, soft ones can stay in longer.

CassandraW said:

Ipso facto irrational?

Does that mean anyone who is willing to die for something they believe in is ipso facto irrational? Or just those on hunger strikes?

Were the suffragettes on hunger strikes (see my second link) irrational? How about Gandhi?

If someone is obviously off his onion and believes he can absorb all the nutrition he needs from sunlight and air, I can see deeming him irrational and force-feeding him for his own good.

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It's my understanding that such a person (breatharian) only needs access to a food supply so they can "sneak" it and still claim to only be living off air and sunlight. But that's a separate topic...

But a person who knows perfectly well he will die and chooses to do so as a protest is making a rational choice IMO, though it might not be one most of us would make. (I dunno, though -- if I were locked up in an oubliette at Gitmo, I might be inclined to hunger strike, too.)


ETA:

From the World Medical Association's Declaration of Tokyo (see my first link above for wikipedia entry):



In other words, if the prisoner understands he might die, he's not ipso facto irrational, in the view of the WMA.

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One could argue (narrowly) for medical necessity, that not eating leads to death, thus forced feeding is needed to save the life. It may take a Do Not Resuscitate order for a doctor not to do that.

Haggis said:

I'm not finding anything that confirms ng tube feeding to be painful, and I suspect the practice is fairly common in medical patients. Clearly it's degrading if not wanted, so it would fit the definition of torture in that regard. Any links regarding tube feeding being painful?

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Haggis said:

I'll check further. Thanks.

And, yeah, the human dignity angle is a no brainer.

eta: More checking. WTF are MPs doing inserting ng tubes or being involved in the process at all? It's a medical procedure. No wonder it sometimes causes problems.

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Gee, that sounds a lot like the executions attempted in recent years - done by non-medical personnel (because docs and nurses refuse to do it).

This sort of thing SHOULD be done by a qualified medical person. Just that it wasn't suggests less that it was done out of medical necessity and more that it was done as torture.

See the Wikipedia I link to below - doctors don'skip anesthesia when doing intubation ONLY when it's an outright emergency.

Moving on, I've come to think of torture as something done to either 1)get information otherwise not gettable (though we all know it's often bad information that's gotten), or 2)cause pain for the fun of it. I don't think the intent of tube feeding fits either category. The intent is clearly to keep the prisoner alive. But the whole human dignity thing--yeah. If this isn't torture, it borders on it.

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I think if that (what I bolded) is truly the intent, it should be done by someone medically qualified to do it. Otherwise it could be (among other things) practicing medicine without a license.

Monkey said:

Why through the nose?

And yes, having a tube run through your nose down into your stomach is going to freaking hurt.

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I wonder too. According to this, it's usually given with some sort of anesthesia, BECAUSE it hurts, whether through the nose or the mouth:
http://en.wikipedia.org/wiki/Tracheal_intubation

c.e.lawson said:

I've placed a fair number of nasogastric tubes into patients during my medical student rotations and internship. The discomfort varies depending on the caliber and stiffness of the tube, and the calmness of the patient. In most patients, I wouldn't call it actually painful. There are small caliber, very soft and flexible tubes, which I assume the Guantanamo tubes are, that are capable of providing liquid nutrition such as Ensure (which is what they give the Guantanamo prisoners, if I read the link or wiki entry correctly.)

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I think this is perhaps one of the biggest issues. In a medical setting, patients usually either consent to treatment directly or have it performed while they're unconscious. Though a lot of people may be scared, I think a lot of emphasis is generally put on trying to put the patient at ease and make the procedure as painless as possible.

Someone who isn't consenting and may be actively resisting is probably more likely to feel discomfort or pain, and more likely to suffer accidental injury during the procedure. And when the reason for the treatment is a protest, there's a greater risk of hostility and impure intentions from the people performing the "treatment." And that's what some of the allegations suggest.

I think a lot of otherwise humane medical procedures can become painful or torturous when they're performed in a context like this. And I don't think the torturous aspects can really be blamed on the prisoners' resistance--medical professionals in hospitals sometimes have to treat people who are in the middle of psychotic episodes or who don't understand what's going on, and who make the doctors' and nurses' jobs harder as a result. When my mom was in the hospital following a bleed in her brain, she was confused and they had to restrain her hands to keep her from pulling at important wires and IV lines. In situations like these, respecting the dignity of the patients and trying to make things comfortable for them is still extremely important.

c.e.lawson said:

I've placed a fair number of nasogastric tubes into patients during my medical student rotations and internship. The discomfort varies depending on the caliber and stiffness of the tube, and the calmness of the patient. In most patients, I wouldn't call it actually painful. There are small caliber, very soft and flexible tubes, which I assume the Guantanamo tubes are, that are capable of providing liquid nutrition such as Ensure (which is what they give the Guantanamo prisoners, if I read the link or wiki entry correctly.)

I never liked (actually, I dreaded) placing the larger caliber ones. I've never seen bleeding occur, but there can be a lot of gagging involved as it passes through the throat. Fortunately, that part is over quickly. (Sometimes the larger ones are necessary for medicine which can only be given in pill form.) I'm thankful that the nurses perform this procedure in our hospital, though I frequently deem them necessary in our stroke patients until they have the alertness and recovery of their swallowing mechanism to make eating by mouth safe. Once the tubes are in, patients who are cognitively fairly intact and not agitated tolerate them very well. Agitated or confused patients often try to pull them out, but patients don't look uncomfortable to me once the tubes are in properly.

The larger, stiffer ones shouldn't stay in for more than a week or two, due to fear of eroding the nasal cartilage. The small, soft ones can stay in longer.

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We've got a doctor in the house! Thanks for the info, c.e. I have a follow-up question.

I am sure it's often medically necessary to feed someone in this way, and when carefully done by qualified medical personnel to a willing (or at least not actively struggling) patient, I'm also sure that the discomfort can be minimized. Your description bears that out.

But what about if it's done by non-medical personnel to someone who is actively struggling against it? Also, looking at the materials above, it doesn't sound like they leave the tubes in -- they put them in and pull them out a couple times a day. It seems to me that it would almost have to hurt, under those circumstances. But I've never done it or seen it done or had it done to me. What do you think?

In the various links we have in the thread, they have some descriptions and a video, and based on those, it looks horrible.

I think DancingMaenid hit it pretty squarely on the head. There are things that can be done to minimize pain - we can put viscous Lidocaine on the tube, for instance - a topical anesthetic that also lubricates the tube. Or as I stated, can use a smaller, softer tube. But if the patient is struggling, then yes, there is a higher chance of injury/pain. And of course, any procedure is more uncomfortable and potentially painful if the patient is agitated, fearful, tense, struggling, etc.

And I have to admit, the thought of having to undergo that procedure 3 times a day is not appealing. My husband is also a doc, and I asked him his thoughts (brief since his San Francisco Giants are in extra innings). He said, "Well, you can't leave it in, because they'll pull it out and hang themselves with it." He also thought they should be able to refuse food. He said, "Starving oneself a slow process, and it's one they can change their minds and opt out of fifty times if they want to." But he was distracted by the game and hasn't thought this through fully yet.

I haven't completely formulated my thoughts on this yet. I hate the thought of people killing themselves, yet we do allow patients who require nutrition by feeding tubes to opt out if they are competent to make that decision. And we keep them as comfortable as possible while they go through the process. It's more allowing them to die by the natural progression of their illness than actively killing themselves, though. If a healthy person who is perfectly able to eat, refuses to eat, then that's a different thing.