We write regarding the forcefeeding and restraint of Guantanamo Bay detainees currently on hunger strike.1,2 The World Medical Association specifically prohibits forcefeeding in the Declarations of Tokyo and Malta, to which the American Medical Association is a signatory.

Fundamental to doctors' responsibilities in attending a hunger striker is the recognition that prisoners have a right to refuse treatment. The UK government has respected this right even under very difficult circumstances and allowed Irish hunger strikers to die. Physicians do not have to agree with the prisoner, but they must respect their informed decision. Those breaching such guidelines should be held to account by their professional bodies. John Edmondson (former commander of the hospital at Guantanamo) instigated this practice, and we have seen no evidence that procedures have changed under the current physician in charge, Ronald Sollock.3

Edmondson, in a signed affidavit, stated that “the involuntary feeding was authorized through a lawful order of a higher military authority.”4 This defence, which has previously been described as the Nuremberg defence,5 is not defensible in law. In a reply to an earlier draft of this letter, Edmondson said that he was not forcefeeding but “providing nutritional supplementation on a voluntary basis to detainees who wish to protest their confinement by not taking oral nourishment”.

Recently, it was confirmed that health-care staff are screened to ensure that they agree with the policy of forcefeeding before working in Guantanamo Bay.1 On his departure, Edmondson was awarded a medal for his “inspiring leadership and exemplary performance [which] significantly improved the quality of health care for residents of Guantanamo Bay” and “scored an unprecedented 100% on both the Hospital and the Home Health surveys.”3 The New York Times, however, reports that hunger striking detainees are strapped into restraint chairs in uncomfortably cold isolation cells to force them off their hunger strike.2

We urge the US government to ensure that detainees are assessed by independent physicians and that techniques such as forcefeeding and restraint chairs are abandoned forthwith in accordance with internationally agreed standards.

We declare that we have no conflict of interest.