Purpose of saving lives doesn’t lessen opposition by medical, rights groups
[Jerusalem] Mohammed Allaan is set to become the first hunger-striking Palestinian administrative detainee to be force-fed under a new bill enacted by the Israeli parliament (Knesset) last month. The contentious legislation, which generated a maelstrom of controversy and condemnation from rights groups and medical organizations as it made its way toward passage, is again evoking strong responses as its first application nears.
On Friday, the determination by the International Committee of the Red Cross that Allaan’s body was no longer absorbing drinking water after fasting for 50-days triggered plans by the Israel Prison Service to invoke the new law and subject Allaan, a lawyer and alleged member of the Gaza-based Islamic Jihad terrorist organization, to the procedure.
In advance of administering food forcibly, arguments that were heard during the Knesset debate are being heard again. Why, for instance, is a procedure ostensibly intended to save the prisoner’s life considered to be a bad thing; or how is a procedure little different from the normal intra-nasal feeding tube familiar to hospitals more dangerous in this context? Making it more confusing to the layman is the strength of the opposition expressed by both human rights and medical organizations.
During a forced feeding a prisoner is physically restrained, his head belted in place in order to prevent his movements from removing the tube through which he’ll be fed. Once immobilized, a tube is inserted through one nostril, down the throat, and into the stomach. Liquefied food is then pumped gently into the tube. While the procedure itself is the same as that used for feeding patients needing a nasal-feeding tube, the possibility – and arguably the probability – that the prisoner fights back, injury can be caused by the tube ripping an internal passageway or by food accidentally being fed into the lungs. The procedure is repeated two or three times each day until the prisoner ends the hunger strike.
“When discussed in the Knesset it is very clean language, but is actually a very dirty procedure to do,” Professor Avinoam Reches, former chairman of the Committee for Ethics and current chair of the Committee for Discipline at the Israeli Medical Association, told The Media Line. “You have to shackle him to his bed then force a tube into his stomach against his will. When someone is fighting against you, you can tear his esophagus or misplace the tube into his lungs.” Historically, people have died as a result of force feeding, Reches said.
Both the Israeli Medical Association and the non-governmental organization Physicians for Human Rights opposed passage of the “Prevention of Damage by Hunger Strikers” bill. Now that the bill is law and an increasing number of Palestinian prisoners have gone on hunger strikes in recent months, the issue is not going to abate.
Opponents of forced-feeding argue that the overwhelming majority of Palestinian prisoners who are conducting hunger strikes are being held under administrative detention which means they have never been charged or found guilty of a crime. Proponents argue that to allow a situation whereby a prisoner is expected to be released simply because he or she stops eating is a mockery of the justice system.
The Israeli Medical Association (IMA) has declared its opposition to the practice in order to fall in line with its parent organization, the World Medical Association, Reches, a neurologist at Jerusalem’s renowned Hadassah Hospital, explained. “Force feeding is a type of torture – you can physically hurt people,” Reches said, explaining that although the procedure was conducted in order to save a life it was physically invasive and was done so against the patient’s will. He adamantly insisted that this belief is not political, but an understanding shared by 90% of the IMA’s 20,000 physicians, many of whom are considered hawkish on security matters.
Asked to compare forced feeding to other procedures with less risk to the prisoner’s life, Reches argued that any advantage gained by drugging a patient so that they avoided injuring themselves during feeding was diminished by the damage continuous anesthetic would cause. “You cannot put a person to sleep every time you want them to eat,” he declared. The second alternative, injecting nutrients directly into the body, necessitates surgery to allow doctors access to vein within the body, as surface veins are not sufficient to feed a patient through. Such surgery would be against the patient’s will and was therefore “mutilation, (and a)… physical assault on the patient,” Reches stated.
Forced feeding, though, is not the primary concern of the new bill, Yoel Hadar, legal advisor to the Ministry of Public Security, told The Media Line. “Saving lives is.” According to Hadar, the bill allows doctors to conduct whatever medical treatment is necessary in order to save a prisoners life, with force feeding only being conducted in extreme circumstances. Hadar says a plethora of legal checks and balances have been put in place to ensure that the necessary level of oversight protects the prisoner from harm, even after a doctor has passed his written medical opinion that the prisoner’s life is in danger, Hadar said. Insisting that the state of Israel has a responsibility to protect people incarcerated within its jails, the legal advisor offered an analogy: “You can’t allow anybody to jump from a roof to commit suicide; by law we are obliged to keep them alive.”
The repercussions for the state of Israel if it were to fail in this regard warranted the treatments described in the new bill, Hadar argued, illustrating his point by recalling an incident where rioting by Palestinians was triggered by the death of a Palestinian prisoner from cancer. “If Israel could be blamed for the death of a man by cancer what would happen if a prisoner was allowed to starve to death during a hunger strike?” he challenged.
Like many others, Hadar confessed that he was bewildered by the motivation of the IMA to publically denounce the change in the law. “I really don’t understand – I can’t understand (it),” Hadar stated, pointing out that the new law in no way compelled doctors to act against their own moral beliefs.
A spokesperson for the Israeli Prison Service refused to comment to The Media Line about the issues raised in this article and said only, “We don’t treat prisoners by force.”
Judges and the courts, not a patient’s doctor, will hold the decision making power under the new laws and this is what has moved Physicians for Human Rights to condemn the bill, Amany Daiyf, the organization’s director for prisoners and detainees, told The Media Line. Under the bill, state security and public safety are brought into consideration alongside the prisoner’s health, when deciding whether or not to conduct a force feeding, Daiyf said. Such a scenario was likely to lead to decisions being made based on secret evidence that a prisoner and his lawyer were unable to see or dispute, Daiyf suggested.
It was likely that the new bill would lead to deaths, Daiyf arguing, as had been claimed in regard to a number of incidents during the 1970s and 1980s when Palestinian prisoners had allegedly been killed by food entering their lungs during forced feedings. Such practices stopped following the passage of the Patients’ Rights Act 1996 but could begin again since the Knesset passed the Prevention of Damage by Hunger Strikers bill, Daiyf said.
Force feeding is “torture and an immoral practice against prisoners” that has led to a number of deaths in the past, Issa Qaraqe, Palestinian Authority Minister for Prisoners, told The Media Line. Prisoners’ decisions and personal dignity should be preserved.