The Deadly Science Of Force-Feeding

Earlier this week, the Guardian published a video of rapper Yasiin Bey demonstrating a force-feeding procedure that Guantanamo Bay Prison inmates on hunger strike undergo. The video shows Bey, formerly known as Mos Def, gasping and writhing in pain as someone in scrubs attempts to insert a feeding tube up his nose. With more than 4 million YouTube views as of this writing, the video has become the latest symbol of the United States’s problematic treatment—some say torture—of Guantanamo prisoners. Setting aside, for a moment, the moral implications, let us consider the visceral ones: What can the procedure do to your health?

For starters, it can kill you, says Dr. Steven Miles a practicing physician and founder of the Doctors Who Torture accountability project.

A force-feeding procedure can kill you.Here’s how the procedure is supposed to work: You take something called a nasogastric feeding tube, and you insert it through the nose and drop it into the esophagus. That allows doctors to pump liquid nutrients directly into the stomach. But the human throat has two passageways, the esophagus, and the trachea, or upper airway. For a feeding tube to successfully drop into the esophagus, the epiglottis—a flap above the trachea–has to be covering the trachea. Otherwise, the tube will drop into the trachea and right into the patient’s lungs.

“That’s the point where [Bey] starts gasping and saying, ‘Stop, stop, stop.’ And that’s what happens when you get an uncooperative person,” Miles says.

Swallowing closes the epiglottis, so Miles typically instructs his patients to sip water while their feeding tubes are inserted. But in the Guardian video, “there’s nobody giving [Bey] sips of water through a straw, guiding the tube into his stomach. There’s nobody telling him to swallow now, swallow now, swallow now,” he says.

If a tube is indeed dropped into a patient’s lung and left undetected, the tube floods the lung with feeding solution and could cause the patient’s death. “There are a lot of potential complications, including pneumonia and respiratory failure,” Justin Sewell, an assistant clinical professor at the UCSF School of Medicine, says.

Such complications are rare. Nevertheless, at least three major medical associations consider force-feeding a violation of international medical ethics. Yet of the 166 detainees at Guantanamo Bay–106 of whom are on hunger strike to protest prison conditions–45 are currently being force-fed. Four of those detainees are protesting the continuation of the procedure into Ramadan.

There’s another way out of this.According to psychologist Steven Reisner, Ph.D., the health effects of force-feeding extend into the psychological sphere. “Here’s the thing about trauma,” Reisner says regarding force-feeding. “Physical violation is not what causes trauma. What causes trauma is the psychological violation on top of the physical violation, the absolute destruction of something somebody holds deep or meaningful.”

When prison officials force-feed an inmate, they silence his ability to communicate something he deems important. This could constitute the ‘absolute destruction’ to which Reisner’s referring, and could induce trauma.

Several counterarguments exist in support of force-feeding. At an April 30 press conference, Obama defended the military’s decision to continue the practice, saying, “I don’t want these individuals to die.”

But the notion that it’s an either-or situation is “simply not true,” Dr. Steven Miles says. “The prisoners have said, ‘look, if you change the conditions of our confinement, we’ll eat,'” he says. “So there’s another way out of this.”