TIME health

Why Fat-Shaming by Doctors Really, Really Matters

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Between 210,000 and 440,000 people die every year as a result of preventable hospital mistakes. How many of those are casualties of weight bias?

xojane

This story originally appeared on xoJane.com.

Recently I ran across an article in the Boston Globe detailing a new survey on medical errors in Massachusetts. The findings were stunning: Nearly 25% of Massachusetts residents reported a medical mistake had occurred either to them or to someone they know, and of those, half said the oversight had serious repercussions to their health.

The study, along with other new research into medical mistakes and patient safety, was commissioned by the Betsy Lehman Center, an organization named for a Globe health reporter who died in 1994 when she was given an overdose of chemotherapy for her breast cancer — an overdose that was four times the correct amount.

Medical errors are no small matter in the US. A 2013 report shocked everyone when it revealed that between 210,000 and 440,000 people die every year as a result of preventable hospital mistakes. To put that in context, heart disease, the number one cause of death in the US, killed just shy of 600,000 people in 2010. Cancer, death-causer number two, killed 577,000 people the same year. Horrifically, the 2013 report places preventable medical mistakes as the third-biggest cause of death in the US.

It’s enough to make you not to want to go to a hospital, ever.

I talk a lot about fat-shaming in medical contexts. I’ve done so for years, and the single most common misapprehension I get from people is that fat-shaming by a doctor is merely a matter of personal discomfort. People assume that complaints about bad treatment by weight-biased doctors — doctors who often ignore symptoms or fail to run tests, or run tests that are unnecessary, or who knee-jerkily prescribe weight loss for everything from allergies to acne — are simply a matter of fat patients wanting their doctors to be nicer to them. “Doctors need to be able to tell you when you’re morbidly obese!” critics assert, as though that is even approaching the point.

In the first place, fat patients — or ANY patients — wanting their doctors to be nicer to them is entirely warranted. Doctors are not gods, and patients do not need to accept condescension, rudeness, or cruelty simply because the person dispensing it wears a white coat. I realize virtually every GP in the world is overworked and overstressed and trying to do way more than is reasonable for one person, and I have no doubt that eventually patients start to all run together, an endless parade of meatpuzzles with varying sets of symptoms, but that’s not an excuse. Doctors should consider how they communicate with their patients, and should make efforts to do so in ways that are at the very least respectful of basic human dignity. Even noncompliant patients — which I suspect is how many doctors see fat people — deserve to be treated with respect.

But besides all that, fat-shaming is not just an issue of feeling comfy and safe in the exam room. Fat-shaming can have life-threatening consequences when a doctor is making assumptions about a patient’s health and needs based exclusively on a visual appraisal and personal assumptions. This is not to say that a visual assessment isn’t useful as a part of an exam, but it’s just that — a PART of an exam, and insufficient for an accurate picture of an individual’s whole health.

While limited research has been done on this angle specifically, I think it’s reasonable to suggest that a doctor with unexamined weight bias is going to be at a far greater risk of making mistakes when diagnosing and treating fat patients.

And when people argue that doctors are entitled to weight bias, they are overlooking the very real danger that weight bias can and does lead to serious consequences for fat patients, when doctors assume that an ovarian tumor is just weight gain caused by overeating, or that asthma is just a patient being “out of shape,” or that fibromyalgia is just laziness.

If you don’t believe me, then check out the #DiagnosisFat hashtag on Twitter, which I inadvertently started when I had a little ramble on the subject and solicited people’s stories of medical misdiagnosis or delayed diagnosis owing to weight bias.

Even I’m a little stunned by the number of people responding, and the fact that so many of the stories have similar themes. The experiences being shared are by turns frustrating, enraging, and in some cases, downright brutal. While culturally we’re very eager to blame fat people for rising healthcare costs, we seem unwilling to consider that assigning that blame creates an environment in which many fat people are not being treated with the same level of care as thinner patients.

And I shouldn’t need to explain that when quality of care goes down, so does a patient’s health and prognosis. A fat patient whose cancer goes undetected for far longer as she struggles to follow her doctor’s advice to lose weight is going to require far more dramatic efforts than a patient who receives the correct diagnosis and treatment in the earlier stages of the disease. A fat patient whose doctor is praising sudden weight loss caused by a gastrointestinal disorder will suffer debilitating symptoms longer than a patient whose doctor doesn’t assume unexplained weight loss is always a positive thing. A fat patient whose Lupus is ignored for a decade because her doctor assumes her symptoms are weight-related will have permanent damage — damage that a patient whose doctor identifies the condition sooner will not.

Weight bias in medicine has dire repercussions for many, and so when a doctor makes a fat-shaming comment during an exam, while it may be a momentary source of distress, it’s also much larger than that — it’s a red flag. And in a medical environment where literal hundreds of thousands of people die every year as a result of preventable medical errors, it’s a red flag worth heeding. Your survival may depend on it.

Lesley Kinzel is Deputy Editor at xoJane.com.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Innovation

Five Best Ideas of the Day: December 8

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. A new crowdfunded software tool for reporting sexual assault can reduce stigma and protect survivors.

By Shafaq Hasan in Nonprofit Quarterly

2. Millions of discarded laptop batteries could light homes in the developing world.

By David Talbot in the MIT Technology Review

3. A long overdue transparency plan for clinical trials will finally open results to the medical community and the public.

By Julia Belluz in Vox

4. Without role models or a road map through the upper ranks, women are leaving the tech industry at the mid-career point in droves.

By Sue Gardner in the Los Angeles Times

5. A new plan to drop strips of prairie into cropland helps preserve soil and battle climate change.

By Dylan Roth in Iowa State Daily

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME India

Indian Doctor Arrested After Women Die Following Sterilization Surgery

Women, who underwent a sterilization surgery at a government mass sterilisation "camp", lie in hospital beds for treatment at CIMS hospital in Bilaspur
Women, who underwent a sterilization surgery at a government mass-sterilization "camp," lie in hospital beds for treatment at the Chhattisgarh Institute of Medical Sciences hospital in Bilaspur, in the eastern Indian state of Chhattisgarh, on Nov. 13, 2014 Anindito Mukherjee—Reuters

The surgeon blames pressure to meet targets and faulty medicine for the deaths

The doctor at the center of a tragedy in which at least a dozen women died following sterilization surgery in Bilaspur, India, was suspended from duties and arrested on Wednesday night.

R.K. Gupta, 59, operated on 83 women in five hours on Saturday, according to the BBC.

“It was not my fault, the administration pressured me to meet targets,” local news outlet NDTV quoted Gupta as saying. The doctor attributed the deaths to the medicines given to the women after the surgery.

In January, the Chhattisgarh state government gave him a commendation for performing a record number of sterilizations.

Meanwhile, another woman lost her life at a different sterilization camp in the same district and 20 others reported postsurgery complications, the Indian Express reports.

Authorities are still investigating the fatalities, which occurred during one of the many mass-sterilization drives organized to combat the country’s rapid population growth. The exact cause of death remains unclear, but so far the quality of medicines administered, as well as the infrastructure of the hospitals where the operations were conducted, has been identified as possible culprits.

“To me it’s not the surgeon’s fault, because if there was a problem with the surgeon’s actions there would have been bleeding and damage to the organs,” says Dr. Ashutosh Halder of the All India Institute of Medical Sciences (AIIMS) in Delhi.

Halder speculates that the complications were most likely caused by inadequate sterilization of the equipment used or an unfavorable hospital environment, although a team of four AIIMS doctors who visited the site told reporters they were “satisfied” with the arrangements there.

Sujatha Natarajan, president of the Family Planning Association of India, says that although precautions are necessary, doctors are not the sole bearers of responsibility. “Quality of service involves much larger stakeholders than that,” Natarajan tells TIME. “Putting all the responsibility on the doctor is putting a very high risk on the program itself,”

India sterilized over 4 million people last year, about 97% of whom were women. People in rural areas are offered financial incentives to undergo sterilization.

TIME Innovation

Five Best Ideas of the Day: November 4

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. Peer-to-peer sharing of experiences could transform health care.

By Susannah Fox in Iodine

2. A technological and analytical arms race is producing the best athletes in history. Can those advances be applied to education?

By James Surowiecki in the New Yorker

3. In South Bronx, startups are ‘onshoring’ technology jobs and trying to spark a revolution.

By Issie Lapowsky in Wired

4. ‘Sister City’ relationships foster cross-border collaboration and spur economic development.

By Nehemiah Rolle in Next City

5. Colleges and universities should focus on student success beyond graduation.

By Karen Gross and Ivan Figueroa at Inside Higher Ed

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

MONEY Health Care

The Simple Way to Get a Flu Shot for Free

Flu Shot sign in pharmacy
Terry Vine—Getty Images

Under Obamacare, most Americans will pay nothing for an influenza vaccine. And skipping the shot can be costly.

When you think of the flu, the cost of getting sick probably isn’t the first thing that jumps to mind. But coming down with the virus can prove pricey.

A visit to the doctor’s office can run $80 to $100—or more. If you need to head to the ER on a night or weekend for care, the tab can easily total $500. With the average health plan deductible rising, you could owe the whole bill, or at least a decent share. In extreme cases, if you land in the hospital the cost (before insurance) can be $2,000 a day. And the average stay for the flu is about four days.

As a parent, you also need to think about time away from work if your child gets sick. A 2012 study found that when children under the age of 5 came down with the flu parents missed an average of seven work hours if the child was treated in an outpatient setting, 19 hours if the child went to the ER, and 73 hours if the child was hospitalized.

The good news is that you probably don’t have to pay a penny for the best defense against the flu. Under Obamacare, a flu shot is free as long as you have health insurance (though plans that were in place before the law passed in 2010, known as grandfathered policies, are exempt). It’s one of the preventive services that insurers must fully cover without charging you a co-pay or co-insurance—even if you haven’t met your annual deductible yet. Under Medicare, you also pay nothing.

Still, even though the U.S. Centers for Disease Control recommends that everyone older than six months get the vaccine annually, many skip it. Vaccination rates top 70% for children ages six months to four years and are almost as high for those 65 and older, according to the National Foundation for Infectious Diseases. But 18-to-64-year-olds lag, with fewer than 40% rolling up their sleeves last year.

Where to go for the vaccine

Your vaccine should be free as long as you choose a provider that’s in your plan’s network. That could mean making an appointment with your doctor, or walking into your neighborhood drug store, urgent care clinic, or big-box retailer. Walgreens, CVS, Target, Walmart, and Kroger all dole out the vaccine, though make sure the branch near you offers the service (not all do). You can use this vaccine finder tool to look up providers near you.

Without insurance or outside your insurance network, you’ll probably pay the list price. At Walgreens, that’s $30 to $55, depending on the form of vaccine. Although a shot in the arm is the most common, you have options, including a nasal spray.

This week Sam’s Club announced it will match any competitor’s price at its in-store pharmacies. Other stores are running flu shot promotions to get you in the door, offering discounts on whatever else you buy on your visit. One caveat: Not every state allows stores to vaccinate children, so call ahead.

Your employer may also offer flu shots in its medical center or conference room, letting you get in and out in five minutes. Some schools provide free shots for students. (In a few states, including New Jersey and Connecticut, it is mandatory that children in licensed day care centers and preschools be vaccinated.) Many community health centers also offer the vaccine.

No matter where you go, don’t worry about missing out: The National Foundation for Infectious Diseases reports a “plentiful” supply this year. But don’t wait until the last minute. It takes about two weeks for the protection to kick in.

TIME Innovation

Five Best Ideas of the Day: September 26

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. Al-Shabaab is stronger a year after their horrific attack on a mall in Kenya, thriving on widespread resentment of Kenyan anti-Muslim policies which must be reformed.

By the International Crisis Group

2. The unnecessary separation of oral care from the rest of medical care under Medicaid puts the poor at risk of worse health and even death.

By Olga Khazan in the Atlantic

3. In these views from activists and intellectuals in Syria, we see rueful themes of a hijacked revolution and an intervention that may be coming too late.

By Danny Postel in Dissent

4. Adding a way to assess learning for students is the key to making education games work for schools.

By Lee Banville in Games and Learning

5. The toothless early warning system designed to head off future financial crises must be strengthened or it risks missing the next market cataclysm.

By the Editors of Bloomberg View

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Innovation

Five Best Ideas of the Day: September 8

1. To calculate the value of vaccines, we must imagine the economic cost of a world without them.

By Michael White in Pacific Standard

2. Apple may change everything again, this time by finally killing the credit card.

By Marcus Wohlsen in Wired

3. Local government – often heralded as the best kind of government – is actually America’s most broken and oppressive.

By Jonathan Chait in New York Magazine

4. “Instagram for doctors” can help solve medical mysteries.

By Sarah Kliff in Vox

5. A policy of realism, tempered with humanity, is good for people and nations.

By Walter Isaacson in Time

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Infectious Disease

Ebola Patient in U.S.: ‘I Am Growing Stronger Every Day’

Kent Brantly is one of two Americans being treated for the ebola virus

Kent Brantly, one of two Americans being treated for the deadly Ebola virus in Atlanta, said in a Friday statement that he is “growing stronger every day.” In the message, released by international relief agency Samaritan’s Purse, Brantly also thanked God for aiding his recovery.

Brantly’s words come six days after he arrived in the United States from Liberia, where he was working as a doctor in a post-residency program.

“I am writing this update from my isolation room at Emory University Hospital, where the doctors and nurses are providing the very best care possible,” Brantly’s statement reads. “I am growing stronger every day, and I thank God for His mercy as I have wrestled with this terrible disease.”

The Ebola virus has killed more than 900 people in West Africa. On Friday, the World Health Organization declared the outbreak an international health emergency.

For more about the Ebola outbreak, see TIME’s video above.

TIME Research

15 Diseases Doctors Often Get Wrong

Doctor looking at x-ray
Chris Ryan—Getty Images/OJO Images RF

When you experience strange pains, mysterious digestive issues, or other unexplained symptoms, you’d hope a trip to the doctor would solve your health woes. But sometimes, doctors have just as much trouble identifying certain disorders and conditions as their patients. “A lot of symptoms are nonspecific and variable, depending on the person,” says David Fleming, MD, president of the American College of Physicians and a professor of medicine at the University of Missouri. “On top of that, many diagnostic tests are expensive and aren’t done routinely, and even then they don’t always give us a black and white answer.” The following 5 conditions are notoriously difficult to pin down.

Health.com: 27 Mistakes Healthy People Make

Irritable bowel syndrome

Some conditions are difficult to diagnose because there is no real test to prove their existence; rather, they require a “diagnosis of elimination,” says Dr. Fleming, as doctors rule out all other possibilities. Irritable bowel syndrome (IBS)—a chronic condition that affects the large intestine and causes abdominal pain, cramping, bloating, diarrhea, and/or constipation—is one of these cases. According to diagnostic criteria, a patient should have symptoms for at least six months before first being seen for a formal evaluation, and discomfort should be present at least three days a month in the last three months before being diagnosed with IBS.

Celiac disease

So much confusion surrounds celiac disease—an immune reaction to gluten that triggers inflammation in the small intestine—that it takes the average patient six to 10 years to be properly diagnosed. Celiac sufferers would, in theory, have digestive problems when eating gluten-containing foods like wheat, barley, and rye, but in fact, only about half of people diagnosed with the disease have experienced diarrhea and weight loss. Celiac disease can also cause itchy skin, headaches, joint pain, and acid reflux or heartburn, and it’s all too easy to blame these symptoms on other things. A blood test can diagnose celiac disease no matter what symptoms are present, and an endoscopy can determine any damage that’s been done to the small intestine.

Health.com: 14 Reasons You’re Always Tired

Fibromyalgia

Fibromyalgia, which is characterized by widespread musculoskeletal pain, involves “medically unexplained symptoms”—a term doctors use to describe persistent complaints that don’t appear to have an obvious physical cause. When doctors can’t find a root cause for a patient’s chronic pain and fatigue, they often settle on this diagnosis. This may involve seeing specialists and ruling out other diseases, some of which prove equally difficult to diagnose, says Eugene Shapiro, MD, deputy director of the Investigative Medicine Program at Yale University. “There are studies that show that people with certain symptoms who show up at a rheumatologist will be diagnosed with fibromyalgia, but if the same patients show up at a gastroenterologist they’ll be diagnosed as having irritable bowel syndrome.”

Rheumatoid arthritis

Unexplained aches and pains may also be caused by rheumatoid arthritis (RA), an autoimmune disorder. Unlike osteoarthritis (the “wear and tear” kind that appears as people get older), RA causes inflammation and painful swelling of joints and can occur at any age. “Early stages of RA can mimic many other conditions—sometimes it’s just a sense of aches or stiffness in the joints, which could be caused by a lot of different things,” says Dr. Fleming. Blood tests can help detect the presence of inflammation in the body, he says, but an exact diagnosis of RA also must take into account a patient’s medical history and a doctor’s careful physical exam.

Multiple sclerosis

Another autoimmune disease, multiple sclerosis (MS) occurs when the immune system attacks the body’s own nerve cells and disrupts communication between the brain and the rest of the body. Some of the first symptoms of MS are often numbness, weakness, or tingling in one or more limbs, but that’s not always the case. “Multiple sclerosis can be episodic; the disease waxes and wanes,” says Dr. Shapiro. Depending on the number and location of lesions in the brain, he adds, signs and symptoms may be more or less severe in different people. Once a doctor does suspect MS, however, a spinal tap or MRI can help confirm the diagnosis.

Health.com: Could You Have MS? 16 Multiple Sclerosis Symptoms

Lyme disease

You probably know to look out for tick bites and the telltale bullseye rash that can form around them if a person is infected with Lyme disease. But not everyone develops this rash—and Lyme disease’s other symptoms (like fatigue, headaches, joint pain, and flu-like symptoms) can easily be confused for other conditions, says Dr. Shapiro.

A blood test can check for Lyme disease antibodies in the blood, but those usually don’t show up until a few weeks after infection and the test is notoriously unreliable. It’s important to remove the tick immediately and see a doctor right away. Quickly removing a tick can possibly prevent the transfer of dangerous bacteria, and antibiotics for Lyme disease are most effective when given immediately.

Lupus

The most distinctive sign of lupus—another chronic inflammatory disease—is a butterfly-shaped rash across a patient’s cheeks, but that’s not present in all cases. For those who don’t develop the rash, diagnosis can be a long and difficult process, says Dr. Shapiro. “Lupus can present in different ways; it can affect the joints, kidneys, brain, skin, and lungs, and can also mimic many different issues.” There is no one way to diagnose lupus, but blood and urine tests, along with a complete physical exam, are usually involved. Treatment also depends on a patient’s individual signs and symptoms, and medications and dosages may need to be adjusted as the disease flares and subsides.

Polycystic ovary syndrome

Irregular periods, unexplained weight gain, and difficulty getting pregnant can all be symptoms of polycystic ovary syndrome (PCOS), a hormonal disorder affecting women of reproductive age. Many women with this condition also have enlarged ovaries with numerous small cysts, but not everyone with PCOS has these enlarged ovaries, and not everyone with enlarged ovaries has PCOS. To be diagnosed with PCOS, a woman must also be experiencing infrequent or prolonged periods or have elevated levels of male hormones, called androgens, in her blood. Androgen excess may cause abnormal hair growth on the face and body, but women of certain ethnic backgrounds (like Northern European and Asian) may not show physical signs.

Appendicitis

You might think that an inflamed or burst appendix should be easy to identify, and often, it is: typical appendicitis symptoms include nausea, pain and tenderness around the belly button, and possibly a low-grade fever. But not always. “Some people have an appendix that points backward instead of forward in the body, so the symptoms present in a different location,” says Dr. Shapiro. “And sometimes people do have pain, but then the appendix ruptures and the pain is relieved so they think they’re fine.” In this case, he says, intestinal fluids can seep into the abdominal category and cause a potentially life-threatening infection—but it can take days or even weeks before these symptoms appear.

Endometriosis

Many perfectly healthy women deal with menstrual pain and discomfort, so it’s not surprising that endometriosis is often misdiagnosed. However, women with endometriosis (in which uterine tissue grows outside the uterus) often report pelvic pain, cramping, and heavy bleeding that’s far worse than usual, and that gets worse over time. A pelvic exam can sometimes detect endometrial tissue or cysts that have been caused by it. In other cases, an ultrasound or laparoscopy is required for a definite diagnosis.

Migraines

For many migraine sufferers, nothing could be more obvious than the severe headaches, which are usually characterized by intense throbbing or pulsing and can be accompanied by nausea, vomiting, or sensitivity to light and sound. But some people may get migraines without even knowing it, says Dr. Fleming.

“Sometimes migraine symptoms can be very severe, where the patient can even develop paralysis, and other times they can be very subtle,” he says. “Patients might feel dizzy or lightheaded or feel a vague discomfort in their heads, and oftentimes they’ll get treated with medication that might not be appropriate for a true migraine.” A neurologist should be able to rule out other possibilities, and make the proper diagnosis.

Cluster headaches

Another headache disorder that’s often misunderstood, cluster headaches are extremely painful but also very rare—affecting less than 1 million Americans. Cluster headaches tend to occur close together, often on the same day, and last 30 minutes to three hours, on average. Scientists aren’t sure why, but cluster headaches tend to occur when seasons change. Because of this, they can sometimes be misdiagnosed as allergy-related sinus headaches.

Hypothyroidism

Hypothyroidism (also known as underactive thyroid) is a condition in which the thyroid gland produces an insufficient amount of the hormones that help regulate weight, energy, and mood. In the early stages, thyroid problem symptoms are subtle and can include fatigue, weight gain, dry skin, muscle aches, and impaired memory. “It can mimic depression, fibromyalgia, and many other conditions,” says Dr. Shapiro. And because hypothyroidism is most common in people (especially women) over 60, it’s easy to attribute its symptoms to simply getting older and more out of shape.

Health.com: 19 Signs Your Thyroid Isn’t Working Right

Diabetes

Type 2 diabetes can’t stay hidden forever; if left untreated, it can cause life-threatening damage to the body’s major organs. Before signs of diabetes develop, says Dr. Fleming, adults can have diabetes for years without knowing it. “There are a lot of people out there with elevated blood sugar levels who aren’t getting to the doctor regularly, so they aren’t getting checked for it,” he says. “They won’t realize it until it gets severe enough that they start developing side effects, like problems with their vision or numbness in their feet or hands.” To avoid these problems, watch for earlier symptoms like increased thirst or hunger, frequent urination, sudden weight loss, and fatigue.

Inflammatory bowel disease

There are primarily two types of inflammatory bowel disease (IBD)—Crohn’s disease and ulcerative colitis. Both cause inflammation of the digestive tract, as well as pain, diarrhea, and possibly even malnutrition. Because there’s no one test for IBD, however, it is diagnosed primarily by excluding everything else. “If a patient comes in with severe abdominal pain, we might first think it’s their gallbladder,” says Dr. Shapiro. “If he comes in with loose stools, we might think it’s an infection. So we go through a litany of tests—imaging, blood tests, assessments—and sometimes we finally come down to the fact that we’ve ruled out every other possibility, so this is what we’re going to treat you for and we’ll see if it works.”

15 Diseases Doctors Often Get Wrong originally appeared on Health.com.

TIME Military

Navy Nurse Refuses Gitmo Force Feed Order

Guantanamo Hunger Strike
In this photo Nov. 20, 2013 file photo reviewed by the U.S. military, a U.S. Navy nurse stands next to a chair with restraints, used for force-feeding, and a tray displaying nutritional shakes, a tube for feeding through the nose, and lubricants, including a jar of olive oil, during a tour of the detainee hospital at Guantanamo Bay Naval Base in Cuba. Charles Dharapak—AP

A detainee described the act as a conscientious objection

A Navy medical officer at the U.S. military prison at Guantánamo Bay, Cuba has refused an order to continue force-feeding hunger-striking prisoners in what one detainee lawyer described as an act of conscientious objection.

“There was a recent instance of a medical provider not willing to carry-out the enteral feeding of a detainee. The matter is in the hands of the individual’s leadership,” a Pentagon spokesperson said in an email. “The service member has been temporarily assigned to alternate duties with no impact to medical support operations.”

It is the first known instance of a U.S. service member rebelling against the Pentagon’s force-feeding policy. An unknown number of the 149 detainees at Guantánamo’s Camp Delta have been on hunger strike for the past year and a half to protest their indefinite detention.

News of the refusal comes to the public by way of an attorney for one of the detainees, who, according to The Miami Herald, says his client described how some time before the Fourth of July a Navy medical nurse suddenly shifted course and refused to continue force-feeding prisoners. The nurse, he said, was abruptly removed from duty at the detention center. The attorney said his client described the nurse’s action as a conscientious objection.

The Herald reports that the prisoner who provided news of the incident described the nurse as a roughly 40-year-old Latino man most likely with the rank of lieutenant in the Navy.

Last year, civilian doctors writing for the New England Journal of Medicine declared that medical professionals taking part in force-feeding was unethical and called the Guantánamo medical staff to refuse to participate.

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