Force-feeding is the practice of feeding a person or an animal against their will. The term "gavage" refers to the supplying a nutritional substance by means of a small plastic tube passed through the nose or mouth into the stomach.
Force-feeding of humans
Force-feeding is the administration of tube feeding against a person's will.
Tube feeding can be given through different types of tubes. One type of tube can be placed through the nose into the stomach or bowel. This tube is called a nasogastric or nasoenteral feeding tube. Sometimes the tube is placed directly through the skin into the stomach or bowel.
Force-feeding is the practice of feeding someone against their consent, and, with several exceptions, is generally not an acceptable practice in the medical community.
Nutrition support therapy should only be administered when medically necessary, such as with gastric obstruction, swallowing disorders etc., and only to be administered with a patient's full consent. Some of the many reasons a person may refuse to eat are hunger strike, mental illness, eating disorders, phobias such as sitophobia (aversion to food) or phagophobia (fear of swallowing), and Alzheimer's/dementia. Despite the fact that it may be necessary for the person to eat, medical professionals should not administer feeding without consent from the patient.
This technique is often used in premature babies as their sole source of nutrients.
While forcible feeding procedures are invasive, and may be perceived as a threat to individual autonomy, the principle of supported autonomy suggests that in certain specialized circumstances, it may be in the best interests of persons being forcibly fed in the short term to preserve their autonomy in the long-term. Other definitions of the autonomy imagine such persons as contained and self-sufficient beings whose rights to bodily integrity should not be compromised under any circumstances.
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On many occasions in the past prisoners have been force-fed by feeding tube when they went on hunger strike. It has been prohibited since 1975 by the Declaration of Tokyo of the World Medical Association, provided that the prisoner is "capable of forming an unimpaired and rational judgment".
"The unfortunate patients had their mouth clamped shut, had a rubber tube inserted into their mouth or nostril. They keep on pressing it down until it reaches your esophagus. A china funnel is attached to the other end of the tube and a cabbage-like mixture poured down the tube and through to the stomach. This was an unhealthy practice, as the food might have gone into their lungs and caused pneumonia."[broken citation]
In the United Kingdom, force-feeding was used against hunger-striking suffragettes, until the Cat and Mouse Act of 1913. Rubber tubes were inserted through the mouth (only occasionally through the nose) and into the stomach, and food poured down; the suffragettes were held down by force while the instruments were inserted into their bodies, an experience which has been likened to rape. In a smuggled letter, suffragette Sylvia Pankhurst described how the warders held her down and forced her mouth open with a steel gag. Her gums bled, and she vomited most of the liquid up afterwards.
Emmeline Pankhurst, founder of the Women's Social and Political Union in the UK, was horrified by the screams of women being force-fed in HM Prison Holloway during hunger strikes in which she participated. In her autobiography, she wrote: "Holloway became a place of horror and torment. Sickening scenes of violence took place almost every hour of the day, as the doctors went from cell to cell performing their hideous office. …I shall never while I live forget the suffering I experienced during the days when those cries were ringing in my ears." When prison officials tried to enter her cell, Pankhurst, in order to avoid being force-fed, raised a clay jug over her head and announced: "If any of you dares so much as to take one step inside this cell I shall defend myself."
The United Kingdom also used forcible feeding techniques against Irish Republicans during their struggle for independence. In 1917 Irish prisoner Thomas Ashe died as a result of complications from such a feeding while incarcerated at Dublin's Mountjoy Jail.
Under United States jurisdiction, force-feeding is frequently used in the U.S. military prison in Guantanamo Bay, prompting in March 2006 an open letter by 250 doctors in the The Lancet, warning that, in their opinion, the participation of any doctor is contrary to the rules of the World Medical Association. Retired Major General Paul E. Vallely visited Guantanamo and reported on the process of force-feeding:
They have to restrain the prisoners when they feed them because they attack the nurses. They spit in their faces. They're simply restrained for 20 minutes so they can be fed Ensure. They get their choice of four flavors of Ensure. It's put in a very unobtrusive feeding tube smaller than a normal straw and it's put in there for 20 minutes, so they get breakfast, lunch, and dinner.
On December 6, 2006, the UN War Crimes Tribunal at The Hague approved the use of force-feeding of Serbian politician Vojislav Šešelj. They decided it was not "torture, inhuman or degrading treatment if there is a medical necessity to do so...and if the manner in which the detainee is force-fed is not inhuman or degrading".
In the 2009 case Lantz v. Coleman, the Connecticut Superior Court authorized the state Department of Correction to force-feed a competent prisoner who had refused to eat voluntarily. In 2009, terrorist Richard Reid, known as the "shoe bomber," was force-fed while on a hunger strike at the United States Penitentiary, Florence ADX, the federal supermax prison in Colorado. Hundreds of force-feedings have been reported at ADX Florence.
Coercive and torturous use
Force-feeding by naso-gastric tube may be carried out in a manner that can be categorised as torture according to the Declaration of Tokyo, as it may be extremely painful and result in severe bleeding and spreading of various diseases via the exchanged blood and mucus, especially when conducted with dirty equipment on a prison population. Large feeding pipes are traditionally used on hunger striking prisoners whereas thin pipes are preferred in hospitals.
A brief, first-person account of a force-feeding session given by Vladimir Bukovsky describes the procedure in detail: "The feeding pipe was thick, thicker than my nostril, and would not go in. Blood came gushing out of my nose and tears down my cheeks, but they kept pushing until the cartilages cracked. I guess I would have screamed if I could, but I could not with the pipe in my throat. I could breathe neither in nor out at first; I wheezed like a drowning man — my lungs felt ready to burst. The doctor also seemed ready to burst into tears, but she kept shoving the pipe farther and farther down. Only when it reached my stomach could I resume breathing, carefully. Then she poured some slop through a funnel into the pipe that would choke me if it came back up. They held me down for another half-hour so that the liquid was absorbed by my stomach and could not be vomited back, and then began to pull the pipe out bit by bit."
Force-feeding of pernicious substances may be used as a form of torture and/or physical punishment. While in prison in northern Bosnia in 1996, some Serbian prisoners have described being forced to eat paper and soap.
Sometimes it has been alleged that prisoners are forced to eat foods forbidden by their religion. The Washington Post has reported that Muslim prisoners in Abu Ghraib prison under the U.S.-led coalition described in sworn statements having been forced to eat pork and drink alcohol, both of which are strictly forbidden in Islam. Other prisoners described being forced to eat from toilets.
Gavage for girls before marriage
In the past, force-feeding has also been a practice in the Middle East and in Mauritania where fatness was considered a marriage asset in women; culturally, voluptuous figures were perceived as indicators of wealth. In this tradition, some girls are forced by their mothers or grandmothers to overeat, often accompanied by physical punishment (e.g., pressing a finger between two pieces of wood) should the girl not eat. The intended result is a rapid onset of obesity, and the practice may start at a young age and continue for years. This is still the tradition in the rather undernourished Sahel country Mauritania (where it is called leblouh), where it induces major health risks in the female population; some younger men no longer insist on voluptuous brides, but traditional beauty norms remain part of the culture.
Force-feeding of animals
Force-feeding has been used to prepare animals for slaughter. In some cases, such as is the case with geese raised for foie gras, it is still practiced today.
Force-feeding is also known as gavage, from a French word meaning "to gorge". This term specifically refers to force-feeding of ducks or geese in order to fatten their livers in the production of foie gras. In modern Egypt, the practice of fattening geese and male Muscovy ducks by force-feeding[dubious ] them various grains is present, mostly by individuals, unrelated to foie gras production, but for general consumption of those birds later. It is not widespread on commercial farms however. The term used for such a practice is called "Tazgheet" تزغيط from the verb "Zaghghat" زغَط.
Force-feeding of birds is practiced mostly on geese or male Moulard ducks, a Muscovy/Pekin hybrid. Preparation for gavage usually begins 4–5 months before slaughter. For geese, after an initial free-range period and treatment to assist in esophagus dilation (eating grass, for example), the force-feeding commences. Gavage is performed 2–4 times a day for 2–5 weeks, depending on the size of the fowl, using a funnel attached to a slim metal or plastic feeding tube inserted into the bird's throat to deposit the food into the bird's crop (the storage area in the esophagus). A grain mash, usually maize mixed with fats and vitamin supplements, is the feed of choice. Waterfowl are suited to the tube method due to a non-existent gag reflex and an extremely flexible esophagus, unlike other fowl such as chickens. These migratory waterfowl are also said to be ideal for gavage because of their natural ability to gain large amounts of weight in short periods of time before cold seasons.
Shen Dzu is a similar practice of force-feeding pigs.
In scientific research
Gavage is used in some scientific studies such as those involving the rate of metabolism. It is practiced upon various laboratory animals, such as mice. Liquids such as medicines may be administered to the animals via a tube or syringe.
- Pankhurst, Emmeline (1911). The Suffragette. New York: Sturgis & Walton Company. p. 433.
- "A.S.P.E.N. What is Enteral Nutrition?". Nutritioncare.org. 2013-06-10. Retrieved 2013-06-25.
- "A.S.P.E.N. 2008 Statement on Ethics of Withholding and/or WIthdrawing Nutrition Support Therapy". Nutritioncare.org. 2013-06-10. Retrieved 2013-06-25.
- "Social Sciences - Consent and capacity in Ontario's civil mental health system". Socscience.com. Retrieved 2013-06-25.
- WMA - Policy[dead link]
- Purvis, June; Emmeline Pankhurst, London: Routledge, p 134, ISBN 0-415-23978-8
- Pugh, Martin; The Pankhursts, UK: Penguin Books, 2001, p 259, ISBN 0-14-029038-9
- Pankhurst, Emmeline (1914). My Own Story. London: Virago Limited (1979). pp. 251 & 252. ISBN 0-86068-057-6.
- Barbara Olshansky, Gitanjali Gutierrez (2005-09-08). "The Guantánamo Prisoner Hunger Strikes & Protests: February 2002 – August 2005". Center for Constitutional Rights. Archived from the original on 2010-01-21.
- Savage, Charlie (2005-12-30). "46 Guantanamo detainees join hunger strike". Boston Globe. Archived from the original on 2010-01-21. Retrieved 2007-09-17.
- "Gitmo Hunger Strikers' Numbers Grow". The New Standard. 2005-12-30. Archived from the original on 2010-01-21. Retrieved 2007-09-17.
- "Doctors attack U.S. over Guantanamo". BBC News. 2006-03-10. Archived from the original on 2010-01-21. Retrieved 2006-03-15.
The letter, in the medical journal The Lancet, said doctors who used restraints and force-feeding should be punished by their professional bodies.
- "A View from Inside Gitmo". FrontPage Magazine. May 5, 2006. Retrieved 2007-09-16.
- Traynor, Ian (December 7, 2006). "War crimes tribunal orders force-feeding of Serbian warlord". London: The Guardian. Retrieved 2007-09-16.
- Lantz v. Coleman, 978 A. 2d 164 (Conn. Super. Ct. 2009)
- Appel, Jacob M. Beyond Guantanamo: Torture Thrives in Connecticut November 17, 2009
- "'Shoe bomber' is on hunger strike". BBC News. June 11, 2009. Retrieved 2009-03-10.
- "Supermax: A Clean Version Of Hell". CBS News. October 14, 2007. Retrieved 2009-05-31.
- BBC News: "UN concern at Guantanamo feeding."
- Daily Kos: "The WaPo prints a torture story."
- Banks, Lynne Reid (30 March 1996). "Serb prisoners 'forced to eat soap' during months of beatings in solitary confinement". The Independent (London).
- "New Details of Prison Abuse Emerge". The Washington Post. 2004-05-21.
- "Women rethink a big size that is beautiful but brutal" Clare Soares 11 July 2006. Christian Science Monitor
- "Gavage in Mauritania" [Subalternate Reality]
- An obesity-associated gut microbiome with increased capacity for energy harvest : Abstract : Nature
- BBC 1 TV programme "Force-fed" November 2, 2005
- Works related to How It Feels to Be Forcibly Fed at Wikisource
- Voluntary and Voluntary Total Fasting and Refeeding, Detention Hospital, Guantanamo Bay, Cuba
- Manifesto for the abolition of force-feeding
- Bibliography on hunger strikes and force-feeding in the IFHHRO Right to Health Wiki