Saturday, March 11, 2006

Gitmo's Gastric Grief

To eat or not to eat, that is the question. Should the prisoners of Guantanamo be allowed to commit self-starvation in the form of hunger strikes to protest their situation or should they be force fed through the use of a common medical practice called "tube feedings" in laymans terms?

Some 260 doctors from 7 countries think that these prisoners should be allowed to starve themselves regardless of the ethical stance that doctors share, which is to preserve life. These doctors feel that due to the circumstances involved with achieving the medical procedure, forced feedings are in direct violation of self-will or the right to make ones own medical decisions. They also feel that because the prisoners are determined to fight those medics at Gitmo (that are trying to preserve their lives) the means used to restrain the prisoners to accomplish the feedings may border on torture.

Torture. That is a huge accusation to be made when it comes to performing a life sustaining procedure. It could well be said that "torture" is then committed countless times by hospitals around the world on a daily basis. Why do I say this? Because of the typical circumstances involving the procedure. Many times a patient will not be lucid enough (i.e. in a state of mind that is disoriented) to make a decision to have such a procedure performed. In most cases the tube is inserted while the patient is awake (even if they are confused). In most cases regardless of how oriented (i.e. lucid) the person is they will fight during the insertion of the tube. Why? Because it is not a "normal" thing for a body to experience and the tube passing through the back of the throat will trigger gag reflexes (the body's natural way of stopping an unnatural or possible life threatening phenomena such as swallowing an object that could induce air-way blockage or vomiting) to compensate. During that time people will automatically try to pull away from the tube however they can manage it by either turning their head or actually grasping at it with their hands. This is a NORMAL reaction. It isn't torture (although it may feel like it at the time to the recipient). Anticipation of the need to restrain the patient during insertion is expected by the medical staff in nearly every case. Heads or hands may be held by staff members to minimize the discomfort felt during insertion because the more the procedure is fought/resisted the higher the likelihood that trauma will occur to the nasal or oral-gastric path which will increase the amount of discomfort.

As a nurse I have performed or have assisted with this procedure countless times over the years. It is the first line of defense medically for a doctor to take when the stomach contents need to be suctioned out or nutrition needs to be given in the case of an individual with swallowing related problems.

(pictured to left - Salem Sump) Two common types of tubes can be placed, either a Salem sump (which is a larger semi-rigid plastic tube) or a Dobhoff (which is smaller bore and more flexible). The Salem is less expensive than the Dobhoff (which contains a small metal guide wire to stiffen it up enough to pass through the sphincter at the bottom of the esophagus into the stomach and is always followed up by an x-ray to ensure proper placement - this guide wire is removed from the tube after placement is verified). The Salem is easier to check for immediate correct placement by the medical staff, by simply attaching an air filled syringe to the end of it and while listening with a stethoscope in the stomach region the air is pushed quickly from the syringe into the stomach causing a "whoosing" sound to be heard. Additionally, the plunger of the syringe is then pulled back on which causes suction in the stomach and the contents of the stomach are then pulled back through the tube to be easily identified visually by the medical staff.

After insertion of the tube, the tube is then taped to the nose or mouth to hold it's place in the stomach. This is done to avoid the tube slipping to a higher location in the nasal or oral-gastric path, which could create another medical problem such as aspiration (where the feeding goes into the lungs in the case of using the tube for feeding). The lady pictured here has had a Dobhoff placed, which has been taped to her nose to hold it's position. In this particular case, there is a 99% chance that this was done without anesthesia and some form of restraint was used to insert the Dobhoff on this woman. (Granny doesn't look tortured, does she?).

This whole Gitmo mess is exactly that, a mess. Probably things could be handled differently by the medical staff there. In other words, they could videotape the prisoners refusing medical treatment. This would create a binding legal agreement, that would be beyond litigation or question. Should they be allowed to die? Yes, if they are deemed competent to make such a decision and are foolish enough to think that such an action would actually help anyone, including themselves.

(BTW - for those foolish individuals who have never experienced a medical problem in their lives that truly believe this is torture, let me remind you that your day will come and you will find that unfortunately in medicine the cure oftentimes creates more discomfort than the medical condition.)

This post was regurgitated at Stop the ACLU

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posted by Is It Just Me? at 8:02 AM