Health

"Opponents of torture have spent the past seven years advocating for a halt to the brutal excesses of the "War on Terror" from the Bush administration's rejection of the Geneva Conventions for detainees in Afghanistan to the waterboarding of prisoners at Guantanamo Bay. Ironically, as progress is finally being made in the international struggle against torture, the state of Connecticut has chosen this moment to launch a radical, pro-torture initiative of its own. In the case of Coleman v. Lantz, now awaiting a ruling by Superior Court Judge James T. Graham, the state's Department of Corrections has argued for the right to force feed a hunger-striking inmate in an excruciatingly painful manner -- although doing so has been condemned by the American Medical Association, the World Medical Association and the nation's leading medical ethicists."

"Detaching the self. Five of the eight nursing assistants reported actively detaching themselves from the process when they were administering manual restraint for CNF. This was predominately described by female nursing assistants and was evidenced through the use of terms such as “zoning out”, “shutting off” and “taking my mind off”. Detaching the self appeared to be a conscious response used by participants to cope with the adverse psychological outcomes of manual restraint use: I sort of try to stay focused on what I’m doing during the whole process but sort of try to take my mind out of this as well so that I can cope with it because it’s a very stressful procedure so I’m trying to think of something more calming. (Participant 1) I get to a point when I just shut off and then I’m just staring into nowhere and just trying to remain in the restraint position because it’s just too much to take in. (Participant 8) For one nursing assistant, detaching the self was a “necessary” coping strategy that guarded against the adverse psychological outcomes that could result from paying attention to the young person’s distress during restraint. Failing to “zone out”, in this participants view, was self-destructive: It becomes quite emotionally damaging to pay attention too much to what the patients are screaming and shouting about in the feed so I prefer to kind of zone out, it’s my coping mechanism . . . it’s necessary to zone out and I kick myself if I don’t do it because it’s just self-destructive not to. (Participant 5)"

"Margaret Sanger opened the first birth control clinic in the U.S. on October 16, 1916 in the Brownsville section of Brooklyn, New York. Sanger, her sister Ethel Byrne, who was a registered nurse, and Fania Mindell, an interpreter from Chicago, rented a small store-front space in Brownsville and canvassed the area with flyers written in English, Yiddish and Italian advertising the services of a birth control clinic. Sanger modeled the Brownsville Clinic after the birth control clinics she had observed in Holland in 1915. For ten cents each woman received Sanger's pamphlet What Every Girl Should Know, a short lecture on the female reproductive system, and instructions on the use of various contraceptives. The Clinic served more than 100 women on the first day and some 400 until October 26 when an undercover police woman and vice-squad officers placed Sanger, Byrne and Mindell under arrest. After being arraigned, Sanger spent the night in jail and was released the next morning. She re-opened the Clinic on November 14, only to be arrested a second time and charged with maintaining a public nuisance. Sanger opened the Clinic once again on November 16, but police forced the landlord to evict Sanger and her staff, and the Clinic closed its doors a final time. Sanger, Byrne and Mindell went to trial in January of 1917. Byrne, tried first, was convicted and sentenced to 30 days in Blackwell's Island prison and immediately went on a hunger strike. After 185 hours without food or water, she was forcibly fed. Before Byrne's condition proved fatal, Sanger and supporters prompted New York's Governor Whitman to issue a pardon. Sanger's own trial began on January 29, and she too was convicted. However, the court offered her a suspended sentence if she promised not to repeat the offense. She refused and was offered a choice of a fine or jail sentence. She chose the latter and spent thirty days in the Queens County Penitentiary without incident."

"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."

"Talking with others. Six of the eight nursing assistants reported seeking out conversations with their colleagues and young persons who were further in their recovery, after they had been involved in a manual restraint for CNF. For some participants, this appeared to be a method of cheering up through humour: Sometimes you just need to get away and be lifted up by someone else. If you can bounce off of a staff member it’s pretty good...or go to some of the hyper kids, the kids that at the moment are really doing well, and if they’re all having banter with each other, you can sort of get brought into it and sometimes you just forget what’s just happened in the restraint. (Participant 5) For other participants conversing with their colleagues was a method of “venting out” after a particularly challenging restraint which had elicited feelings of frustration: You can vent out amongst each other as the people that have done the restraint. (Participant 3) Four nursing assistants reported seeking out trusted staff members to confide in. For the majority of these participants this was a method of expressing their feelings, especially in circumstances where they had partaken in a restraint that had upset them: . . . and then I spoke to a member of staff that I trusted in that situation and it turned out that the same thing had happened to her so it was nice to have that understanding, it made me feel much less alone. (Participant 7)"

"The purpose of this phenomenological study was to explore nursing assistants’ experiences of administering manual restraint for CNF of young persons with AN. The findings paint a physically and emotionally distressing picture of the participants’ experiences and provide valuable insight into the experience of applying manual restraint for CNF of patients with AN. It is clear from the analysis that administering manual restraint for CNF of young persons with AN was a distressing practice for nursing assistants. The practice elicited numerous unpleasant emotions including anxiety, guilt and anger, and a small number of participants described becoming emotionally sensitised to the practice over time. Although the majority of participants expressed becoming emotionally desensitised to the manual restraint procedure, their accounts were often contradictory, suggesting that they had not necessarily become desensitised to the practice. These findings are in line with that of previous studies of staff’s manual restraint experiences in both child and adolescent, and adult consumer settings, which have also highlighted the experience of distress and numerous unpleasant emotions as a result of administering manual restraint (e.g., Bigwood & Crowe, 2008; Bonner et al., 2002; Chapman et al., 2016; Lombart et al., 2019; Sequeira & Halstead, 2004; Steckley & Kendrick, 2008; Svendsen et al., 2017; Wilson et al., 2017). It is not surprising that the theme “Importance of coping” was extracted from the analysis, given the illustrated adverse physical and psychological staff consequences that could result from applying manual restraint for CNF of young persons. The majority of nursing assistants described consciously detaching themselves from manual restraint incidents as a means of coping with the distress it elicited. Detaching oneself appeared to serve a protective function for participants, somewhat safeguarding them against the experience of distressing emotions; this is in line with the findings of previous studies in both child and adolescent, and adult consumer settings which have highlighted how some staff “switch off” their feelings or “temporarily suspend” their ability to empathise with patients during manual restraint incidents (Lombart et al., 2019; Sequeira & Halstead, 2004). Talking with colleagues and young persons who were further in their recovery were also cited by nursing assistants as coping strategies. These strategies appeared to help nursing assistants regulate their emotions through humour (e.g., “banter”), and through cathartic processes (e.g., “venting out”). Staff participants from previous studies of manual restraint within adult mental health settings have similarly highlighted the importance of colleague support in coping with restraint use (Bigwood & Crowe, 2008; Bonner et al., 2002; Sequeira & Halstead, 2004). However, this finding has not been explicitly reflected in studies within child and adolescent settings (e.g., Lombart et al., 2019; Steckley & Kendrick, 2008; Svendsen et al., 2017)."

"A government lawyer said that Reid had refused 58 meals by 9 April and that prison officials decided "that medical intervention was necessary". The lawyer added that prison officials were monitoring his condition."

"Dec. 30, 2005 – At least 46 people held at the Guantánamo Bay, Cuba detention camp joined a disputed number of fellow detainees already refusing food in protest of their indefinite detention last week, the Department of Defense said in a statement yesterday. The announcement puts the official number of prisoners still fasting at 84. The Center for Constitutional Rights (CCR) and other humanitarian groups maintain that the real number of detainees refusing food could be much higher, a contention that is impossible to verify because the prison facility is closed to nearly all visitors. Two months after the hunger strike began, CCR and other detainee lawyers put the number who have been involved in the fast at over 200. But the military told The NewStandard that the number topped off at 131 and had dropped to about 26 in October. In a recent statement released by the Southern Command, the military said the number of participants fluctuated with the anniversary of the September 11 attacks and with the arrival of detainee lawyers, possibly accounting for the discrepancies between the two sides. "This technique [hunger striking] is consistent with Al-Qaeda training and reflects detainee attempts to elicit media attention and bring pressure on the United States government to release them," the statement added. The new hunger strikers refused food on Christmas day, according to the military, and joined a five-month fast kept up by detainees to draw attention to what they, human rights groups and their lawyers say are inhumane conditions outlawed by international accords and domestic law. The renewed strike comes amid accusations from the United Nations that long-term hunger striking detainees have been treated cruelly. According to UN torture investigator Manfred Nowak, prison guards and doctors involved in force-feeding some of the prisoners did so with particular zealousness, causing an unspecified number to bleed and vomit. Nowak was among the investigators who had previously turned down an invitation to visit the camp, citing access restrictions imposed by the US. Thirty-two hunger strikers have been hospitalized and force-fed through nasal tubes, a prison camp spokesperson told the Boston Globe. In late October, US District Judge Gladys Kessler ordered the Defense Department to notify the lawyers of prisoners it intends to force-feed before doing so."

"Physical exhaustion. All nursing assistants described the physical exhaustion they felt in relation to applying manual restraint for CNF, especially in circumstance where the young person was highly resistive. There were multiple manual restraints to perform per shift, and reports of sweating during restraints were not uncommon. At times, the manual restraint continued even after nasogastric feeding had been completed because the young person was either trying to self-harm or purge the liquid supplement they had just been given. This made the whole restraint even more tiring for participants: Once you’ve been in a restraint in a feed you just want to be done with it because it’s a physical thing, your body’s tired, you’re hot and sweaty, you’re covered in their sweat as well . . . and if someone continues it by trying to purge, it’s more tiring than anything else. (Participant 5) Despite the physical exhaustiveness of using manual restraint, all nursing assistants also reported that the restraint of some young persons involved minimal physical exertion because of their increased compliance and preference to be fed under restraint: I was restraining her arm and one of her legs, and it wasn’t very intense. The patient was going through this process for a very long time, so she was at that stage where she wanted this holding let’s say, but she wasn’t aggressive or very resistive. (Participant 1) Once you’ve been in a restraint in a feed you just want to be done with it because it’s a physical thing, your body’s tired, you’re hot and sweaty, you’re covered in their sweat as well . . . and if someone continues it by trying to purge, it’s more tiring than anything else. (Participant 5)"

"The American Medical Association and the Red Cross both condemn force-feeding as a form of torture. And yet, the U.S. government and the United Nations have both force-fed hunger-striking prisoners. The real problem? Most people probably don’t realize how complicated force-feeding is, and how much can go wrong."

"1914 New York World magazine article. Barnes wrote, "If I, play acting, felt my being burning with revolt at this brutal usurpation of my own functions, how they who actually suffered the ordeal in its acutest horror must have flamed at the violation of the sanctuaries of their spirits. I had shared the greatest experience of the bravest of my sex.""

"Patient aggression. All nursing assistants frequently reported being subjected to physical and/or verbal aggression by some young persons during manual restraint use. It appeared from their accounts that these young persons were using whatever means they could, to prevent or stop the restraint, in order to stop or avoid nasogastric feeding. Commonly cited verbal aggression included swearing and shouting. Commonly cited physical aggression included spitting, kicking, scratching, biting, punching and head-butting. Some participants reported being subjected to such physical aggression even when nasogastric feeding had been completed: We were starting to leave the restraint . . . I was doing the lower part of the legs and I was kind of tilted over and she actually head-butted me on the head . . . the feed’s finished but she still lashes out at staff. (Participant 4) Being on the receiving end of physical aggression elicited reciprocal urges of aggression for two nursing assistants. These urges were cited in the context of self-defence and the participants in question were clear that they did not reciprocate aggression in any form: One of the patients was trying to dig her nails in my skin and rip whatever I was wearing to protect my arms. . . I hate these moments particularly because I feel I want to hurt the child . . . at that moment you want to hurt them in order to protect yourself. (Participant 1)"

"In 2013, a mass hunger strike took place in Guantanamo Bay as a response to the indefinite detention and unjust treatment of prisoners captured during the ‘war on terror’. In response, the US used force-feeding against the hunger strikers, arguing it was needed to save their lives and uphold US security. Although the US argued its force-feeding policy was legal and humane, human rights and medical organisations criticised US force-feeding practices as constituting torture or cruel, inhuman or degrading treatment or punishment. This article argues that the US undermined international human rights norms, laws and medical ethics in its management of hunger striking prisoners by using force-feeding to suppress hunger strikers and achieve national security interests. In doing so, the Obama administration reignited accusations of US torture and harmed its ethical standing in international society. The article argues that the US needs to incorporate international human rights standards into its hunger striker policy to uphold the dignity of prisoners in detention and overcome its legacy of torture in the ‘war on terror’."

"Romanos has not been charged with terrorism. But two cases concerning terrorism acts are still pending — a fact that has kept Romanos from attending school. The only way he could think to claim his rights was to use his “body as a roadblock, for a breath of freedom,” as he stated at the start of his hunger strike. At N.Gennimatas general hospital, where Romanos was transferred after his health began to deteriorate, the atmosphere is tense. Hundreds of protesters are gathered outside. Inside, police officers are everywhere, trying to control the flow of information. The minister of justice is working on a proposal that would allow Romanos to take distance learning courses. But Romanos has rejected that idea, insisting he should be able to attend classes. With the help of the doctors in the hospital, Romanos is successfully resisting an order issued by a district attorney to force feed him. His lawyer confirmed last week that the order had been issued, adding that “This is obviously torture. It’s something never seen before in Greece.”"

"An Unpleasant Practice Administering manual restraint for CNF of young persons with AN was an unpleasant practice for all nursing assistants, and this was evidenced by the numerous reported adverse physical, psychological and interpersonal outcomes. Some felt that they did not receive enough support from the eating disorder organisation in managing these outcomes. Six subthemes are reported. Emotional distress. Despite recognising the necessity of CNF under manual restraint for young persons with AN who were refusing all foods and/or fluids, seven of the eight nursing assistants described the emotional distress they experienced as a result of administering manual restraint. Some described the practice as “traumatising” both for themselves and the young person; this was predominately attributed to the coercive nature of the practice and the young person’s distressing response to it, which typically included active resistance, aggression, screaming, coughing, complaints of discomfort, and occasional nasal bleeding from nasogastric tube insertion: It’s scary, it’s emotionally draining for both the patient and staff . . . there’s blood coming out [from the young person’s nose], the child is screaming down the place, so as much as you’re supporting the child, it becomes very difficult because it seems like you’re either attacking or physically punishing somebody. (Participant 2) Seven nursing assistants reported experiencing a range of unpleasant emotions as a result of applying manual restraint for CNF. Anxiety, guilt and anger were commonly cited emotions. Participants felt anger, often, in response to being hurt by the young person during restraint, and the young person’s lack of cooperation. Anxiety and guilt were commonly attributed to the unpredictability and coerciveness of manual restraint respectively: Before I go into a restraint, my heart starts pumping a bit more . . . I feel very anxious because we don’t know what could happen. (Participant 4)"

"Six weeks into his hunger strike, Israel's parliament passed a law permitting the force-feeding of prisoners in order to keep them alive. Allan might have become a test case for the law, but doctors made it clear they would not participate, calling it unethical medical treatment. "It's like rape," says Yoel Donshin, a retired anesthesiologist and a member of Physicians for Human Rights. "You will ask a physician to rape a patient for treatment? This is unacceptable." Donshin doesn't believe Israeli politicians who supported the law want to save the lives of prisoners. "They do not care for the welfare of the prisoners," he says. "They just want him not to become a symbol or martyr.""

"When federal prison officials at British Columbia’s Matsqui Psychiatric Centre routinely examined a Doukhobor woman on a hunger strike last week, they quickly realized that the frail 69-year-old was deteriorating. Doctors who saw Mary Astaforoff, a member of the radical Sons of Freedom sect, sent her by ambulance to Vancouver General Hospital about 90 km away. There, hospital staff force-fed Astaroroff for the second time since she again began refusing food in late September to protest against a three-year prison sentence for arson."

"A man jailed in the US for trying to blow up an airliner with explosives hidden in his shoes has gone on hunger strike, court papers have revealed. Briton Richard Reid is said to have been refusing food for several weeks and is being force-fed and hydrated."

"Within the UK, it is common for graduates of non-nursing degrees (e.g., psychology) who are wishing to pursue a career in mental health (e.g., clinical psychology) to first start out working as healthcare and nursing assistants in mental health settings to gain relevant clinical experience."

"Participants were recruited from a private 25-bed locked inpatient specialist child and adolescent eating disorder service in the UK which provides inpatient treatment to young persons aged 9-18 years with eating disorders. In addition to providing multidisciplinary input from a number of professionals including psychiatrists, paediatricians, psychologists, family therapists and dieticians, the eating disorder service, under the powers of the Mental Health Act 1983 (Department of Health, 2015), and occasionally parental consent, also provides CNF under manual restraint as an intervention to young persons with AN presenting with ongoing food and/or fluid refusal and subsequent non-compliance with nasogastric feeding. A standard CNF intervention under manual restraint within the eating disorder service could typically last between 10 and 30 minutes, and involve up to five nursing assistants restraining the young person in the seated position, and up to two registered mental health nurses inserting the nasogastric tube, checking the tube’s placement, and delivering subsequent dietary nutrition through the tube via syringe. As reported by participants, up to 12 CNF interventions under manual restraint could occur per shift within the eating disorder service. This was owing to the fact that some young persons had care plans in place for pre-planned CNF interventions under manual restraint to be implemented multiple times per day (e.g., at specific times during the mornings, afternoons and evenings) due to their global and ongoing refusal of all foods and fluids, and their non-compliance with nasogastric feeding. Chemical restraint was not routinely used within the eating disorder service, and there was a service policy in place for CNF interventions under manual restraint to be aborted and reattempted at a later time in circumstances where it was not possible to safely administer nasogastric feeding within 30 minutes of manual restraint holds being applied."

"Three themes were extracted from the analysis: An unpleasant practice, Importance of coping, and Becoming desensitised and sensitised. It is important to consider these themes in relation to the 5-36 month difference within the experience level of nursing assistants."

"Coleman's stated purpose in starving himself was to draw attention to perceived injustices within Connecticut's legal system. He was neither suicidal nor mentally ill -- and, even today, retains his full mental capabilities. On September 16, 2008, he raised the stakes of his protest by refusing liquids. Shortly afterward, the prison's medical director, Dr. Edward Blanchette, had Coleman strapped down and -- without sedation -- tried to force a feeding tube through his nose into his stomach. This first attempt failed. "Success" only came after the inmate was screaming in agony and sneezing up blood. Eventually, Coleman succumbed to this torture and agreed to ingest liquids once again. He is now fighting in court for the right to resume his hunger campaign."

"Physical injury. All nursing assistants reported sustaining frequent physical injuries as a result of applying manual restraint for CNF. Injuries typically ranged from back pains to bruises and were reportedly sustained by the physical aggression of young persons or through the execution of the manual restraint itself: When the patient was moving, as we were restraining her, I got thrown at a door handle and that caused quite big bruising on my back. (Participant 8) Some nursing assistants reported only becoming aware of a sustained injury after they had returned home from their shift: Sometimes it happens with bruises, like you go home, you haven’t realised how you might have sustained this bruise and then you realise . . . or you might feel back pains which you don’t really realise when you’re in the restraint. (Participant 6) In addition to back pains and bruises, two participants reported that they had either obtained, or had witnessed their colleagues obtain more severe physical injuries during manual restraints such as dislocated shoulders, head injuries and being kicked in the groin. In all reported instances this was due to the physical aggression of a young person: For some reason, one of the legs had not been held tightly, and she kicked the nurse who fell over and landed down. That was very scary because the staff banged her head and she got unconscious . . . they had to call an ambulance. (Participant 2)"

"Through the biotechnology of the force-feeding chair and the hunger strike in Guantanamo, this paper examines the camp as a site of necropolitics where bodies inhabit the space of the Muselmann – a figure Agamben invokes in Auschwitz to capture the predicament of the living dead. Sites of incarceration produce an aesthetic of torture and the force-feeding chair embodies the disciplining of the body and the extraction of pain while imposing the biopolitics of the American empire on “terrorist bodies”. Not worthy of human rights or death, the force-fed body inhabits a realm of indistinction between animal and human. The camp as an interstitial space which is beyond closure as well as full disclosure produces an aesthetic of torture on the racialised Other through the force-feeding chair positioned between visibility and non-visibility. Through the discourse of medical ethics and the legal struggle for rights, the force-feeding chair emerges as a symbol of necropolitics where the hunger strike becomes a mechanism to impede death while possessing and violating the corporeal body."

"Manual restraint is a form of physical restraint practice, used particularly within inpatient mental health settings, whereby one or more persons restrict the movement of another by manually holding them (Stewart et al., 2009; Stubbs & Paterson, 2011). This differs from mechanical physical restraint which refers to the use of devices (e.g., belts or cuffs) to restrict movement (Care Quality Commission, 2018). Manual restraint is commonly used in conjunction with seclusion and chemical restraint to prevent harm to patients and staff, or to administer medications and other treatments (Chapman et al., 2016; Hawkins et al., 2005; Ryan & Bowers, 2006). For instance, the literature has highlighted the use of manual restraint in response to patient self-harming, aggressive and attempted absconding behaviours (Bowers et al., 2015), and patient medication refusal (Owiti & Bowers, 2011). Concerns have been raised about manual restraint use (Mind, 2013), and internationalguidelines and programmes advocating for its reduction have emerged (e.g., Department of Health, 2014; Mental Health Commission, 2014; O’Hagan et al., 2008; Royal Australian and New Zealand College of Psychiatrists, 2016). Within England alone, over 50,000 incidents of manual restraint were recorded between the years of 2016 and 2017 in National Health Service funded secondary mental health, learning disability (LD) and autism services (Collinson, 2017), demonstrating the commonality of manual restraint practice. This study explores nursing assistants’ experiences of administering manual restraint for compulsory nasogastric feeding (CNF) of young persons with anorexia nervosa (AN)."

"Doctors force-feeding prisoners at |Guantanamo are acting as an arm of the military and have abrogated their medical-ethical duties."

"The literature has highlighted the numerous adverse physical and psychological staff outcomes as a result of manual restraint use. Staff have reported experiencing physical exhaustion, physical pain and injury, and numerous unpleasant emotions (e.g., anxiety, fear, anger) as a result of administering manual restraint (Bigwood & Crowe, 2008; Bonner et al., 2002; Chapman et al., 2016; Sequeira & Halstead, 2004; Wilson et al., 2017). Manual restraint has also been linked to staff feelings of internal conflict, as staff may perceive the act of manually restraining patients as incongruent with their therapeutic role (Bigwood & Crowe, 2008; Chapman et al., 2016; Sequeira & Halstead, 2004; Wilson et al., 2017). Although manual restraint is commonly administered within inpatient mental health settings (Stewart et al., 2009; Wilson et al., 2017), the literature has also illustrated its use within the emergency department, LD services, and paediatric general hospital and residential childcare settings (Chapman et al., 2016; Fish & Culshaw, 2005; Lombart et al., 2019; Steckley & Kendrick, 2008; Svendsen et al., 2017). The manual restraint of young persons raises ethical and moral issues for staff, and this has been evidenced by the distress and internal conflict staff may experience when manually restraining young persons (Lombart et al., 2019; Steckley & Kendrick, 2008; Svendsen et al., 2017). For instance, staff have reported feeling guilty when restraining children for medical procedures, with some describing how “difficult and demanding” the process can be (Lombart et al., 2019; Svendsen et al., 2017). Presently, little research has been conducted on the use of manual restraint within child and adolescent settings. However, even less research has been conducted on the use of manual restraint for CNF of patients with AN within inpatient eating disorder settings."

"3rd. By means of “gavage”.-This way of feeding infants is in use in France only, so far as I know. It is easily learnt, but cannot be performed by an uninstructed person. It is of great service in the case of prematurely born or weakly infants, whose power of suction is feeble. The illustration is from a photograph taken at the “Maternite de Paris”. Belluzzi appears to have been the first to try “gavage”."

"In February 1914 Ethel Moorhead became the first suffragette to be force fed in Scotland. Force feeding, whilst it could never be described as fun, was particularly brutal in Perth Prison where rectal feeding was forced on some suffragettes. Fortunately for Ethel, she was confined in Calton Jail in Edinburgh and was released with nothing more severe than double pneumonia – the result of food getting into her lungs whilst being forcibly fed."

"She was on the run for several months during which time police attributed at least four arson attacks to her. Presumably they would have ascribed a fifth if she hadn't been spotted and arrested at Traquair House. This time though there was no Cat and Mouse Act release and she was force fed, causing the double pneumonia. She was released again with instructions to return to prison to complete her sentence. Guess what .... she went on the run again."

"Manual restraint, a type of physical restraint, is a common practice in inpatient mental health settings linked to adverse physical and psychological staff and patient outcomes. However, little is known about the use of manual restraint for compulsory nasogastric feeding of patients with anorexia nervosa within inpatient eating disorder settings. The present phenomenological study aimed to explore nursing assistants’ experiences of administering manual restraint for compulsory nasogastric feeding of young persons with anorexia nervosa. The study followed COREQ guidelines. Eight semi-structured interviews were conducted with eight nursing assistants from one UK inpatient child and adolescent eating disorder service. Interviews were transcribed verbatim and analysed using Thematic Analysis. Three themes were extracted: An unpleasant practice, Importance of coping, and Becoming desensitised and sensitised. Nursing assistants commonly experienced emotional distress, physical exhaustion, physical injury and physical aggression as a result of their manual restraint use. Nursing assistants appeared to cope with their distress by talking with colleagues and young persons who were further in their recovery, and by detaching themselves during manual restraint incidents. The findings highlight that the use of manual restraint for compulsory nasogastric feeding of young persons with anorexia nervosa in the UK, is a highly distressing practice for nursing assistants. It is therefore important that sufficient supervision, support and training is made available to staff working in these settings."

"Mr Nowak has not been to Guantanamo, and turned down an invitation to the camp because the US refused to give him unrestricted access to the detainees. He told the BBC that he had received reports that some hunger strikers had had thick pipes inserted through the nose and forced down into the stomach. This was allegedly done roughly, sometimes by prison guards rather than doctors. As a result, some prisoners had reported bleeding and vomiting he said. "If these allegations are true then this definitely amounts to an additional cruel treatment," Mr Nowak said."

"AN is an eating disorder characterised by an extremely low body weight, a severe restriction of food, a strong desire to be thin, and an intense fear of gaining weight (National Institute of Mental Health, 2018). Under relevant mental health legislation, patients with AN can be administered CNF in extreme cases when they are presenting with very low body weight, and refusing to eat and/or drink (Fuller et al., 2019; Royal College of Psychiatrists, 2014). In the rare case when a patient is resistant to nasogastric feeding, staff members may administer manual restraint to ensure the safety of themselves and the patient during feeding (Fuller et al., 2019, 2020; Neiderman et al., 2001). Within the UK, manual restraint in this context may be used in the absence of other restrictive practices (e.g., seclusion), and may involve holding the patient’s arms, legs and head in a safe position, in order to allow for the safe passing of a nasogastric tube and subsequent feeding (Fuller et al., 2019; Neiderman et al., 2001). Feeding in the context of active resistance is a rare event and raises ethical, legal and clinical issues for all those involved (National Collaborating Centre for Mental Health, 2004). Despite the wealth of research that exists on the treatment of AN, we could only locate one published qualitative study that explored the experience of CNF in the context of AN, including the experience of CNF under manual restraint (Neiderman et al., 2001). In this qualitative survey study exploring children and adolescent patients’, and their parents’ experiences of nasogastric feeding, the authors summarised patients’ nasogastric feeding experiences into two main categories: “I regretted it at the time but think that it was necessary” and “I hated it then and hate it now”. This study however did not focus specifically on the practice of CNF under manual restraint, and did not use in-depth qualitative data collection methods such as individual interviews (the authors used qualitative questionnaires). Studies specifically exploring the experience of CNF under manual restraint from either the patient or staff member’s perspective using in-depth data collection methods, could provide valuable insight into this under-researched practice."

"I'll fuckin', I'll fuckin', sew your asshole closed, and keep feedin' you And feedin' you, and feedin' you, and feedin' you."

"Israel's public security minister opposed the ruling. He warned that more Palestinian prisoners will now go on extreme hunger strikes and, on his Facebook page, criticized the doctor who heads the Israel Medical Association for telling physicians to ignore the new Israeli law. (Updated 1:30 p.m., Aug. 24: On Sunday, four days after the court ruling, Israeli media reported that more than a dozen well-known Israeli academics and physicians signed a paper supporting the state's position, saying a doctor's responsibility is to save lives). That doctor, Leonid Eidelman, says he did nothing wrong. "It's not breaking [the] law because there is no law in Israel to force doctors to use a treatment they don't believe should be used," he said. Under Israel's force-feeding law, a judge can allow, but not order, a doctor to participate. Israel is not the only place force-feeding is an issue. The U.S. military has repeatedly force-fed hunger strikers held at Guantanamo Bay, and American courts have upheld the practice."

"In Israel, Eidelman and other physicians say they would honor a patient's wish to refuse food, but would step in to save that same patient's life if he or she were unconscious. Eidelman says that worked for Mohammad Allan, who wanted a trial or freedom — not death. "And in this case actually, it was proven. Because after he was resuscitated he regained his consciousness and didn't regret that he was resuscitated." Mohammad Allan ended his hunger strike after the Israeli court ruling. The force-feeding law remains on the books, awaiting a future case and a future debate with Israel's doctors."

"To our knowledge, this study is the first to explore nursing assistants’ experiences of administering manual restraint for CNF of patients with AN, and makes a substantial contribution to the limited literature on this practice. The findings highlight that the use of manual restraint for CNF of young persons with AN is a highly physically and emotionally distressing practice for nursing assistants. It is therefore important that sufficient supervision, support and training is made available to staff working in these settings."

"While stating that any force-feeding deemed necessary for lifesaving purposes should not contradict "compelling internationally accepted standards of medical ethics or binding rules of international law", the judges at the tribunal also noted that the body of law laid down by the European court of human rights did not view force-feeding as "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"."

"Previously secret sworn statements by detainees at the Abu Ghraib prison in Iraq describe in raw detail abuse that goes well beyond what has been made public, adding allegations of prisoners being ridden like animals, sexually fondled by female soldiers and forced to retrieve their food from toilets. The fresh allegations of prison abuse are contained in statements taken from 13 detainees shortly after a soldier reported the incidents to military investigators in mid-January. The detainees said they were savagely beaten and repeatedly humiliated sexually by American soldiers working on the night shift at Tier 1A in Abu Ghraib during the holy month of Ramadan, according to copies of the statements obtained by The Washington Post. The statements provide the most detailed picture yet of what took place on the cellblock. Some of the detainees described being abused as punishment or discipline after they were caught fighting or with a prohibited item. Some said they were pressed to denounce Islam or were force-fed pork and liquor. Many provided graphic details of how they were sexually humiliated and assaulted, threatened with rape, and forced to masturbate in front of female soldiers."

"60 Minutes has been told that there have been frequent hunger strikes among the Islamic terrorist inmates inside Supermax and to keep the inmates alive there are often force feedings. That's when an inmate is restrained and liquid nourishment is poured down a tube in his nose. We're told there have been about a dozen hunger strikers and one of them used to be Osama bin Laden's secretary. Former Warden Robert Hood told us that he supervised many of these feedings. "I probably conducted, authorized, conducted 350, maybe 400 of involuntary feedings. Again, not…individuals, because you could have one person, three meals a day for, you know, two months. That adds up," he tells Pelley. Bureau of Prisons' records that 60 Minutes has seen show there have been as many as 900 of what the bureau called "involuntary feedings" of terrorists in H-unit since 2001. Why did the prisoners stop eating? What was the complaint? Says Hood, "It was conditions of confinement." Some of the conditions they object to are outlined in a document: inmates get letters only from people approved by the prison and they get one, monitored, phone call a month, for 15 minutes."

"Pressure and responsibility. Six of the eight nursing assistants voiced feeling pressured and responsible for their colleagues and themselves while applying manual restraint for CNF. These participants appeared to attribute these feelings to their manual restraint performance, which could have a direct impact on their colleagues’ ability to effectively restrain, and the overall success of the nasogastric feeding procedure: You know in every restraint that if you lose your grip and they get a hand through or a leg through, the whole thing’s going to go wrong, so you feel responsible . . . If you lose their hand, they’ll grab the tube out and then the whole process has to start again . . . you feel the responsibility from all the other staff as well. (Participant 7) Failure to execute or maintain restraint positions could result in feelings of frustration and failure, and this was explicitly expressed in four nursing assistants’ interviews. It appeared that these participants placed a great deal of pressure and responsibility on themselves to execute their designated manual restraint positions."

"In October, lawyers for detainees told a judge that medics tried to persuade those on a hunger strike to start eating on their own by force-feeding them with unusually large feeding tubes inserted through their noses -- without painkillers."

"Mohammad Allan's situation was different. Solo, and much closer to death, Palestinian protests over his continued detention grew as his health got worse. Israeli authorities feared his death could trigger street violence. But amid the turbulent public debate, one lawmaker who had voted against allowing force-feeding said he changed his mind. Yaakov Peri also used to head Israel's internal security. "The only solution is that he be fed," said Peri on an Israeli radio program last Wednesday. "I was against the force-feeding bill, but the alternative is an end to his life. There are times when the state of Israel has to make a decision, and if we need to force-feed him, we will have to force-feed him." He spoke before an Israeli high court ruling that ended the question of force-feeding Allan. The court suspended his detention until doctors could determine any long-term health consequences and Allan agreed to take nutrients."

"The United States could be violating the U.N. Convention Against Torture by force-feeding immigrant detainees on a hunger strike inside an El Paso detention facility, the United Nations human rights office said Thursday. The Geneva-based Office of the High Commissioner for Human Rights is concerned that force-feeding could constitute “ill treatment” that goes against the convention, which the United States ratified in 1994, spokeswoman Ravina Shamdasani told The Associated Press. The U.N.'s statement echoes concerns raised by 14 Democratic lawmakers who sent a letter to U.S. Immigration and Customs Enforcement on Thursday requesting more information about nine Indian men who are being force-fed through nasal tubes after refusing to eat to protest what they described as unfair treatment. One of the hunger strikers, a 22-year-old asylum seeker who has not eaten in more than a month, said he was dragged from his cell three times a day and strapped down on a bed as a group of people poured liquid into tubes inserted into his nose. “It is critical that ICE commit to ending this practice,” said the letter spearheaded by Texas Democratic Rep. Veronica Escobar, who toured the El Paso Processing Center and met with the men after AP reported on the force-feeding last week."

"The nation of Mauritania faces a myriad of social, political and economic problems, which has greatly impacted it’s ability to develop. While most Mauritanians live and work in urban centers, a sizable number still depend on agriculture and animal husbandry, specifically in rural areas where the government has had little influence in affecting policy. One area where this is most apparent has been with gavage, or the practicing of force feeding. In his book Mauritania, Alfred G. Gerteiny wrote this of gavage: Women are subjected to gavage-that is, forced feeding, in order to gain weight. Fathers send daughters 10 or 11 years of age to live with herdtending dependent aznagui who see to it that the girls gain weight … often by being tied to the ground, and, to expand their stomachs, given nothing by water for three days. Then they are crammed with milk, usually camel’s milk. Though decades have passed since Gerteiny wrote of the practice, gavage still occurs. In Mauritania, women who are overweight, or in some cases, obese, are considered beautiful and alternatively, women who weigh what we here would consider a healthy weight are shunned. In recent years, the government and NGO’s have forcefully led a campaign to discourage the practice. The forceful feeding of adolescent girls creates a plethora of health complications as the young girls mature into women. In the larger cities, the practice has visibly been cut, both by a changing of the times and by the discouragement of the practice. However, things are different in the desert, where people continue traditional practices."

"Ducate has experience with hunger strikes, and ending them, on six occasions in Texas. She indicated that the preferred means of feeding an inmate on a hunger strike is to sedate the prisoner, insert a nasogastric tube into his stomach, via the nose and throat, and then pipe nourishing liquid directly into the stomach. It is not a medically difficult procedure, and, in her experience, inmates who are so fed begin to eat normally soon thereafter. On the basis of her experience with hunger strikes in Texas, she believes that such incidents have a serious and detrimental effect on the other inmates. In her experience, inmates look to the department for their care and would be shocked if an inmate was allowed to kill himself without intervention. She adds that a hunger strike has a detrimental impact on prison safety and security. In this case, where the defendant is in the infirmary full-time, it leads directly to mentally ill prisoners being transferred to other facilities, away from treatment teams familiar with them, because this inmate is taking an otherwise available bed for his self-induced hunger strike."

"Hunger strikes are relatively uncommon inside ICE detention. Last month, ICE began non-consensual feeding and hydration of numerous El Paso detainees after a federal judge issued a court order allowing them to be force-fed against their will. “ICE is committed to preserving the lives of those in its custody and maintaining orderly detention facility operations,” the agency said Thursday in response to the U.N.'s statement. “For their health and safety, ICE closely monitors the food and water intake of those detainees identified as being on a hunger strike. Medical staff constantly monitor detainees to evaluate whether the hunger strike poses a risk to the detainee’s life or permanent health.” While ICE doesn’t keep statistics on force-feeding throughout the immigration detention system, attorneys, advocates and agency staffers AP spoke with did not recall a situation where it had come to force-feeding. Federal courts have not conclusively decided whether judges must issue orders before ICE force-feeds detainees, so rules vary by district and orders are sometimes filed secretly. The controversy comes as President Donald Trump prepares to visit El Paso on Monday for his first campaign rally of the year to be held at a coliseum in the bustling border city. The detainees, who are refusing food to protest what they describe as verbal abuse and threats of deportation from guards, are being held in a highly guarded facility surrounded by a chain-link fence on a busy street near the airport."

"6. Where a prisoner refuses nourishment and is considered by the physician as capable of forming an unimpaired and rational judgment concerning the consequences of such a voluntary refusal of nourishment, he or she shall not be fed artificially. The decision as to the capacity of the prisoner to form such a judgment should be confirmed by at least one other independent physician. The consequences of the refusal of nourishment shall be explained by the physician to the prisoner."

"July 2005: 52 detainees begin hunger strike, second of the year, in protest at detention and treatment 14 Sept: Lawyers say more than 200 are refusing food. The US military says 128 21 Sept: US says number falls to 45. No explanation given but some tube-feeding admitted 7 Oct: US says number down to 28, 20 of whom are force-fed 27 Oct: US judge "deeply troubled" by force-feeding 25 Dec: Hunger strikers leap to 84, the US says 9 Feb, 2006: US says number down from 84 to four but gives no reason"

"Dr David Nicholl, a UK neurologist who initiated the Lancet letter, told the BBC's World Today programme that US doctors going to Guantanamo Bay were being screened to ensure they agreed with the policy of force-feeding. "In effect they are screened to make sure they don't have doctors with a conscience." Dr Nicholl said it was the patient's decision to go on hunger strike and the doctor's responsibility was to explain the consequences and confirm the patient was sane. In February, Lt Col Martin, chief military spokesman at the US detention facility, said force-feeding was administered "in a humane and compassionate manner" and only when necessary to keep the prisoners alive. But Dr Nicholl said that "horrible as it may sound" the doctor had to conform to the wishes of hunger strikers, even if it led to their deaths. Dr Nicholl said the letter's signatories felt there was not enough publicity about the matter in the US media and that Americans needed to be challenged."