God Mode, by Luke Mitchell

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    He has chosen death:Refusing to eat or drink, that he may

    bring

    Disgrace upon me; for there is a custom,

    A n old and foolish custom, that if a man

    Be wronged, or think that he isu.'Y onged,and starve

    Upon another's threshold till he die,

    The common people, for all time tocome,

    Will raise a heavy cry against that

    threshold,

    Even though it be the K ing's.

    L-W. B.Y eats

    ast August, seventy-six foreign

    nationals held at the U.S. Naval

    Station at Guantanamo Bay, Cuba,

    began what was likely the largesthunger strike ever to take place at anAmerican-run prison. By September,

    when theprotestreached itspeak,more

    than a quarter of the prison's nearly

    500 inmates wererefusingto eat. Pen-

    tagon officials were dismissive of thestrikes, which they called "voluntary

    fasts."DefenseSecretaryDonald Rums-feld even compared the processof star-

    vation, in which the body, deprived ofnutrition, eatsitsown organs, togoing

    "on a diet." But given the means bywhich the strike would be controlled,suchnonchalance madea certain sense.Rather than let the men die, our gov-

    ernment simplytied them to chairsand

    made them eat.There wasno special art to it. Mil-

    itary guards bound the men to the

    chairs by their ankles, waists, wrists,

    shoulders, and heads, and military

    nurses forced flexible plastic tubes

    through their nostrils, down their

    throats, and into their stomachs. In

    Luke M itchell is a Senior Editor of Harp-er's Magazine.

    NOTEBOOKGod Mode

    B yL uke M itchell

    went the food. Nor was the feeding

    necessarily sadistic. Lawyers for the

    prisoners say that the doctors some-

    time; used excessively thick tubes

    that caused internal bleeding and

    that they deliberately overfed theprisoners, causing them to vomit andto defecate in their clothing and on

    their chairs; but Pentagon officials

    deny these charges, and outside

    physicians who have witnessed thefeedings support the official ac-

    counts. No, what was peculiar about

    the force-feeding was that the Penta-

    gon seemed soperfectly convinced it

    had done something that was, for

    once, beyond criticism.\Vhen the first known instance of

    Guantanamo-sanctioned force-feedingtook place, in 2002, a Guantanamo

    spokesman named James Bell ex-

    plained that Naval doctors would put

    afeeding tube into any prisoners whothreatened to succeed at dying. "Re-

    gardlessof whether they wereinvolvedin killingthousands of innocent people

    in the World Trade Center attacks ornot," Bell said, "we have a responsi-bility to maintain their health andwel-

    fare, and that certainly includes taking

    actions to preserve their lives." Fouryearslater, Dr. WilliamWinkenwerder

    Jr., who isthe assistant secretaryof de-fensefor health affairsandthe chief ar-

    chitect of the Guantanamo force-feed

    policy, told the New York Times thatforce-feedingwasboth ethical andnec-

    essary."There isamoral question," he

    said. "Do you allow a person to com-

    mit suicide? Or do you take steps to

    protect their health and preservetheir

    life?" Winkenwerder added that he

    and his colleaguesat the Pentagon had

    considered this question carefully andconcluded that preventing suicidewas

    ethical. "The objective in any cir-

    cumstance," hesaid,"isto protect and

    sustain a person's life."

    Most Pentagon officials, of course,

    are focused on objectives other than

    protecting and sustaining the lives of

    foreignnationals. ButI wasmoreboth-ered byWinkenwerder's claim that he

    had decided upon the policy only afterdeliberately contemplating its ethical

    implications. The United States has

    force-fed many people-A mericanslaveswho hoped to escapeservitude,

    American womenwhosoughtthe right

    tovote-but the practice has been lit-

    tle utilized in modem times, primarily

    becausemostpeoplefind it repugnant.

    At a1975 conference in Tokyo, mem-bersofthe World Medical Association

    crafted an unambiguous ban on force-feeding, which was later endorsed by

    the American Medical Association. I n

    2000aU.S. District Court judgefound

    that a federal prisoner could not be

    force-fed,despite the fact that FederalBureauofPrison guidelinesallowedfor

    it. ("I just don't think the government

    hasputforwardany kind ofcompellinginterest that would allow me to over-

    ride a person's last, ultimate means ofprotesting government," the judge

    wrote.) And when county prison offi-cials in Bangor, Maine, did manage to

    obtain a court order last October toforce-feedasuicidalburglaron ahunger

    strike,the doctorsat the EasternMaine

    Medical Center refusedto perform the

    procedure.J ill McDonald, aspokesman

    for the hospital, told theBangor Daily

    News that the hospital could not op-

    erate without apatient's consent. "We

    are not parties to court orders," Me-

    Donald said. "We areunder adifferent

    set of obligations."

    Had Winkenwerder really engagedin a long dialogue with doctors andother specialistsonly to conclude, con-

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    trary to thirty yearsof establishedmed-ical guidance, that binding people tochairs and forcing food down their

    throats washis only ethical option asa medical professional? I called the

    public affairsnumber at the Pentagon

    on the offchance that he would agreeto an interview and, somewhat to

    mysurprise,wastold that

    " T he would.l'l'inkenwerder was reasonably

    affable on the telephone but also

    clearly aware that what he said couldhave political implications. He was a

    health-insurance executive in Massa-chusetts before he took responsibilityfor the medical policies of the United

    States military; in the picture next to

    his online biography, he wears a two-tone broker shirt and a pocket

    square. Two publicists listened in onour conversation.

    Winkenwerder said that a physi-cian's obligations arecomplex. He cit-ed the World Medical Association's

    1991 Malta Declaration, afollow-ontothe Tokyo Declaration that more

    specifically addresseshunger-strike is-sues.The preamble notes that doctors

    treating hunger strikers are faced withaconflict between "a moral obligation

    on every human being to respect thesanctity of life" and "the duty of thedoctor to respect the autonomy whichthe patient has over his person."

    Winkenwerder read apassagealoudto me in order to underscore the am-biguity inherent to that conflict:

    This conflict is apparent where ahungerstrikerwhohasissuedclearin-structionsnot to beresuscitatedlapsesintoacomaand isaboutto die. Moralobligationurgesthedoctor to resusci-tate the patient even though it is

    against the patient's wishes. On theother hand, duty urgesthe doctor torespecttheautonomyof thepatient.

    "So that's the moral question," hesaid. "That's the moral issue." And

    he was right, of course. Autonomy isthe central question. The Malta De-

    claration, a notably sensible and hu-mane document, despite its having

    been written by a committee, isquite clear about this. It turned out,though, that Winkenwerder had not

    read me the entire passage:

    However, the doctor should clearly

    10 HARPER'S MAGAZINE I AU GUST 2006

    stateto the patientwhether ornot heisableto acceptthe patient'sdecisiontorefusetreatmentor, incaseof coma,artificial feeding, thereby riskingdeath. If thedoctor cannot acceptthepatient's decision to refusesuch aid,the patient wouldthen beentitled tobeattendedbyanother physician.

    In short, the doctor should be al-lowed to practice medicine by the

    light of his or her own conscience,

    and the patient should have accesstoa doctor who can accept his or herdecision to refuse artificial feeding.Had Winkenwerder really thought

    this through? Was he trying to trick

    me somehow? An AMA official latertold me she had heard of four Guan-

    tanarno doctors who apparently did

    not think it wasethical to participatein involuntary feeding and so didn't.

    The doctors were not punished, butnor could hunger strikers choose tobe"treated" by them.

    Winkenwerder, though, wasdrivingat a larger point. "So with the Malta

    Declaration," he continued:

    When the hunger striker has becomeconfused and is therefore unable tomake an unimpaired decisionor haslapsedintoacoma,thedoctorshal1befreeto makethe decisionfor his pa-

    tient astofurther treatmentwhichheconsidersto be in the best interestofthat patient...

    My own confusion deepened. ThePentagon wasputting tubes into menso healthy they had to be bound tospecial chairs, and Winkenwerder wastalking about the ethics of feedingpeople in comas. I askedhim if "unableto make an unimpaired decision" or

    "lapsed into a coma" really were therelevant criteria for force-feeding the

    hunger strikers at Guantanamo."That's their criteria,"Winkenwerder

    said, acknowledging my confusion.

    "And here's the distinction with ours.

    And this isnot aswild adifference as

    somehave made it out to be. And I 'dask you to think about this yourself."

    What came next genuinely surprised

    me. "We would prefer not to havepeople lapse into coma or to be neardeath when we make that decision,"

    Winkenwerder said, meaning the de-cision to force-feed."In other words,if

    we're there to protect and sustainsomeone's life, why would we actual-

    ly go to the point of putting that per-son's life at risk before we act? So I

    think we're operating on a very simi-

    lar set of ethical reasoning, but it's ap-plied at an earlier stage."

    That is, Winkenwerder and his

    doctors were forcing perfectlyhealthy prisoners to eat even beforethey were at risk of starving. Absurdas it sounds, he was describing, with

    medical precision, the Bush doctrineof "forward deterrence," in which

    potential enemies are confronted ontheir own territory before they be-come an actual threat. He was de-

    scribing the same policy that was

    driving the entire war on terror.I asked Winkenwerder if his pre-

    emptive force-feeding policy was the

    same as forward deterrence. Theanalogy was obvious to me, but heseemed offended by the question.

    "Our intentions are good," he said

    a moment later, not quite plaintive-

    ly. "We are seeking to pre-

    rJ "'" servelife,"

    .1here is a certain kind of videogame, called afirst-person shooter, in

    which you run through a maze andfire at Whatever comes your way.

    These games are challenging because

    ammunition is limited, because everyliving thing is trying to kill you, and .because (as a result) you can't stopthinking, even for aminute. The first-

    person shooter exists in a nightmar-ish Hobbesian state of nature. In acomputer game, though, the state ofnature iseternally malleable. Y oucanuse cheat codes to remove gravity,addextra "lives," increase the amount

    of gore, and so on. The most power-ful cheat is called god mode. In godmode, younever run out of ammuni-

    tion and nothing can ever kill you.Y ou are free to turn your mind off fora moment and enjoy the synthetic

    beauty of the game.

    I mention this as a contemporary

    example of alongstanding oppositionin the American psyche between lib-

    erty and death. In the old American

    religion we were supposed to be ableto choose between one and the other.

    The basic premise, according toPatrick Henry, the state of NewHampshire, and countless Mel Gib-

    son movies, was that the absence ofliberty actually required death. The

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    new American religion, however, in-sists that we choose life.

    "Life" in America is not a simplematter of cell division, though. It isan issue. When we think about life,wethink about abortion or the recent

    trialsofTerrySchiavo.We think aboutthe sanctity oflife.Indeed,ourpresident

    celebrated the firstanniversary of hisinauguration byestablishing aholidaycalled National Sanctity of HumanLifeDay, which, wereit not for his in-volvement in what has come to becalled the "culture of life," might seeman odd move by a man who haslaunched two wars and vociferouslysupported the death penalty.

    It is easy to understand "culture oflife"tomean"cultureinwhich abortion

    isoutlawed,"and in fact the phrasewasinvented by Pope John Paul II for a1995 encyclical, Evangetium vitae,

    which addresses abortion in somedepth. Butthe popewasat leastascon-cerned with matters of power andcon-trol-and therefore of liberty-as hewas with death itself. Suicide, for ex-ample, wasnot to be rejected becauseof the anguishit causedthe survivorsorbecause it was aneedless squanderingof aprecious gift. It wasto be rejectedbecause this act of defiance was often

    committed specifically in the name offreedom. To John Paul's wayof think-ing, that desire for freedom was thevery essence of the sin. "In its deepestreality," the pope wrote, "suiciderep-resents a rejection of God's absolutesovereignty over life and death."

    In this light, Winkenwerder's no-tion ofprotecting "life"beginsto makesense. Consider the major national se-curity initiatives of the last fewdecades, and especially the last fewyears:the doctrines of "overwhelming

    force" and "shock and awe," in whichmassive technological superiority di-minishes the chance of actual battle-field injury or death (on the part ofour own forces); "missile defense,"

    which theoretically, if not actually,renders impotent all nuclear weaponsbut our own; unmanned Predatordrones,whosefocusedair strikesput noAmerican life in jeopardy; motion-detecting fortificationsalongoursouth-ern border to ward off threats botheconomic and martial; surveillance of

    our everyutterance bycomputers care-fully programmed to detect the words

    most preferred byour enemies; and, ofcourse, force-feeding, in which wepre-empt even the prick to our consciencethat is the essence of aprincipled sui-cide. Consider that the man in chargeof medical ethics for the most power-

    ful killing machine in history spentmost of his professional career in the

    insurance trade, a business based onthe premise that if we just spendenough money, wecan reducethe lev-el of risk in our lives to zero.

    We, asanation, seemto beseekingatechnological circumstance that al-lows the United States not just todominate but to dominate so ab-solutely and effortlessly that weneednot even think about our enemies,much lessfear them-something that

    allows us to tum off our minds andenjoy the synthetic beauty of thegame. The phrase the Pentagon uses

    is "Full-spectrum Dorni-, ' - V - nance." I call it god mode.. o u have to understand," Wink-

    enwerder said. "Our policy is not toprevent people from hunger striking.Our policy is to sustain life, is toprevent people from dying as a resultof hunger striking."

    The doctor was becoming increas-

    inglyexasperated. It seemedto methatallowing people to hunger strike andpreventing them fromdyingasaresultweremutually contradictory aims. Af-ter all, if ahunger strike isthe final at-tempt by the powerlessto assert theirautonomy-"a person's last, ultimatemeans of protesting"-then force-feedingisthe ultimate rejection ofthatautonomy. In that it reduces its sub-

    ject to astate of total submission,pow-erlesseven within the bounds ofhis orher own flesh, force-feeding isno less

    violent an act than isrape.But Winkenwerder was sincere inhis defense, if somewhat inconsistent,and the longer I spoketohim the moreI cametorealizethat it wasthisveryin-

    consistency that allowed him to besin-cere. He spokerepeatedly of the com-plexityofthe debate-"There aremanyissuesin the world of medicine, in theworld of health care," he said, "about

    which good people with good inten-tions can have differing opinions"-and he seemed genuinely to believe

    that it wasimpottant tojustifyhis poli-cies in terms of ethics rather than in

    terms of discipline or punishment."Youknow," he said,"there areoth-

    er parallels in medical practice. I cancertainly recall earlier in mycareer at-tending to young women who wereanorexics, who literally wouldn't eat.

    And 1think if we had stood by andrespected their autonomy they wouldhave died."

    I wastaken abackbythe comparison.I askedifhe meant tocomparehis pris-oners to anorexic girls. He said, "No,no, no. I'mnot. And don't saythat, be-causeI didn't do that. I'm just givingyou an example of the fact that thereare other situations in which peopletake actions that place their life ortheir health in serious jeopardy andmedical professionals take actions to

    prevent them from harming them-selves." I tried to draw a distinctionbetween mental pathology and polit-ical speech. 1mentioned the case ofBobby Sands, the Irish RepublicanArmy member who died after a sixty-six-day hunger strike in 1981. "Well,

    I don't know what wasgoing on withBobby Sands," Winkenwerder said. "Ihaven't studied that case."

    Winkenwerder never didmakeclearto me what wassocomplex about thedecision to forceaman to eat. Maybe

    hecouldn't. Or maybehe conceivedofthat complexity as a final formof de-fense, an imaginary "safeplace" of the

    sort that psychiatrists advise their pa-tients to escapeto in times ofcrisis. AfewweeksafterI spoketo him, though,an anonymous official did explain tothe Toronto Star that the death of aGuantanarno prisoner would bedisas-trous for the administration. "Theworstcasewould beto have someonegofromzeroto hero," the official said."We don't want a Bobby Sands."

    At Guantanamo, the preemptiveforce-feedingcontinues, but, likeshockand aweand missiledefenseand everyother doomed attempt to remove fearandambiguityfromour fallenworld, it

    has failed to achieve itsend, In June,asweall know, three prisoners in thatfacility, all ofwhomhad failedin theirattempt to starve, managed instead tohang themselves with their own bedsheets. The test ofgodmode in Amer-ica today is whether that fact, whichmen likeWinkenwerder no doubt will

    call "complex," is simple enough toprick your conscience. _

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