- David J Nicholl, consultant neurologist ()
EDITOR—I agree with Wilks that the declarations of the World Medical Association in relation to force feeding of hunger strikers will have limited effect unless national medical associations are willing to make their members accountable when practice departs from principles.1 Sadly, it has not been my recent experience that national medical associations and the medical establishment are prepared fully to investigate such breaches.
In response to our letter,2 Duane Cady (the chair of the American Medical Association, AMA) issued a press statement confirming the AMA's endorsement of the Declaration of Tokyo, yet stating that the AMA is not a regulatory or licensing agency.3 Although this is factually correct, it is not sufficient for the AMA to avoid this issue when some of its own members have been involved with force feeding in Guantanamo. Clearly, the AMA needs to investigate such serious allegations when the individuals concerned are in danger of bringing the AMA into disrepute.
Secondly, our letter was originally submitted to the New England Journal of Medicine in November 2005, but publication was declined, “strictly on editorial considerations,” nearly three months later. Finally, Wilks was originally a co-signatory to the letter, and because of concerns within the BMA's legal department, had to withdraw as a co-author. I was not prepared to accept a sanitised version of our letter suggested by the BMA when over 250 coauthors, the Lancet, and our own legal advice were all satisfied with the published version.
I therefore fully agree with Wilks that international medical bodies have a basic ethical duty to use their power to enforce their declarations. In relation to Guantanamo, the international medical community could do well to remember the words of the philosopher Edmund Burke: “All that is necessary for the triumph of evil is that good men do nothing.”4
Competing interests None declared.