refused to leave his pets. we are leaving, though. that's al jazeera america. "inside story" is next. ♪ doctors to help fortune detainees. that's in tonight's "inside story." >> hello, i'm libby casey. doctors take an oath to do no harm. medical professional working with the u.s. military and intelligence services were forced to violate that oath in the treatment of terror suspects captured after 9/11. even though torture was banned by executive order in 2009 the

report said ethical violations continue at the president in guantanamo bay where detainee s staging hunger strikes have been forced fed. detainee abuse on the war of terror. it was funded in the open society foundation. since 2011 the u.s. department of defense and c.i.a. have had policies requiring guantanamo doctors and other medical personnel to breach national standards including on site physicians have participated in interrogations and by assisting in force feeding. also the report found that military medical training lacks ethical grounding for doctors to protect human rights.

the report comes months after president obama reiterated his promise to close down the prison. >> the pentagon is trying to manage the situation as best as they can. but i think all of us should reflect on why exactly are we doing this? >> reporter: the president's renewed effort to push congress towards the camp's shutdown was spurred by a long time detainee hunger strike. at the height of the protest, 106 men refused food and as many as 46 from forced fed. forced feed something a technique typically used for six patients having trouble heating. using into you bashan is painful, especially for an unwilling patient. >> it requires some force to be able to insert the tube into the thousand. sometimes you can use some an

thes anesthesia to put it in. but it doesn't mean that it's humane . >> reporter: guantanamo bay's detention center follows a federal code of conduct which does not allow prisoners to die in its custody. when al jazeera reached out on the latest report, the pentagon responded healthcare providers at task force at guantanamo routinely better care than any of these detainees ever received in their lives. they do not always require the tube feeding. frequently they'll drink the supplement out of sight of their peers. until justice changes the law we'll humanely safeguard those held in our charge there. although half of the detainees have been released, many have

not transported because of a moratorium. other detainees are in legal limbo. they cannot be tried because they've been tortured in past. and some cannot be released because they are deem do dangerous. 164 prisoners are held there now. it has cost $5.2 billion to keep guantanamo open since 2002. in a few minutes we'll talk more about the new reports ethics abandoned with two of the task force members but first we're joined by al jazeera's ross lind jordan who covers guantanamo and all the ethical issues surrounding guantanamo. where is this report significant. >> there have been a lot of criticisms aimed at the

pentagon about the way the men have been treated since the hunger strikes which for all intents and purposes is effectively over. it comes down to this. they have free will and their right to explain their political opposition to their detention. and it's being under cut by defense department policy. what this new report does is spell out what the defense department during the bush administration and by subsequent measure the obama administration has on to under cut these men's right. the department of defense will argue that it has a legal obligation to safeguard these men's health and well-being. when it comes to the matter of forced feeding, we should know that is a term that president obama has used, that they have

an obligation to make sure that nothing untoward has happened to these men while in u.s. custody. >> there are still a handful of men who are still using that. why is it over? were they able to achieve anything? where are we at? >> essentially once president obama said on may 23rd this having this hunger strike taking place is really bad for the u.s.' reputation give that it wants to stand for the respect of human rights, and it wants to stand for using the justice system to deal with wrongs against society, once the president acknowledged that these men were being force fed, the detainees, according to their lawyers decided we've gotten the white house's attention. we've gotten the world's attention by extension, and we feel that there are going to be legal changes to get us out of this legal limbo. what you've seen announced in the coming months is that some of these detainees are going to have their bids to be

transferred out of guantanamo back to their home countries or perhaps to a third country reviewed again. that has not happened for thee years. and you're also going to see more people finding out whether they can actually be tried with any cases. so they feel that this is a victory. however, they say that they reserve the right to stop eating and to stop drinking water again if that's what it takes to get them out of guantanamo. >> president obama has professed want to go close guantanamo bay prison down. where is that at? >> well, he's hired or appointed two men at the state department, and paul lewis at the pentagon, to try to move those who can be transferred out of guantanamo, to look for legal ways to actually close the detention center, and to try to resolve some of the outstanding claims that the countries of which these men are citizens might

have against the u.s. government. the u.s. did pass laws that say you cannot bring anyone who has been held on guantanamo on continental soil for prosecution. you cannot house anyone from guantanamo on u.s. soil. and say the president were to decide tomorrow i'm issuing an executive order despite what congress says, there is no money apportioned to that, he would be breaking u.s. law to do that. >> we'll bring in two members of the task force that authored the report on medical ethics. this is "inside story."

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retired stephen zenakus. medical doctor and an anti-for tour expert for physicians for human rights. also a member of the group human rights first. thank you for being here. if in boston, leonard reube reubensteen, and berman institute of medical ethics and still with us ross lind jordan. you're a lead author of this report. most important take away. >> the most important take away the legacy of the detainee abuse is still with us in the erosion of medical, ethical standards for health personnel working at guantanamo. the department of defense changed ethical standards. even though there are changes and interrogation practices those rules are still with us and they undermine ethical practice.

>> any surprises in this report? >> no, no surprises. what was really valuable about the report was that you had a proud group of people senior doctors and leaders who looked at all the information and was very objective and confirmed what had been coming out for years, and we recognized was a problem for military medicine. >> torture, the interrogation process, we're talking about waterboarding and things like that, is this different? >> what's really different about this question is the fact that you have medical doctors, people who are licensed by one state or another here in the united states, and yet when they join the military it seems that their obligations to their state board of medicine is superseded by what the pentagon requires them to do at guantanamo. it really does show how the pentagon codified a set of

changes to effectively undermine their legal responsibility as medical doctors. >> leonard, i want to get at who is responsible. the report points to the government rather than the medical professionals themselves. >> yes, that's one of the key points in the report these were not bad doctors. these were policies set forth mostly in writing by the pentagon or the black sites when they existed by the c.i.a. they rewrote the standards, and that's what the legacy is. general, what is the medical responsibility? you're a doctor. if you're a medical professional going into this environment where is your responsibility? >> your responsibility is to the patient. it's first and foremost, and it is, in fact, what is most important even in accomplishing the military mission because military

physicians come in with an allegiance to this country and take an oath. they are there to serve and keep the force fit and healthy so it can do its job. that is grounded , and you keep the interest of your patient first and foremost. >> i want to hear about force feeding. what does that feel like? what is the process. >> the process of forced feeding is a tube, there are several sizes, it passed through the nose into the throat and into the stomach. there is gel put on t and there is sometimes an anesthetic with it.

in terms of how comfortable it is, it varies a lot because people have different gag reflexes. after several times people do get used to it. once the tube is past and you're sure it is in the stomach, then the food, the nutrient , usually ensure, is poured in after an hour. >> the alternative is what, if you're a doctor, and you have a patient, a detainee who is refusing food. what is the alternative? letting them starve? >> you can let them for a period of time refuse food. many and most majority take water. that buys you a lot of time. weeks and months at least eight weeks. during that time the individuals who engage in hunger strikes are really using a means of

non-violent expression. these particular men at guantanamo are expressing their disillusionment and despair over their conditions. the first step is to engage them. what is going on there. >> if i could add with forced feeding. it's not just the tube. they use a chair with restraints where wrists, ankles and ways to restraint, five-point restraints, and they're kept in that chair up to two hours twice a day, and it's an extremely uncomfortable and sometimes very, very painful procedure. that's why the medical industry has called forced feeding de grading and inhumane treatment. >> what is the alternative ? to see to the detainee's needs.

they can work with the council and almost in all hunger strikes, the hunger strike is resolved, and there are very, very few cases where you get into an accuse situation because hunger strikers are political protesters, they don't want to die. they want their protest to succeed. the doctor's role is to work with the patient, that's what is done in many other parts of the world. >> the pentagon said the detainees are getting treated better than they would have been treated in their hom homelands,d this is up to congress to change the law. this is legal. >> they're following the protocol used in the federal bureau of prison systems where people are convicted of federal crimes where they serve their time. however, it's worth noting that in v.o.p. facilities. >> v.o.p.

>> federal prisons. >> they're not restrained with this five-point restraint system as is being done in guantanamo. that's one of the points that is brought up in this report, that it's creating basically another standard for these men most of whom have not been charged with anything and yet to find out if they're going to be charged with anything and then go into a courtroom and challenge the allegations against them. it's sort of a fancy jail, as it were, and yet they're being suspected to treatment that is harsh than anyone who has been convicted with murder would be subjected to. >> you've seen how these prisoners are treated? >> yes, they find the conditions harsh. they find that it is in their sense abusive .

the restraints are painful. one thing to recognize as with other federal prisons, the bureau, at the warden or the doctors who wish to force feed a prisoner often have to go to the courts because they respect the autonomy. this is one of our at grounds of what we do as doctors, we respect the autonomy of our patient. that's not the case here. >> we'll take a short break. when we come back what the task force recommends and what could be done to improve the situations. stay with us. this is "inside story." [[voiceover]] every day, events sweep across our country. and with them, a storm of views. how can you fully understand the impact unless you've heard angles you hadn't considered? antonio mora brings you smart

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you. >> welcome back to "inside story." we're discussing medical ethics and treatment of prison detainees at guantanamo bay. >> leonard reubenstein, i want to talk about the psychology, the psychological angle and the role of behavioral science

consultation team. what role do they play? >> they had basically three functions. the first was to identified vulnerability for detainee for intergas station. the second is to establish conditions of confinement to maximize the opportunity to get intelligence from the detainees, and the third, somewhat on it traditio contradictory, one of the problems is you can't have it both ways. you cannot impose harm on people by exposing vulnerability, and then label them a safety officer. i think the task force use is more of a to portray the psychologist involved to comply with

to exploit vulnerability as the die dance suggests. who. >> who are these people. how are they trained? what are we talking about? >> first team, you have a varied training amongst them, and there are people who have been working as treating clinicians and military clinics. you also had psychiatrist who is were medical doctors, who had been working as treating doctors, and then you had some family fissions. these are people who usually worked with patients, and did it in a traditional way . they were pulled at of these clinics to be part of these teams to advise the interrogators. >> what are their ethical responsibility. >> their ethical responsibility first is to say they were not going to do that.

that does not conform to the principles of do no harm, respect the patient's autonomy and i think they first have to say this is not what they were trained for. clearly as a psychiatrist or general physician we're not trained to calibrate stress. we're not trained to alter and modify conditions like that. >> yet, if the u.s. is at war, ros ros jordan, if we can get information out of these detainees, if they have vital intel, that's our job to do so. >> that was the thought of the pentagon since 2001. however there, is a legitimate question about whether sense there hasn't been any significant transfer of people into the camps since 2006, what information do people have, how relevant is it at this point, or are they simply being held because they have not been able to do something with them because of the legal constraints

imposed by congress. it really does beg the question is there anything relevant to be gained from the vast majority of the 164 men who are still there at this point. >> task force recommendations. dig into those for us. >> if i could just address the last point first, which is that one of the problems is that rules and directives have institutionalized. when the 165 people leave guantanamo some day, these rules will still be in place. and that's in some ways the most insidious problem and goes to the heart of the recommendations. which we think the rules that require deviation were core ethical responsibility, particularly as the doctor said, to do no harm, those need to be gotten rid of. second, the task force was restricted public domain.

there is much more information , so to order a full investigation of the role of how professionals relation to detainee s , particularly forced feeding and general care. >> general, your thoughts and the precedence that this sets? >> i think this report helps the government, helps the country sort of take corrective action. now it's all disclosed. we have affirmed--we've heard for over the years and suspected but if we're going to take corrective action we needs these facts out, and they need to be public. we need to fix some changes that were made early in 2003. second of defense said we're going to take the gloves off, and by doing that he crossed the boundary of what traditional medicine, traditional military

practice is, having to do with what are the rules that governor what we do as an army, and what we do as a country. this now sets the stage to do that, to rebalance what we're doing and to move forward. but it all has to come out. that change, that shift back to what are the standards both as a military and a medical practice take very positive action and require positive action from the government. >> we'll have to leave it there. thank you so much to all of you for joining us. that's it for now. from the team in washington, d.c. and from me, libby casey. you can keep the debate going by logging on to our facebook page or send us yo your thoughts on twitter. thanks for watching.

hello, i'm del walters live in new york these are the stories we are working on on al jazeera america. voters head to the poles to make key decisions today. and also the dire outlook for syrians. and this stunning video of an aerial accident captured on camera by one of the people involved. ♪ it is the first tuesday in november. it is election day. the races and issues voters are