Hunger striking inmates and detainees, and medical ethics.

A hunger striking inmate is not sick. He is an individual who chooses to express his protest, his position, to achieve personal, political or other goals by refusing food. A hunger striker is willing to jeopardize his own health, and even bring about his own death, as the only personal tool of protest available to someone incarcerated. An inmate in this case generally will not request that a doctor provide sustenance, and certainly not forcibly. It is the basic need of life – food and water – that the inmate has consciously chosen to abstain. An external observer would feel tremendous frustration witnessing a person acting in a manner that could be considered suicide, without intervening. Even more so, physicians would have difficulty confronting such a situation since they have been trained to save lives, to care and do no harm. Seeing a prisoner under their care embark on a hunger strike challenges the notion of the supreme value of the sanctity of life, but does it supersede respecting an individual’s rights over his own body and life? The Code of Ethics for Physicians in Israel [3] written in 2009 states: 1. The physician will explain to the prisoner, who is refusing to eat, that this action is a valid threat to his life if he continues his hunger strike. t he patient-physician relationship has changed dramatically over recent decades in Israel as well as throughout the western world. In the past, medicine was paternalistic: it was accepted that the doctor knew what was best for the patient and this fact afforded him/her the ability to care for their health with little restriction. This was how medicine was practiced for many years in Europe, particularly in Germany, and this had a major influence on medicine in Israel. The evolution that began with aligning the practice of Israeli medicine with the accepted standards in the United States, Canada, Britain and many other nations belonging to the World Health Organization (WHO) changed the picture. Patient autonomy has become the guiding principle in the patient-physician relationship. Autonomy means the patient has full rights to make decisions freely and without coercion regarding the method of treatment and to grant, or not, permission prior to the start of a treatment plan. This permission is given based on the complete, honest and transparent delivery of information to the patient by the attending physician in a reasonable and balanced manner. Autonomy means that the patient has the right to refuse or defer the physician’s suggestions without the latter’s opinions forced upon the patient. Respecting a patient’s humanity involves acknowledging 2. The physician will not use undue pressure upon the prisoner, to dissuade him from hunger striking. The physician will check with the prisoner on a daily basis what course of treatment is permissible in the event that the prisoner loses consciousness. This must be documented in the medical records and kept confidential. 3. The physician will continue to treat the hunger striking prisoner in the best manner possible, according to his knowledge and conscience, after the patient has lost consciousness, in keeping with the hunger striking prisoner’s request as expressed during the hunger strike. 4. The physician will not participate in force feeding the hunger striking prisoner.