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Ethics briefings
  1. Veronica English,
  2. Jessica Gardner,
  3. Gillian Romano-Critchley,
  4. Ann Sommerville
  1. Medical Ethics Department, British Medical Association

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    Management of prisoners on hunger strike

    Management of prisoners on hunger strike has always been a contentious ethical issue. Two arguments are advanced. One is that the authorities and prison doctors have duties to save prisoners' lives. This can entail forcible feeding. The counterargument is that prisoners retain certain rights, including that of deciding when to refuse medical treatment and artificial nutrition. In some countries, practice involves respecting prisoners' refusal of food until they lose consciousness and then forcibly feeding the then incompetent person, on the grounds of “best interests”. In the UK, the arguments came to a head in the 1970s when two Irish prisoners, the Price sisters, legally challenged the Home Office's right to force-feed in any case other than where refusal of food arose from a medical or psychiatric condition. It caused a furore and the earlier prison policy of involuntary feeding was overturned. In 1981, the wishes of hunger strikers, including IRA prisoner Bobby Sands, were respected and doctors supervised death-fasts in Northern Ireland. During the 1980s and 90s, the same arguments were used in response to mass hunger strikes in Spain, Morocco and South Africa. In Spain, where 60 political prisoners fasted, some regional judges ordered forcible feeding, while others allowed prisoners to fast. The debate about conflicting moral duties became highly political and in 1990 a Spanish doctor who began involuntary nutrition of hospitalised prisoners was assassinated. Nevertheless force-feeding continued until 1991 when the strike ended. In the same year, in South Africa, sophisticated protocols evolved which applied the concept of advance directives (binding advance refusals) to force-feeding.

    Since 1980, hunger strikes by political prisoners have been endemic in Turkey where well documented allegations of torture are common. In 1996, for example, 12 hunger-strike deaths occurred in prison. In December 2000, two types of hunger strike began: over 2000 protesters …

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