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Hunger strikes in prisons: a narrative systematic review of ethical considerations from a physician’s perspective

Published online by Cambridge University Press:  19 July 2017

G. Gulati ,
B. D. Kelly ,
D. Meagher ,
H. Kennedy  and
C. P. Dunne
G. Gulati*
Affiliation:
Department of Psychiatry, University Hospital Limerick, Limerick, Ireland Department of Psychiatry, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
B. D. Kelly
Affiliation:
Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
D. Meagher
Affiliation:
Department of Psychiatry, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
H. Kennedy
Affiliation:
Department of Psychiatry, Trinity College Dublin, Dublin, Ireland Central Mental Hospital, Dublin, Ireland
C. P. Dunne
Affiliation:
Graduate Entry Medical School, University of Limerick, Limerick, Ireland
*
*Address for correspondence: G. Gulati, Consultant Psychiatrist, Department of Psychiatry, University Hospital Limerick, Limerick, Ireland and Adjunct Senior Lecturer in Psychiatry, Graduate Entry Medical School, University of Limerick, Ireland. (Email: [email protected])
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Abstract

Objectives

We sought to identify and review published studies that discuss the ethical considerations, from a physician’s perspective, of managing a hunger strike in a prison setting.

Methods

A database search was conducted to identify relevant publications. We included case studies, case series, guidelines and review articles published over a 20-year period. Non-English language publications were translated.

Results

The review found 23 papers from 12 jurisdictions published in five languages suitable for inclusion.

Conclusions

Key themes from included publications are identified and summarised in the context of accepted guidelines from the World Medical Association. Whilst there seems to be an overall consensus favouring autonomy over beneficence, tensions along this fine balance are magnified in jurisdictions where legislation leads to a dual loyalty conflict for the physician.

Keywords

Asylum seekerethicsfood refusalhunger strikeprison
Type
Review Article
Information
Irish Journal of Psychological Medicine , Volume 35 , Issue 2 , June 2018 , pp. 135 - 142
Copyright
© College of Psychiatrists of Ireland 2017 

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References

Alempijevic, D, Pavlekic, S, Jecmenica, D, Nedeljkov, A, Jankovic, M (2011). Ethical and legal consideration of prisoner’s hunger strike in Serbia. Journal of Forensic Sciences 56, 547–550.CrossRefGoogle ScholarPubMed
Anonymous (2014). AJOB case presentation: hunger strike or suicide by starvation: is force feeding a prisoner ethical? American Journal of Bioethics 14, 46.CrossRefGoogle Scholar
Arda, B (2002). How should physicians approach a hunger strike? Bulletin of Medical Ethics 181, 13–18, (http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=med4&NEWS=N&AN=12705250).CrossRefGoogle Scholar
Beauchamp, TL, Childress, JF (2001). Principles of Biomedical Ethics, 5th edn. Oxford University Press: New York.Google Scholar
Beresford, D (1997). Ten Men Dead: The Story of the 1981 Irish Hunger Strike. Atlantic Monthly Press: Boston, MA.Google Scholar
Bob, YJ (2016). Israel’s High Court: forced feeding of hunger striking detainees is legal, The Jerusalem Post, 11 September (http://www.jpost.com/Arab-Israeli-Conflict/Israels-High-Court-Forced-feeding-of-hunger-striking-detainees-is-legal-467486). Accessed 25 January 2017.Google Scholar
Boehnlein, JK (2013). Should physicians participate in state-ordered executions. Virtual Mentor: American Medical Association Journal of Ethics 15, 240–243.Google ScholarPubMed
Blightman, K, Griffiths, SE, Danbury, C (2013). Patient confidentiality: when can a breach be justified? Continuing Education in Anaesthesia Critical Care & Pain 14, 52–56 https://doi.org/10.1093/bjaceaccp/mkt032 (http://ceaccp.oxfordjournals.org/content/early/2013/08/28/bjaceaccp.mkt032.full.pdf+html). Accessed 23 January 2017.Google Scholar
Brockman, B (1999). Food refusal in prisoners: a communication or a method of self-killing? The role of the psychiatrist and resulting ethical challenges. Journal of Medical Ethics 25, 451–456.CrossRefGoogle ScholarPubMed
Boyd, JW (2015). Force-feeding prisoners is wrong. American Medical Association Journal of Ethics 17, 904–908.Google ScholarPubMed
Caenazzo, L, Tozzo, P, Rodriguez, D (2016). Hospitalized hunger-striking prisoners: the role of ethics consultations. Medicine, Health Care, and Philosophy 19, 623–628.CrossRefGoogle ScholarPubMed
Crosby, SS, Apovian, CM, Grodin, MA (2007). Hunger strikes, force-feeding, and physicians’ responsibilities. Journal of the American Medical Academy 298, 563–566.Google ScholarPubMed
Dahlberg, J, Dahl, V (2015). Asylum seekers on hunger strike – how far does the patient’s right to refuse treatment go? Tidsskrift for Den Norske Laegeforening 135, 45–47.CrossRefGoogle ScholarPubMed
Dougherty, SM, Leaning, J, Greenough, PG, Burkle, FJ (2013). Hunger strikers: ethical and legal dimensions of medical complicity in torture at Guantanamo Bay. Prehospital and Disaster Medicine 28, 616–624.CrossRefGoogle ScholarPubMed
Druml, C, Ballmer, PE, Druml, W, Oehmichen, F, Shenkin, A, Singer, P, Bischoff, SC (2016). ESPEN guideline on ethical aspects of artificial nutrition and hydration. Clinical Nutrition (Edinburgh, Scotland) 35, 545–556.CrossRefGoogle ScholarPubMed
Fayeulle, S, Renou, F, Protais, E, Hedouin, V, Wartel, G, Yvin, JL (2010). Management of the hunger strike in prison. Presse Medicale 39, e217–e222.CrossRefGoogle ScholarPubMed
Fessler, DT (2003). The implications of starvation induced psychological changes for the ethical treatment of hunger strikers. Journal of Medical Ethics 29, 243–247.CrossRefGoogle ScholarPubMed
Fung, G (2016). Chinese political prisoner ends hunger strike, transfers to another prison. Radio Free Asia Cantonese Service, 23 August (http://www.rfa.org/english/news/china/china-guofeixiong-08232016135452.html). Accessed 25 January 2016.Google Scholar
Garasic, M, Foster, C (2012). When autonomy kills: the case of Sami Mbarka Ben Garci. Medicine and Law 31, 589–597.Google ScholarPubMed
García-Guerrero, J (2013). Hunger striking in prisons: ethics and the ethical and legal aspects. Revista Española De Sanidad Penitenciaria 15, 8–15.CrossRefGoogle ScholarPubMed
García-Guerrero, J, Vera-Remartínez, EJ (2015). Episodes of voluntary total fasting (hunger strike) in Spanish prisons: a descriptive analysis. Journal of Forensic & Legal Medicine 34, 34182–34186.CrossRefGoogle ScholarPubMed
Getaz, L, Rieder, JP, Nyffenegger, L, Eytan, A, Gaspoz, JM, Wolff, H (2012). Hunger strike among detainees: guidance for good medical practice. Swiss Medical Weekly 142, w13675.Google ScholarPubMed
Gevers, JK (2000). Assistance in hunger strikes: legal guidelines. Nederlands Tijdschrift Voor Geneeskunde 144, 1008–1011.Google ScholarPubMed
Grégoire, G, Derderian, F, Le Lorier, J (1995). Selecting the language of the publications included in a meta-analysis: Is there a tower of babel bias? Journal of Clinical Epidemiology 48, 159–163.CrossRefGoogle Scholar
Irmak, N (2015). Professional ethics in extreme circumstances: responsibilities of attending physicians and healthcare providers in hunger strikes. Theoretical Medicine and Bioethics 36, 249–263.CrossRefGoogle ScholarPubMed
Kenny, MA, Silove, DM, Steel, Z (2004). Legal and ethical implications of medically enforced feeding of detained asylum seekers on hunger strike. Medical Journal of Australia 180, 237–240.CrossRefGoogle ScholarPubMed
Martin, J (2010). Hunger strike – imperative forces in conflict. Revue Medicale Suisse 6, 1562–1563.Google ScholarPubMed
McKinney, EB (2008). Hard time and health care: the squeeze on medicine behind bars. Virtual Mentor: American Medical Association Journal of Ethics 10, 116–120.Google ScholarPubMed
Oguz, N, Miles, S (2005). The physician and prison hunger strikes: reflecting on the experience in Turkey. Journal of Medical Ethics 31, 169–172.CrossRefGoogle ScholarPubMed
Rieder, J, Huber-Giseke, T, Getaz, L, Kramer-Gauchat, M, Nyffenegger, L, Gaspoz, J, Wolff, H (2010). Hunger strike and forced feeding: a historical look at medical practices. Revue Médicale Suisse 6, 2313–2318.Google Scholar
Röggla, G (2005). Medically enforced feeding of detained asylum seekers on hunger strike. Wiener Klinische Wochenschrift 117, 436.CrossRefGoogle ScholarPubMed
Sakelliadis, EI, Spiliopoulou, CA, Papadodima, SA (2009). Health care provision in prisons: a review on European and international guidelines. Acta Clinica Belgica 64, 399–405.CrossRefGoogle ScholarPubMed
Tait, R (2015). Doctors refuse to force feed fasting Palestinian prisoner. The Telegraph, 11 August (http://www.telegraph.co.uk/news/worldnews/middleeast/israel/11796209/Doctors-refuse-to-force-feed-fasting-Palestinian-prisoner.html). Accessed 23 January 2017.Google Scholar
Weisfield, NE, Weisfield, VD, Liverman, CT (2009). Military Medical Ethics: Issues Regarding Dual Loyalties: Workshop Summary. National Academies Press: Washington, DC.Google Scholar
World Medical Association (2006). World Medical Association Declaration on Hunger Strikers, Adopted by the 43rd World Medical Assembly Malta, November 1991 and revised by the WMA General Assembly, Pilanesberg, South Africa 2006 (http://www.wma.net/en/30publications/10policies/h31/). Accessed 6 March 2017.Google Scholar