Artificial feeding, force-feeding, and resuscitation 2
Artificial feeding, force-feeding, and resuscitation 2
Reanimation of a person in a terminal stage of total fasting is not the only issue here. The first distinction that needs to be understood by all physicians involved in hunger strikes is that such feeding in a coercive situation is not always decided on medical grounds – nor even necessarily by a physician.
When a hunger strike has a political component, the authority in charge may decide to put a stop to it, and issue an order to artificially feed the protesters. This may be decided very early on in the fasting, when there is no medical need to administer any nutritional treatment. It may even be decided to feed prisoners who resist by active coercion, tying down their limbs, and forcibly inserting a naso-gastric tube (hopefully) into the esophagus. This coercion is what definesforce-feeding. The act itself will have to be performed by medical staff, often medical orderlies, as doctors would often refuse.
Artificial feeding does not involve this element of brutal coercion. It may be prescribed freely by a physician, or be imposed on the physician by a judicial authority (such as a judge), whether the fasting person agrees or not. This occurs usually at a stage when the hunger striker is no longer fully conscious and too weak to protest or offer any resistance, but may be decided well in advance. By definition – and usually by default – this means that there is no element of active coercion, as is the case in force-feeding.
Artificial feeding involves administering nutriments and liquids parenterally or through a naso-gastric tube. There may be a medical indication for such feeding if the fasting has gone on long enough, and the aim is to save the person’s life.
This raises however the crucial question, and ethical dilemma, of whether a physician should do anything and everything possible in order to save a person’s life, or whether on the contrary s/he should respect the right of individuals to dispose of their bodies as they please. Should a physician, duly informed of a hunger striker’s intention to fast indefinitely, cheat on his patient once the hunger striker is no longer conscious enough to resist or understand what treatment is being applied to him?
This question is highly controversial, and is often further complicated by religious issues. The law of the country may legally require physicians to intervene, even against their will, if a hunger striker’s life is at stake. In this case, it is up to the physician to decide whether to bow to the law and flout the trust of the hunger striker, or to refuse to obey the law – and possibly have to accept the legal consequences for such a refusal.