Prohibition of Force-feeding
Regarding the interdiction of force-feeding, the revised WMA Malta Declaration clearly states in Articles 20 and 21 of the guidelines for the management of Hunger Strikes:
20. Artificial feeding can be ethically appropriate if competent hunger strikers agree to it. It can also be acceptable if incompetent individuals have left no unpressured advance instructions refusing it.
21. Forcible feeding is never ethically acceptable. Even if intended to benefit, feeding accompanied by threats, coercion, force or use of physical restraints is a form of inhuman and degrading treatment. Equally unacceptable is the forced feeding of some detainees in order to intimidate or coerce other hunger strikers to stop fasting.
The revised 2006 WMA Malta Declaration, and particularly these articles, should now be the ethical reference for all physicians worldwide regarding the prohibition of force feeding.
Recent experience, and certainly not only in Guantánamo Bay, has proven that hunger strikes – particularly "high profile" hunger strikes, are not easy for physicians to manage. The main issue is most often the well-meant, but often problematic intervention by lawyers and judges. Also a dilemma is the fact that "high profile" hunger strikers, particularly where they have access to the Media, can try to "manipulate" the authorities and the physician.
Understandably, judges may wish to "preserve the lives" of the prisoners on trial, and refuse to envisage a possible "escaping from justice" by a prisoner "starving him/herself to death". The issue is not merely theoretical (although such cases are rare), as R.A.F[16], prisoner under trial Holger Meins did indeed die after 56 days of hunger striking, despite repeated attempts to force-feed him…
To be fair, there have been recent cases wherein "savvy" prisoners have manipulated lawyers, judges and even a whole Tribunal, by going on hunger strike, and threatening thus to "kill themselves", when in fact they hadn't had the slightest intention of doing any harm to their health, let alone risk their lives. Once have obtained everything they demanded, they conveniently stopped fasting… Such cases have been documented in the press and on Internet1.The role of the physician is thus often complicated by outside factors and influences.
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