Hunger Strikers Should Not Be Force Fed

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Main Category: Nutrition / Diet
Also Included In: Primary Care / General Practice
Article Date: 05 Sep 2008 - 0:00 PDT

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Force feeding has no place in the treatment of hunger strikers who are entitled to receive the highest medical care available, including independent clinical assessment and advice from a doctor whom the striker trusts and who explains the risks and effects of fasting.

These are the conclusions of the lead editorial in The Lancet being published on 6th September 2008.

The editorial is timed to coincide with the publication later in September of the UK Department of Health (DH) guidelines for the clinical management of hunger strikers in prisons and detention settings.

The editors write that starvation-induced effects such as electrolyte imbalance, depletion of vitamins and minerals, infection, hypothermia, and kidney failure, complicates the clinical management of hunger strikers. It is essential to understand the physiology of the changes and the best way to manage them. For instance, different care is needed by those who agree to taking some supplements compared to those who agree to being re-fed, which can lead to Wernicke-Korsakoff syndrome, where thiamine deficiency leads to loss of certain brain functions.

Refusing to eat may be a prisoner's only weapon for making demands, to get access to justice or to protest against their conditions. Most hunger strikers do not set out to die, although some may be prepared to do so if their demands aren't met, which makes things very difficult for the attending physician who is faced with the prospect of a death that could be prevented.

The DH guidelines cover not only all aspects of clinical management, but the legal position in the UK, where detainees have the right to refuse food and drink and where it is illegal to force feed a person who is mentally competent.

The editors say the DH guidelines don't emphasize enough the importance of giving hunger strikers access to a doctor who can give independent, impartial and expert advice and care.

Sometimes, after speaking to an expert whom they trust and who explains to them the effects and dangers of fasting, can lead to a change of mind on the part of the striker. Also, an independent physician can help the striker think about and write down instructions for what they want to happen should they lose their mental capacity later on.

The editors conclude:

"There is a clear and urgent need for guidelines on the clinical management of hunger strikers to be disseminated to all medical workers who may need them, and for the guidelines to be followed."

They stressed that independent medical assessment should become part of the routine care of hunger strikers.

"Prisoners or detainees who choose to become hunger strikers are entitled, worldwide, to the highest clinical standards of care available. Force feeding has no place in that care," they added.

Force feeding used to be common in many countries, and is still used in Guantánamo Bay, despite the provisions of the Geneva Conventions, and the fact it is banned by the World Medical Association (WMA) in Declarations, to which the American Medical Association is a signatory.

"Clinical Care of Hunger Strikers."
Lead Editorial.
The Lancet, Vol 372 September 6, 2008.

Click here for the full text of the Editorial.

Click here to read a doctor's account of treating hunger striking asylum detainees in the UK (BMJ eletters 2005).

Sources: The Lancet, BMJ.

Written by: Catharine Paddock, PhD
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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