Prisoners at Guantanamo are apparently on a hunger strike, requiring forced-feeding to keep them alive. And that has some in high dudgeon, with the New York Times aiding the prisoners’ cause (of course!) by publishing an op/ed essay in which one inmate purports to describe the physical ordeal forced feeding causes and to plead for his release.
Hunger strikes are a time-honored way of getting attention to a cause. But a hunger strike does not arise in a vacuum, and the question becomes whether authorities have to cooperate by allowing prisoners to starve themselves to death. Many among the Medical Establishment say it is wrong to force-feed prisoners on a hunger strike because it purportedly violates their right to “refuse treatment.” From an open letter signed by 250 doctors published in The Lancet in 2006:
Fundamental to doctors’ responsibilities in attending a hunger striker is the recognition that prisoners have a right to refuse treatment. The UK government has respected this right even under very difficult circumstances and allowed Irish hunger strikers to die. Physicians do not have to agree with the prisoner, but they must respect their informed decision.
This is more of a political argument, I think, than one truly steeped in medical ethics.
Inmate hunger strikers aren’t cases in which medical treatment is refused for a true medical malady–which should usually be permitted in prison settings, even if prisoners’ autonomy have limits. Rather, they are trying to commit slow motion suicide as a tactical tool to obtain a political benefit. They are self-harming. Why should doctors be ethically required to be complicit by just standing aside and letting the prisoners harm their health or die, or indeed, make it easier by offering palliation?
Look at it this way: If an inmate hanged himself and the guards could save him, should they instead stand back and let him swing? Should doctors refuse to resuscitate a self-hanged prisoner because he clearly “wanted to die” or left a note refusing treatment? Or, if prisoners decided to bash their heads repeatedly into a wall as a means of protest, should officials be prevented from restraining them and doctors be ethically prohibited from staunching the bleeding and binding up their wounds? Of course not.
If that is true, the same rules apply to hunger strikes when they reach the point of health/life endangerment.