Hospitalized hunger-striking prisoners: the role of ethics consultations

Abstract

We refer to hospitalized convicted hunger strikers in Padua Hospital who decided to fast for specific reasons, often demanding, to be heard by the judge, to complain about the existing custodial situation or to claim unjust treatment. The medical ethics of hunger strikers are debated because the use of force feeding by physicians is widely condemned as unethical, but courts, in Italy, sometimes order to transfer the convicted person to hospital and oblige healthcare practitioners to perform forcible feeding. This can engender a profound insecurity for the physicians taking action on the one hand, while preventing patients from fully availing themselves of this principle of self-determination on the other. Physicians are mainly concerned about how to manage this situation and they may request ethical consultation. When it comes to managing hospitalized hunger strikers, the ethics consultant may be able to facilitate the relationship between physicians and hunger strikers, enhance the latter's trust in the former, ensuring that strikers are aware of the risks associated with their fasting, and helping them to arrive of their own free will at the right decision concerning their behavior and their demands.

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

“…The utility of treatment using vitamins was rarely recognised (32.7%). Caenazzo et al (2016) writing from an Italian perspective regarding prisoners hospitalised at Padua hospital, report instances of court ordered treatment including force-feeding. The authors suggest the use of independent 'ethics consultants' becoming involved in the case of hospitalised hunger strikers to assist the building of trust, information giving and to facilitate informed decision making.…”

“…The latter would arguably, fundamentally conflict the principle of autonomy. A number of publications reviewed (Oguz & Miles, 2005;Getaz et al 2012;Caenazzo et al 2016) cited the importance of the 'neutrality' of physicians involved as key to their involvement. Caenazzo et al (2016) argue that such conflicts of interest may be avoided by the use of independent 'ethics consultants'.…”

“…The general practitioner may refer to a psychiatrist to exclude mental illness and assist in capacity assessment (Brockman, 1999). The general practitioner may seek a medical hospital consultant's advice when there is substantial deterioration of physical health including in medical emergencies arising from prolonged fasting or if there is a need for supervised refeeding (Caenazzo et al 2016).…”

The psychiatric management of prisoners on hunger strike: developing a management algorithm using the Delphi technique

“…They argued that this could be achieved by, first, conceding complete loyalty to patients to those healthcare professionals who care for prisoners and, second, utilising independent professionals unencumbered by clinical relationships to prisoners for tasks whereby a prison's administration or the state requires medical expertise at odds with the interests of prisoners. Caenazzo et al (2016), from an Italian viewpoint, suggested the use of independent "ethics consultants" to carry out some of these tasks such as the assessment of decision-making capacity based on the importance of the neutrality of the assessor.…”

Challenges in the early assessment and protection of refugee survivors of torture and extreme violence

“…The issue has also come up in the recent discussion for example in the American Psychological Association (43), and has led to a final reconfirmation of this basic prohibition (44). Participation in torture must be broadly defined and includes also the support of the development of torture techniques, or the lack of documentation and reporting on torture and IDT, or forced feeding of mentally competent hunger strikers (WMA Declaration of Malta (45,46). Doctors can be "at risk" to participate especially in dual obligation situations that might include working in prisons in a totalitarian state, where non-compliance with pressure to support torture might be concretely dan-gerous, but also in less obvious situations.…”