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Correspondence: Hunger Strikes and Psychiatric Care

This document discusses the ethical issues doctors face when treating prisoners on hunger strike. It outlines international guidelines on the treatment of hunger strikers, including the Declaration of Malta which states that forced feeding without consent is unethical. Doctors must balance clinical and ethical duties while remaining neutral to pressures from authorities. Guidelines aim to protect prisoner dignity, consent and confidentiality during medical care for hunger strikes.

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Ελληνικό Κέντρο Ψυχικής Υγιεινής & Ερευνών / Hellenic Centre for Mental Health & Research Βιβλιοθήκη / Library
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38 views

Correspondence: Hunger Strikes and Psychiatric Care

This document discusses the ethical issues doctors face when treating prisoners on hunger strike. It outlines international guidelines on the treatment of hunger strikers, including the Declaration of Malta which states that forced feeding without consent is unethical. Doctors must balance clinical and ethical duties while remaining neutral to pressures from authorities. Guidelines aim to protect prisoner dignity, consent and confidentiality during medical care for hunger strikes.

Uploaded by

Ελληνικό Κέντρο Ψυχικής Υγιεινής & Ερευνών / Hellenic Centre for Mental Health & Research Βιβλιοθήκη / Library
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Correspondence

Hunger strikes and difficult decisions as the health of


their patient deteriorates, sometimes
psychiatric care advising transfer to a general hospital
Recent media reports around the for closer monitoring and consenting
treatment of a foreign citizen on treatment. Psychiatrists, when
hunger strike in Iran are reminiscent involved, have three tasks: to assess for
of issues previously reported in the mental illness, to assess capacity, and
Lancet.1 Reports cite the prisoner to assess the motivation behind the
as being “chained to the bed” in a hunger strike.5 None of these actions
psychiatric unit with constant presence require any form of restraint. In the
of guards.2 Hunger strikes have been absence of a severe mental illness, no
reported from correctional settings reason exists for a prisoner to require
internationally. Most hunger strikes are transfer to a psychiatric unit.
short lived. Many protest against the Much work must be done, despite
conditions of incarceration. Doctors the first ratification of the Declaration
are invariably involved; they attempt of Malta nearly three decades ago,
to navigate clinical, legal, and ethical to support fellow practitioners
complexities while being neutral to internationally to be able to practice
pressures from penal authorities, free from state pressures and in
governments, and the media. keeping with widely accepted
The World Medical Association positions.
has an agreed ethical position, the We declare no competing interests.
so-called Declaration of Malta, first
adopted in 1991, which guides doctors
*Gautam Gulati, Brendan D Kelly,
Colum P Dunne
in these situations.3 This declaration
[email protected]
enshrines the principles of neutrality.
Kilmallock Day Hospital, Limerick V35 VP21, Ireland
Except for exceptional circumstances, a (GG); Graduate Entry Medical School, University of
doctor needs to attend to the prisoner Limerick, Limerick, Ireland (GG, CPD);
out of sight and earshot from prison and Department of Psychiatry, Trinity College,
Dublin, Ireland (BDK)
guards to afford confidentiality. All
investigation and treatment proceeds 1 Nicholl D J, Atkinson H G, Kalk J, et al.
Force feeding and restraint in Guantanamo
only with consent. This declaration bay hunger strikers. Lancet 2006; 367: 811.
states that forced feeding of a prisoner 2 Baynes C. Nazanin Zaghari-Ratcliffe returned
to prison after psychiatric ward ‘torture’.
on hunger strike who has capacity is The Independent. July 22, 2019. https://www.
unethical. independent.co.uk/news/world/middle-east/
The UN has set down rules or nazanin-zaghari-ratcliffe-prison-iran-torture-
hospital-psychiatric-ward-tehran-
minimum standards for the treatment richard-a9016271.html (accessed Aug 1, 2019).
of prisoners. 4 These so-called 3 World Medical Association. WMA Declaration
of Malta on hunger strikers. 1991–2017.
Nelson Mandela rules benchmark clear https://www.wma.net/policies-post/wma-
standards around dignity, consent, declaration-of-malta-on-hunger-strikers/
and confidentiality. Prisoners have (accessed Aug 1, 2019).
4 UN Office on Drugs and Crime. The United
the same rights to confidential Nations standard minimum rules for the
consultation as any other patient. treatment of prisoners (the Nelson Mandela
rules). Dec 17, 2015. https://www.unodc.org/
Prisoners have a right to treatment documents/justice-and-prison-reform/
that does not constitute torture, Nelson_Mandela_Rules-E-ebook.pdf (accessed
inhuman, or degrading treatment. Aug 1, 2019).
5 Gulati G, Kelly BD, O’Neill C, et al. The psychiatric
For member states of the Council of management of prisoners on hunger strike:
Europe, prison conditions (including developing a management algorithm using the
Delphi technique. Intl J Prison Health 2019;
health-care provision) are inspected 15: 66–75.
by the European Committee for the
Prevention of Torture and Inhuman or
Degrading Treatment.
Doctors involved in assessing
prisoners on hunger strike make

www.thelancet.com/psychiatry Vol 6 November 2019 e27

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