Hunger strikes

The management of hunger strikes in correctional settings presents the psychiatrist with unique clinical and ethical challenges. The potential for such complex tensions between medical decision-making and medical ethics rarely exists in other practice settings. A physician’s primary consideration involves the health of their patient and respect for human life. The correctional psychiatrist treating or evaluating a hunger striker may be involved in medical decisions that lead to opposite extremes, from death by starvation to forced-feeding. Concepts such as respect for human life, respect for patient autonomy, beneficence, and non-maleficence present new and difficult considerations in the context of a correctional hunger strike. The psychiatric evaluation and treatment of hunger strikers within the management protocols of the institution is discussed. The lack of international consensus in this area is reviewed. Participating in the management of a hunger-striking prisoner can pose clinical and ethical dilemmas for the correctional psychiatrist. The psychiatrist should have a clear understanding of the international guidelines for physicians on the ethical management of hunger strikes and their institution’s policies and procedures regarding hunger strikes and force-feeding. Consultation with experts in the field may be of assistance in balancing potentially conflicting roles and responsibilities. This chapter provides correctional psychiatrists with the historical, clinical, legal, and ethical background for working with hunger strikers.