The Lancet has a great editorial today. It’s about the need for guidance for doctors who are asked to assess prisoners who are hunger strikers. They say that doctors should recognise that hunger strike may be the sole method of protest a prisoner has. People who are starving, however, may become confused and disorientated; the difficulty then is to decide whether the person is competent, with medical capacity to decline intervention. Intervention has and is used in this situation, for example in Guantanamo Bay, where prisoners have been, and are, force fed. However, says the Lancet, force feeding has no place in high quality medical care. Independent physicans are required to explain the risks to life that the striker is taking. However, advance directives written by a competent person should mean that if confusion afflicts a prisoner due to a chosen hunger strike, their preordained wishes should be followed.  

Force feeding is not nice. Dr David Nicoll, a neurologist in England, has done a huge amount to highlight this issue (correspondence between him and a previous commander of the Guantanamo military hospital is available here.) The picture of the ‘restraint chair’ that is used is especially harrowing. The bottom line is that individuals with mental capacity have the right to choose what medical care they want – and don’t want. Doctors have to respect that right.