Lessons
1 Definitions
2 Perspectives
3 Guidelines
4 Hunger Strikes

Test lesson 3
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Hunger strike - International guidelines and medical management

Dual loyalties and false medical counseling

Pressures may also be exerted by the prison authorities on the prison doctor in a hunger strike. Even in democratic regimes, prison authorities often do not accept a protest that challenges order and security in their custodial setting. The pressure may be to try to influence the prison doctor either to stop the hunger strike, or, worse, to have him threaten force-feeding or actually carry it out, in the most extreme cases.

Hunger strikes obviously only work in those countries where human rights are respected. A totalitarian regime will usually never allow a hunger striker to advertise protest fasting. Any spectators (if tolerated at all) would not be in a position to exert any pressure either. A fatal outcome of a hunger strike under such a regime would not bear any moral pressure at all on authorities in a society where the individual's life has little value.

Physicians working for prison administrations are most often not independent. Even if they are fully aware of the ethical implications of a terminal hunger strike, often they will not be in a position to oppose administrative decisions imposed on them by the prison authorities, or possibly from even higher up.

Outside medical associations, a fortiori international ones such as the World Medical Association , have a duty to inform prison medical personnel of existing ethical guidelines that should be respected at all times and to provide support for them when they do so! At the local level, independent physicians ideally should be permitted to counsel hunger strikers, in the interest of all involved, and obviously to try to avoid any fatal outcome. Some countries do allow this, and these physicians' independent status ensures their credibility as acceptable intermediaries for all parties concerned.


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