1 Definitions
2 Perspectives
3 Guidelines
4 Hunger Strikes

Test lesson 3
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Hunger strike - International guidelines and medical management

International guidelines for physicians involved with hunger strikers

The World Medical Association (WMA) has issued two declarations that deal with force-feeding and hunger strikes. The 1975 Tokyo Declaration – which sets down that physicians should never condone or participate in torture – clearly states that hunger striking prisoners should not be force-fed in order to be sent back to torture. This is the meaning behind article 5 of the Declaration, which should thus be taken within this specific context. See Tokyo Declaration

The 1991 WMA Malta Declaration deals specifically with hunger strikes and gives some leeway to the treating physician, who should have the final word in deciding what is best for the patient, all factors being taken into consideration. Any force-feeding is out of the question – the most a physician can decide, according to Malta , is to artificially feed a hunger striker no longer capable of sound judgment because of advanced fasting, so as to give him or her a second chance. See Malta Declaration.

The Malta Declaration does not give guidance as to what is to be done in such a case – admittedly a rare situation. If after reanimation, the person on the hunger strike still decides to pursue total fasting, the physician should not artificially feed the person again, thereby creating a ‘yo-yo' situation amounting to a form of medical coercion. It would arguably be best, in such a case, for the physician to step back and let the hunger striker die in dignity. Some doctors, however, for personal or religious reasons, refuse to let a hunger striker die, and reject such a solution. In many cases, these doctors see total fasting as a form of suicide. This point is taken up further on.

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