Hunger strike in prison: medical, ethical and legal aspects

A hunger strike is a common form of protest in prison and is a potential cause of many types of problems, both for facility administrators and health care staff. Issues of conflict of rights and obligations involved, and how to treat people who are subject, have created major controversies.

To identify and review published studies that discuss the medical, ethical and legal considerations of managing a hunger strike in a prison setting from a physician's perspective.

A database search using "Medline" "Ovid" and "Science Direct was conducted to identify relevant publications. We included case series, guidelines and, review articles.

The physician must clearly inform the striker of the risks and provide clinical assessment and regular monitoring of the concerned. The role of the psychiatrist is to detect an initial mental pathology underlying or secondary to fasting and assess the capacity of the striker's judgment. Thus, the clinician is faced with two paradoxical obligations: to assist and respect the striker's will. In addition, medical intervention is possible if the prognosis is life-threatening even without the patient's consent.

The current practice of non-consensual attitude among hunger-striking seeking in detention needs a closer inquiry. Medical practitioners should be aware of their ethical and legal responsibilities, and that they should act independently of government or institutional interests.