Ethical and medico-legal problems concerning so-called hunger strikers

In the Middle European medico-legal climate, the moral rule 'salus aegroti suprema lex' has been accepted for a long time. In the last few years, under the pressure of fear of accusation of a paternalistic attitude, this postulate has been changed to 'voluntas aegroti suprema lex'. The question stands: Is this valid in each case and in all the situations? For example, it is possible to use compulsory treatment with those who have not given their informed consent. Even the charter of basic human rights and freedom states in its article 6 that everyone has a right of life. The law specifies in which cases an individual can be accepted or can be held in a health care institution without his/her consent. In cases of so-called 'hunger strikers', the strikers refuse food and expose themselves to extreme starvation in order to reach some political goals or to express their views. If, in such situations, the patient endangers his/her life, the physician who is facing this problem is, according to Czech law and similarly to some other Central European laws, and according to the Ethical Code of the Czech Medical Chamber, bound to act to protect and restore the life and the health of that person. The Health Care Act No. 540/1991 of the Czech Republic states the obligation to provide emergency care to anyone whose life or health is threatened. Compulsory treatment is possible, for example, if an individual shows signs of mental disease or if an intoxication threatens him or his neighbourhood.(ABSTRACT TRUNCATED AT 250 WORDS)