According to article 21 of the World Medical Association (WMA) Declaration on Hunger Strikers:
Forcible feeding is never ethically acceptable. Even if intended to benefit, feeding accompanied by threats, coercion, force, or use of physical restraints is a form of inhuman and degrading treatment. Equally unacceptable is the forced feeding of some detainees in order to intimidate or coerce other hunger strikers to stop fasting.
What if applied to people with eating disorders, or on food tubing for life support who cannot give consent?
What’s your view?
Medically incompetent individuals who refuse to eat due to neuropsychiatric disorders, such as severe depression or Anorexia nervosa, and with no goal in mind other than their own death, would not qualify as legitimate hunger strikers.
Force-feeding is acceptable if it applies only to those who are not actually on hunger strikes, which according to the International Committee of the Red Cross requires “fasting, voluntariness, and a stated purpose,” but who have stopped eating because of a mental illness, such as depression. If and when such feeding is necessary to sustain their lives or health, these individuals can be considered incompetent to refuse treatment, including forced feeding.
In terms of those on life support, if, as assessed by well-qualified professionals, a patient’s brain functioning is minimal and future quality of life low, then it would be unethical to prolong life support via artificial means. Were a patient to become quadriplegic and lose the ability to move, communicate, and breathe without a ventilator, it would be not unacceptable to withdraw treatment. A death surrounded by loved ones is better than one from bedsores, infection, and pneumonia. Ultimately, given the realistic possible outcomes, it is up to the family to decide. Another Terri Schiavo case would not be in the interest of the patient.
What are your thoughts on this question?
Should physicians take charge to make lethal injection deaths less painful? If an inmate requests the involvement of a physician to prevent suffering, would physician involvement be a violation of medical ethics?
But is there a quantitative way to diagnose eating disorders?
http://www.mdconsult.com/das/pdxmd/body/215130964-3/1040535994?type=med&eid=9-u1.0-_1_mt_1014406#620367
View from an institutional IP address.
Your ideas are interesting, and neat link. I wonder how consistently physicians/psychologists/psychiatrists can diagnose someone who’s not obviously afflicted – has some symptoms, or moderate symptoms, and is happy living the way they do. My attitude towards DSM is…skeptical and wary.
I don’t know much about ethics or policy, so I don’t know what the status quo is. That’s probably good, because I don’t have a crutch. XD
I think force-feeding for the purpose of keeping someone alive is acceptable if they cannot give consent – someone unconscious, nearing death in an emergency situation, or having severe dementia, etc. And yes, if their condition deteriorates so that there is effectively no chance that they can lead a satisfactory life, they could and should be removed from it.
force-feeding someone who gives negative consent is less justified to me. chronically force-feeding a person with anorexia is too close morally to force-feeding a person on a hunger strike. People with anorexia do have a specific goal: to stay skinny and look good. Just as feeding hunger strikers would go directly against their goal of appealing to pity and humanity to get what they want, feeding a person who believes they need to eat morsels to stay skinny is directly going against their goal of staying beautiful.
but it sounds cruel and sad, even as I’m saying it.
Another question: what do you think government should do when hunger strikers are demanding something completely unacceptable, and are nearing death?
I agree: the DSM is sketchy (e.g, post-menopausal depression), and very American. Some have wondered whether questionable new symptoms in updated editions of the manual benefit the pharmaceutical industry.
We must distinguish the difference between a hunger-striker and an individual with Anorexia nervosa. A hunger-striker is in control of the situation and willingly refuses to eat in order to protest. Force-feeding a hunger-striker is torture and used as punishment because the prisoner is competent to refuse consent for “treatment”, during which an individual is restrained and force-fed in specially designed prisoner-transfer devices.
On the other hand, an individual who has been diagnosed with Anorexia nervosa is not in control of the situation and suffers from a disorder which is highly dysfunctional and potentially lethal. Although one’s desire to be “skinny” and “beautiful” may have initially contributed to the development of the disorder, biological factors and neuroanatomical differences also play an organic role. That being said, I believe the artificial feeding of an individual with Anorexia nervosa is ethical because the patients are incompetent to refuse consent and that harm would be done by not intervening with treatment, which is performed in a clinical setting with patient comfort being priority.
To address your question, the degree of unacceptability of a demand is subject to a government’s perspective and its interests. Giving the people democracy, as demanded by the hunger-striking students of Tiananmen, is completely unacceptable to the Chinese government. Ending the inhumane treatment and illegal detention of prisoners, as demanded by the hunger-strikers of Guantanamo Bay and in accordance with the Geneva Conventions, is completely unacceptable to the American government. I don’t have the answer to your question, but it is unethical for health care professionals to provide their service and part-take in the advancement of political interests of governments, whether it is force-feeding hunger-strikers or providing comfort to death-row inmates during their execution.
Interesting ideas, and I see that you’re grouping Anorexics with the first group in my dichotomy (unable to give consent). I suppose that anorexia, like most psychological disorders, varies in severity. Anorexia is also an unfortunate disease in that it’s publicized to be a very frivolous affliction. I have to say that the anorexics I have in mind are mild ones who believe what they’re doing is healthy and right, and hate their body after they return to a healthy weight. Which is another question: is there a difference between anorexics seeking some kind of help to get out of their habits and those believing what they’re doing is the right choice for themselves? in other words, if they’re happy and not hurting anyone else, what is the ethical thing to do?
I agree that unacceptability is subject to individual perspectives, but so are ethical decisions – which is why I categorized the demand as something arbitrarily unacceptable instead of any single type. But suppose, for the sake of moral argument, that a large group of hunger strikers are demanding the death of several officials have been involved in transgressions (which are not punishable by death). They will not yield to the legal system or let it handle their transgressions. They are going to die within the week if those officials are not captured and shot. What should a good government do?
When no common ground exists between two parties, every solution is undesirable. It’s easy to say how any one path is bad, but I’d be interested in what people to be consider the better path.
To be honest, I’d rather that Tiananmen officials fed the students instead of shooting them.
Sorry about my late response!
I guess it depends on how we define someone as being “happy and not hurting anyone else.” Individuals with bipolar disorder may be, indeed, extraordinarily happy during maniac episodes and not necessarily hurting others, but are very ingenious and productive at taking away their own lives during mixed episodes.
I agree that it would be better to provide the students with food rather than bullets. If they were, however, force-fed against their wishes in the interest of maintaining the image of the government, such actions are unethical and would amount to torture.