Must Read: The Doctor's Guide to Force-feeding

Ethical concerns prompt Israel Medical Association to publish booklet for doctors treating hunger-striking Palestinian prisoners.

Ido Efrati
Ido Efrati
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Palestinian protesters showing solidarity with hunger-striking prisoners, June 12, 2014.
Palestinian protesters showing solidarity with hunger-striking prisoners, June 12, 2014.Credit: Reuters
Ido Efrati
Ido Efrati

The Israel Medical Association is set to publish a booklet advising doctors on how to treat hunger-striking prisoners. The guide will be distributed to physicians at the internal medicine wards where Palestinian prisoners are being treated.

“The Doctor’s Guide for Treating the Hunger-Striking Prisoner" discusses the bioethical issues and international conventions that prohibit force-feeding, and presents a model for monitoring and treating hunger strikers. The material is drawn from a conference on the subject held several weeks ago. The IMA has also opened a hotline for doctors who encounter medical or ethical quandaries when treating hunger strikers.

Dozens of administrative detainees are currently in hospitals around the country, having been on hunger strike for more than 50 days. A deterioration in their condition could pose ethical dilemmas for the medical profession. Meanwhile, the Knesset is fast-tracking a bill to permit the force-feeding of hunger-striking prisoners, a move that is drawing protests from physicians and human rights organizations.

The IMA has consistently viewed force-feeding as unethical. In a letter sent to emergency and internal medicine wards over the weekend, IMA chairman Dr. Leonid Eidelman wrote: “Every day, the number of hunger-striking prisoners sent from the prisons to the hospitals is growing. Treating them presents a special challenge that doctors have hitherto not encountered on such a scale.” Dr. Eidelman stresses that force-feeding poses a real risk to the health of the prisoners, runs counter to the Hippocratic principles of “Do no harm” and maintaining patient autonomy, and to the medical code of ethics.

The guide presents a treatment model based on four principles: The prisoner shall make his own decision about what is right for him, having been given a detailed explanation by the doctor about his condition and the available options; every medical action taken for the patient’s sake shall be in accordance with his worldview; no medical actions shall be taken that, in the patient’s view, could harm him, including force-feeding; and the prisoners should be fairly distributed among the country's hospitals, so as not to adversely impact the hospitals’ ability to function.

The guide outlines the stages of examination and treatment, and recommends dialogue with the prisoner. The idea is to create a kind of “contract” from the start, on the assumption that the prisoner wants to live and with the understanding that doctor and prisoner share a common goal – to prevent irreversible harm to vital organs and avoid life-threatening situations.

The guide also classifies different risk categories based on age, existing illnesses and the length of hunger strike, and stipulates that any sign of mortal danger or damage to vital organs requires that the patient be sent to a hospital. Once there, the guide outlines what tests should be done and medical action taken. “The last stage in the process is metabolic stabilization,” says Eidelman. “Eating after a prolonged fast can lead to ‘refeeding syndrome,’ in which too-rapid feeding can hurt the patient.”

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