The leadership of the Israel Medical Association, and a number of civil rights organizations, have forbidden physicians to feed hunger-striking prisoners without their consent, under threat of potential trial for human rights violations. I would like to take strong issue with this position.
My contention is in line with the decision of District Court Judge Sara Sirota who ruled in 2005 that the Israeli Supreme Court and legislature have ruled that in the case of a conflict between the right to life and that to dignity, the right to life and health is given priority.
In this ruling she quoted the ruling by Supreme Court Justice Moshe Beisky who said in a precedent-setting judgment that in our culture we cannot abide by the rigid rules against treatment of a patient without consent if non-treatment will result in certain permanent injury or death.
The United States Supreme Court, too, stated, “We do not think a state is required to remain neutral in the face of an informed and voluntary decision by a physically able adult to starve to death,” and just a few weeks ago an American federal court judge permitted force-feeding of a prisoner, stating that “we cannot allow him to die.”
In the face of hunger-striking prisoners there are three potential approaches: 1. Permit them to continue to fast until permanent disability or death – this approach was taken by Margaret Thatcher in the face of hunger-striking Irish prisoners, by the apartheid regime of South Africa toward black prisoners, and by the Turkish government towards Kurdish hunger- strikers. Hundreds of prisoners died in these countries. Shall Israel follow the lead of these countries? Are these appropriate role models for our society? 2. Acquiesce to the demands of the strikers – such action makes hunger striking the ultimate weapon of prisoners to achieve almost any demands, leading to total anarchy in the prisons.
3. Imposing feeding of the prisoners against their will. The opponents refer to this kind of feeding as “torture.” But many of us physicians have personally undergone placement of nasogastric tubes as part of our training. It is not a pleasant experience, but by any objective criterion prolonged fasting until death unquestionably imposes much greater suffering.
Professor George Annas, of Boston, one of the world’s experts on medicine and law, has written, “We restrict the rights of prisoners in many ways. Force-feeding them rather than permitting them to starve themselves to death is probably one of the most benign.”
These considerations are relevant in every democratic country. But I believe that it is permissible, and perhaps mandatory, for each country to act according to its unique culture. Unlike many countries, including the United States, we do not impose death sentences even for the most heinous crimes, and appropriately so. Our law entitled “Do not stand idly by your neighbor’s blood” mandating every citizen to come to the aid of even a stranger in danger, does not exist in the United States. There the culture of individualism is predominant whereas we are more of a communitarian culture. The death of any individual adversely affects us all.
What are my practical suggestions? We should definitely permit prisoners to engage in hunger strikes to protest their grievances, since at times that may be their only way to bring their situation to the public. But we must make it clear to them up front that under no circumstances will we allow them to endanger their lives and health; that when they reach a stage of danger to themselves they will be hospitalized and fed even against their express will.
I believe that this approach represents a humane, ethical and Jewish approach which respects human life in the spirit of our culture.
The author is professor (emeritus-active) of medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba.