Doctors come out against bill to force-feed prisoners

Doctors associations object because it places responsibility on physicians to carry out invasive treatment of prisoners in spite of their preference and right to autonomy.

By JUDY SIEGEL-ITZKOVICH
Eshel Prison (photo credit: ISRAEL PRISON SERVICE)
Eshel Prison
(photo credit: ISRAEL PRISON SERVICE)
The Israel Medical Association and Physicians for Human Rights-Israel protested against the cabinet’s decision on Sunday to approve the renewal of the legislative process to allow force-feeding of hunger-striking prisoners.
IMA chairman Dr. Leonid Eidelman wrote to Public Security Minister Gilad Erdan and Justice Minister Ayelet Shaked to object to the cabinet pushing through the bill, which was removed from the agenda of the 19th Knesset after it was passed on its first reading. The legislation would make it possible to obtain a court order to give medical treatment and/or forcefeed against the hunger striker’s will and even his active opposition.
A number of security prisoners are refusing to eat [and receiving only liquids], and one of them has been doing so for a “long time and was hospitalized,” said Eidelman. Suddenly and speedily reapproving the bill for Knesset handling will “place doctors who treat prisoners in impossible situations,” he added.
The doctors associations object because it places responsibility on physicians to carry out invasive treatment of prisoners in spite of their preference and right to autonomy. The bill thus contravenes the Patients’ Rights Law (1966), said Eidelman, as well as medical ethics accepted in both Israel and the rest of the world. Physicians are sworn to uphold the principle of “non-maleficence,” that is, the obligation of the physician not to inflict harm intentionally.
Thus, doctors will face complicated and difficult ethical dilemmas if the bill passes.
The IMA accepted the Tokyo Declaration in 1975 and the Malta Declaration in 1991, both of the World Medical Association, which specifically anchor the prohibition of forcing hunger strikers to eat against their will.
Not only force-feeding by using a food tube is prohibited, said the IMA chairman; feeding the prisoner intravenously when he is capable of deciding for himself whether to get nutrition is unethical. In recent years, Israeli doctors have amassed much experience in treating security prisoners and hunger strikers “and didn’t have to use such drastic measures and violate ethical rules,” he said.
In fact, the bill “is not realistic, and it will not solve any problem,” Eidelman stressed. “It creates the illustration that with such a law, one can prevent harm to the health of hunger strikers – but it doesn’t actually do so. We will not agree to such a law that places physicians at the front where they don’t belong, both as a group and as individuals, in complete contravention to their professional and ethical responsibilities.”
The bill was erased from the agenda of the 19th Knesset, said the IMA chairman, because the medical association opposed it “fiercely and systematically and because the large hunger strike that prisoners held last year ended without a single one dying or suffering chronic harm.”
As part of the IMA’s professional struggle last time, it held a conference on how to treat prisoners and detainees who carry out hunger strikes. It was attended not only by doctors but also by senior Health Ministry, Prisons Service and Red Cross officials as well as medical ethicists and senior medical administrators. It concluded with a consensus that forced medical treatment including feeding is prohibited.
Copies of his letter went to the deputy health minister, the attorney-general, the Knesset legal adviser, IMA officials and Physicians for Human Rights-Israel, which sent its own letter of protests to the government and urged doctors to continue to oppose the legislation.