Emedinews:Insights on Medicolegal Issues:WMA declaration of Malta on hunger strikers

Such difficult ethical situations in medical practice and the guidelines to deal with them have been addressed thoroughly in the revised WMA Declaration of Malta on hunger strikers with principles of Duty to act ethically, in 2006. All physicians are bound by medical ethics in their professional contact with vulnerable people, even when not providing therapy. Whatever their role, physicians must try to prevent coercion or maltreatment of detainees and must protest if it occurs. The other important component is respect for autonomy. Physicians should respect individuals’ autonomy. This can involve difficult assessments as hunger strikers’ true wishes may not be as clear as they appear. Any decisions lack moral force if made involuntarily by use of threats, peer pressure or coercion. Hunger strikers should not be forcibly given treatment they refuse. Forced feeding contrary to an informed and voluntary refusal is unjustifiable. Artificial feeding in form of intravenous fluid/nutrition with the hunger striker's explicit or implied consent is ethically acceptable.