The Ethicist - Is it O.K. to Force-Feed Prisoners?

I believe medical professionals should act ethically. However, I’m not sure it’s unethical to force-feed prisoners on hunger strike. Setting aside the issues associated with incarceration (and Guantánamo Bay in particular), is it ethical to allow a prisoner to die of starvation, even if that is his/her choice? Or is it more ethical to force-feed them? Most suicides are, at least in part, caused by depression or other mental-health issues. I also realize that prisoners choosing starvation may be making a political statement, and it might be unethical to squelch their political speech. What do you think? SHELLEY MARKS, LOS ANGELES

As noted in your letter, there tends to be a mental-illness component to this type of problem (and that makes an inflexible answer difficult). My superficial reaction is to argue that a prisoner’s ability to rationally explain his or her actions ought to dictate how prison authorities respond — in other words, if the prisoner can present a cogent justification for going on a hunger strike, she should be able to proceed without interference. But there are problems with this view. For one thing, an insane person could still present a wholly sane argument for not eating in prison. There’s also the possibility of a Catch-22 situation: If the prison medical staff operates from the position that wanting to hurt yourself on purpose is a reflection of mental illness — and if they dictate that mentally ill people cannot be allowed to hurt themselves — the act becomes axiomatically impossible.

So let’s remove the specter of insanity.

Let’s suppose we have a prisoner in Guantánamo Bay who is irrefutably sane and has voluntarily elected to stop eating. He is asked, “Why are you doing this?” His answer to that question should dictate the medical response — and not just based on the subjective rationality of his explanation. The motive is what matters. “Hunger striking is a peaceful political activity to protest terms of detention or prison conditions,” write the bioethicist George J. Annas and his colleagues at Boston University. “It is not a medical condition.” In other words, if a person is refusing food to illustrate a social point, the stakes are different. That person is not really trying to kill himself; that person is using the deterioration of his body as a means of making a public argument, typically because he has no other mode of expression. In this case, a feeding tube should not be employed.

Now, this changes if the prisoner’s response to “Why are you doing this?” is not a political activity. If the prisoner states that his reason for not eating is that he has simply lost the will to live, the medical staff would be forced to view that action as a slow suicide attempt. I mean, if a man was trying to hang himself in his cell, they would obviously cut him down — a prison is responsible for the people it holds. So if it’s holding a man who’s not eating for the sole purpose of starving himself to death, authorities should intercede at the point where his life is clearly in danger.

Certainly an ethical issue is dealt with here. Is it unethical to force-feed prisoners even if they are against it? Well for me, the answer seemed clear at first. Dealing with my own biased argument, I would take the side that prisoners should not be force-fed and should be allowed to continue their so-called “hunger-strike”. However while re-reading and analyzing this issue, I remarked that the answer might not be so simple as it does become a dilemma between morals and ethics in the sense that we essentially cannot be sure of what is right and what is wrong.

In response to this issue, the Ethicist brings in a rather valuable idea – toughening the conclusion process. This idea is the one of Catch-22, which deals with mental illnesses. Therefore, if the prisoner at hand is in fact mentally ill, then force-feeding is essentially impossible and restricted. However, this should be proven at first or else the answer to this issue would ultimately be inconclusive – creating no resolution.

Another idea that, in essence, makes this problematic is the whole concept of freedom of speech and the illustration of a social/political point. As the Ethicist explains, “if a person is refusing food to illustrate a social point, the stakes are different. That person is not really trying to kill himself; that person is using the deterioration of his body as a means of making a public argument, typically because he has no other mode of expression.” Hence, in other words, if the prisoner is not mentally ill, and is simply trying to prove his political belief, then force-feeding is not necessary. So basically, the Ethicist is making the claim that it is only unethical if one is mentally ill, and if he is not, then is it ethical? Well that is where confusion arises and where taking sides will be essential. 

The question is very explicit as it only focuses on ethics. In fact, the question asks whether it is UNETHICAL to force-feed prisoners. Hence, morality almost plays a minor role in this. After deep thought, I came to the sudden realization my sides had somewhat changed. At first, I believed it was unethical to force-feed prisoners. However, I now believe that the intentions behind it are more convincing. My reason to believe this is fairly simple. When criminals are sentenced to prison time, it is a punishment. The X number of years in prison should make them realize their mistakes and hopefully improve upon them. Consequently, as dreadful as this sound, hunger strikes are an easy way out.  Society has put the idea that prison is almost this path to redemption into us and, in my biased opinion; it is hard to believe otherwise. In conclusion, taking sides on such an issue is quite arduous. To be frank, I still have not figured which side I am on. I agree with the Ethicist in the sense that it depends whether the subject at hand is mentally ill or is just trying to illustrate a mere social and/or political point. This proves to be an excellent TOK issue as it primarily revolves around the ideas of ethics, bias, generalizations, and of course, assumptions. The dilemma created by this issue is one so immense that countless hours of discussion and debate could be essentially created from this.