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Hunger strikes in prisons: a narrative systematic review of ethical considerations from a physician’s perspective

  • G. Gulati (a1) (a2), B. D. Kelly (a3), D. Meagher (a2), H. Kennedy (a3) (a4) and C. P. Dunne (a5)...

We sought to identify and review published studies that discuss the ethical considerations, from a physician’s perspective, of managing a hunger strike in a prison setting.


A database search was conducted to identify relevant publications. We included case studies, case series, guidelines and review articles published over a 20-year period. Non-English language publications were translated.


The review found 23 papers from 12 jurisdictions published in five languages suitable for inclusion.


Key themes from included publications are identified and summarised in the context of accepted guidelines from the World Medical Association. Whilst there seems to be an overall consensus favouring autonomy over beneficence, tensions along this fine balance are magnified in jurisdictions where legislation leads to a dual loyalty conflict for the physician.

Corresponding author
*Address for correspondence: G. Gulati, Consultant Psychiatrist, Department of Psychiatry, University Hospital Limerick, Limerick, Ireland and Adjunct Senior Lecturer in Psychiatry, Graduate Entry Medical School, University of Limerick, Ireland. (Email:
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Anonymous (2014). AJOB case presentation: hunger strike or suicide by starvation: is force feeding a prisoner ethical? American Journal of Bioethics 14, 46.
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Bob, YJ (2016). Israel’s High Court: forced feeding of hunger striking detainees is legal, The Jerusalem Post, 11 September ( Accessed 25 January 2017.
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Crosby, SS, Apovian, CM, Grodin, MA (2007). Hunger strikes, force-feeding, and physicians’ responsibilities. Journal of the American Medical Academy 298, 563566.
Dahlberg, J, Dahl, V (2015). Asylum seekers on hunger strike – how far does the patient’s right to refuse treatment go? Tidsskrift for Den Norske Laegeforening 135, 4547.
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Fayeulle, S, Renou, F, Protais, E, Hedouin, V, Wartel, G, Yvin, JL (2010). Management of the hunger strike in prison. Presse Medicale 39, e217e222.
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Irmak, N (2015). Professional ethics in extreme circumstances: responsibilities of attending physicians and healthcare providers in hunger strikes. Theoretical Medicine and Bioethics 36, 249263.
Kenny, MA, Silove, DM, Steel, Z (2004). Legal and ethical implications of medically enforced feeding of detained asylum seekers on hunger strike. Medical Journal of Australia 180, 237240.
Martin, J (2010). Hunger strike – imperative forces in conflict. Revue Medicale Suisse 6, 15621563.
McKinney, EB (2008). Hard time and health care: the squeeze on medicine behind bars. Virtual Mentor: American Medical Association Journal of Ethics 10, 116120.
Oguz, N, Miles, S (2005). The physician and prison hunger strikes: reflecting on the experience in Turkey. Journal of Medical Ethics 31, 169172.
Rieder, J, Huber-Giseke, T, Getaz, L, Kramer-Gauchat, M, Nyffenegger, L, Gaspoz, J, Wolff, H (2010). Hunger strike and forced feeding: a historical look at medical practices. Revue Médicale Suisse 6, 23132318.
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World Medical Association (2006). World Medical Association Declaration on Hunger Strikers, Adopted by the 43rd World Medical Assembly Malta, November 1991 and revised by the WMA General Assembly, Pilanesberg, South Africa 2006 ( Accessed 6 March 2017.
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Irish Journal of Psychological Medicine
  • ISSN: 0790-9667
  • EISSN: 2051-6967
  • URL: /core/journals/irish-journal-of-psychological-medicine
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