International Force... Feeding

Newspapers across Europe and the U.S. reported yesterday that high-profile prisoner Vojislav Seselj, held on charges of war crimes, would be force-fed if his condition continued to deteriorate. Seselj is nearly three weeks into his proposed hunger-strike, protesting conditions instituted by The Hague which include limited visitation rights by his wife and family.

Seselj is being held on charges of conspiratorial acts promoting ethnic cleansing and the expulsion of all non-Serbian peoples from the Balkan territories under their control in the early 1990’s.

The spokesman for the UN War Crimes Tribunal announced yesterday that there was “grave concern” for the health of the prisoner, and that if necessary, they were prepared to take steps in order to intervene.

A statement issued by the tribunal and quoted in BBC’s December 6th article, clarifies: "The trial chamber ordered the authorities of the Kingdom of the Netherlands to provide medical services - which may in the case of medical necessity include intervention such as drip-feeding - with the aim of protecting the health and welfare of the accused and avoiding loss of life." (http://news.bbc.co.uk/2/hi/europe/6214862.stm)

The issue, however, is a bit stickier than the statement seems to imply. Similar issues have been under public watch recently- in the case of prisoners at Guantanamo, the United Nations stood to uphold the rights of those on hunger strike, essentially proclaiming force-feeding unethical and a violation of international law. Further, if the hunger-striker is deemed able minded at the time of statement, he or she can refuse future medical treatment even it is the final avenue to saving his or her life.

This last bit is especially conspicuous here, as it has also been reported that just before Seselj’s transfer to a hospital Wednesday, he issued a handwritten statement explicitly rejecting all medical treatment.

Seselj’s supporters from the Serbian Radical Party (SRS), an organization he leads and to which he has recently been reelected in his absence, claim the tribunal is acting irresponsibly. One article quotes a spokesman for the SRS, “Seselj has grave kidney problems and we're seriously concerned for his life.” Among the party there is popular demand for the leader to be moved closer to home; to a hospital in Belgrade.

In 1991, the World Medical Association issued their “Declaration of Malta,” a detailed statement essentially banishing the practice of force-feeding under distinct circumstances. A link to the form can be found on Amnesty International’s website: http://web.amnesty.org/pages/health-ethicswmahs-eng

Essentially, the declaration puts the desire of the hunger-striker first, although in rather runny, ambiguous terms to my eye. One section of the preamble, however, does seem abundantly clear.
It states, “The ultimate decision on intervention or non-intervention should be left with the individual doctor without the intervention of third parties whose primary interest is not the patient's welfare. However, the doctor should clearly state to the patient whether or not he is able to accept the patient's decision to refuse treatment or, in case of coma, artificial feeding, thereby risking death. If the doctor cannot accept the patient's decision to refuse such aid, the patient would then be entitled to be attended by another physician.” (reference link above)

Without little relevant working knowledge of international law and the procedures recognized or followed by The Hague, I feel I can’t draw any definitive lines on the proper course to follow in the case of the striking Seselj, but am obliged to allow the referenced information speak for itself.
It will be interesting indeed to see what type of example The Hague chooses to set next.