Art Caplan: Force-Feeding A Starving Inmate Violates Medical Ethics

Art Caplan's recent trip to Ireland prompted him to pen this Op Ed in the Hartford Courant on Prisoner's Rights:

Earlier this year, I spent a week in Belfast, Northern Ireland. While there, my wife and I took a tour of the city focusing on the events surrounding "The Troubles" -- the bitter fight by the Irish Republican Army to gain independence from Britain.

The troubles have, happily, been resolved by goodwill and diplomacy, but you cannot go far in downtown Belfast without being reminded of the price that was paid. Everywhere in Catholic neighborhoods, there are huge murals remembering the 10 men who died in the 1981 hunger-strikes and the more than a dozen who died in earlier starvation protests. Prisoners in Northern Ireland and elsewhere have long used hunger strikes as a last-ditch form of protest. Now, William Coleman is doing so in a Connecticut prison. The issue is should prison authorities force-feed him?

I think not.

William Coleman is at the Osborn Correctional Institution in Somers. The 48-year-old Coleman is serving an eight-year sentence for rape. Coleman says he was unjustly convicted. In protest, he has gone on a hunger strike, which during the past year has caused him to lose more than 100 pounds.

Recently, he took a turn for the worse. Prison officials, fearing for his life, sought and received a court order giving them the right to force-feed Coleman by giving food and water intravenously. They are wrong. Competent prisoners should not be fed medically against their will.

Feeding Coleman or any other prisoner will require a doctor, nurse or other medically-trained prison worker to use restraints while inserting needles carrying artificial nutrition into the body. Feeding of this sort, as the U.S. Supreme Court recognized in the 1990 case of Nancy Cruzan, a young woman in a permanent coma whose relatives wished to discontinue her feeding tube, constitutes medical treatment. And that makes force-feeding any competent adult against their will unethical.It is a long-established right, both in the United States and under international law, that a competent person may refuse any and all forms of medical treatment including artificial food and water on religious or personal grounds. A competent, adult Jehovah's Witness does not have to accept a blood transfusion even if it means leaving behind a widow and children. A severely ill Christian Scientist, who understands the consequences and risks, can, if competent and an adult, say "no" to life saving care, including feeding tubes. You can decide that you do not want to be a patient and leave any hospital or nursing home as long as you are making an informed and competent choice. And so can a prisoner.

Some would argue that refusing food and water is an act of suicide and prisons do not have to accept suicides on the part of inmates. But a hunger-strike is not a suicide attempt. It is an act of protest. Coleman himself says he does not want to die, but he is willing to in order to draw attention to what he believes is his unjust conviction. Risking death is a means to an end. The end may be horrific, but even prisoners have the right to refuse medical care to make their point.

The World Medical Association specifically prohibits force-feeding as does the American Medical Association. No prison worker at Osborn should become involved in carrying out the court order to feed Coleman. Whether the courts want to reconsider his case or not, he is well within his rights to decline medical treatment.

Prisoners do not have many rights while in jail. But, one right they do have is the right to protest including the decision not to eat or drink. As horrible as it is to watch someone starve when they need not do so, the state of Connecticut should accept that a competent prisoner may make that choice. I hope that Coleman decides that he has made his point and ends his hunger-strike. But it is not right to use medical treatment to force him not to do so.

The original article can be found here.