Hunger strikes

Can the Dutch teach us anything?

A hunger strike “is an age-old ritual act which can serve so many motivations and exigencies that it can be as corrupt as it can be sublime” noted Erikson in his study of Gandhi's nonviolent tactics.1 Within the past few years there have been well publicised hunger strikes for various causes in many countries, including the United States, the former Soviet Union, China, South Africa, Sudan, Poland, the former Yugoslavia, Bangladesh, France, Egypt, Canada, Israel, and the Netherlands.

Although deaths are rare, the power of the hunger strike comes from the striker's sworn intent to die a slow death in public view unless those in power address the injustice or condition being protested about. Hunger strikers are not suicidal and would greatly prefer responses to their demands. The most intractable hunger strikes, from a human rights and medical ethics perspective, are those carried out by people in the custody of the state, usually in prisons or other detention centres. In this context deaths have occurred--most notably those of 10 Irish hunger strikers in Maze prison in Northern Ireland in 1981.

Hunger strikers present two primary ethical issues for doctors--when is it …