Tuesday, February 20, 2018

Hunger strike — nothing new


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A hunger strike is said to be a method of non-violent resistance in which the participant fasts as an act of political protest or to provoke feelings of guilt in others. The participant usually will take liquids but not solid food. The objective is usually to achieve a specific goal, such as a policy change on a national scale. Most hunger strikes involve persons who are in custody such as prisoners or political detainees.

Hunger strikes have increased in popularity to such an extent over the last few decades that medical practitioners have had to address how they should deal with such persons. Some of their recommendations have changed with the times. For instance, it was acceptable in the past for hunger strikes in prison to be terminated by the authorities through force-feeding. This is no longer the case following the Revised (2006) World Medical Assembly Declaration on Hunger Strikes.

This Assembly, which is funded by international medical associations, attempts to provide a consensus of the ethics of how to treat with hunger strikes. The Assembly agrees that genuine and prolonged fasting risks death or permanent damage for hunger strikers and can create a conflict of values for physicians. An ethical dilemma, for instance, can arise when hunger strikers reach a stage of cognitive impairment. It is said that the principle of beneficence urges physicians to resuscitate them but respect for individual autonomy restrains physicians from intervening when a valid and informed refusal has been made.

The Declaration attempts to set out guidelines for medical practitioners to address such difficult situations. Among the guidelines is a requirement for physicians to assess the individual's mental capacity and verify that the striker understands the potential health consequences of fasting. Physicians should also explain how damage to health can be minimised or delayed by, for example, increasing fluid intake. Sometimes hunger strikers accept an intravenous saline solution transfusion or other forms of medical treatment. Treatment or care of the hunger striker must not be conditional upon suspension of the hunger strike.

Physicians should ascertain on a daily basis whether individuals wish to continue a hunger strike and what they want done when they are no longer able to communicate meaningfully. Artificial feeding can be ethically appropriate if competent hunger strikers agree to it. Forcible feeding is never ethically acceptable.

In India in particular it was used as a political weapon by Mohandas (Mahatma) Gandhi, an English-trained barrister, who led the movement for independence from British rule. In the course of so doing he was imprisoned in 1922, 1930, 1933 and 1942. He engaged in several famous hunger strikes to protest British rule of India. Because of Gandhi's stature around the world, British authorities could not allow him to die in their custody and jeopardise Britain's reputation so he was usually released from custody.

Apart from Gandhi others have used the hunger strike option during the Indian independence movement. These include Jatin Das (who fasted to death) and Bhagat Singh. After 116 days of fasting Bhagat Singh gave up his strike (surpassing the previous record of 97 days) when the British agreed to his wishes. After Indian Independence, freedom fighter Potti Sreeramulu used hunger strikes to get a separate state for Telugu-speaking people.

In the early 20th century suffragettes protesting the law which refused women the right to vote frequently staged hunger strikes in British prisons. The Irish republicans engaged in hunger strikes as early as the 1920s to protest their political situation under British rule. The Guinness Book of Records lists the world record in hunger strikes without force-feeding as 94 days set from August 11 to November 12, 1920 by John and Peter Crowley, Thomas Donovan, Michael Burke, Michael O'Reilly, Christopher Upton, John Power, Joseph Kenny and Seán Hennessy at the prison of Cork. The strikes were called off after the deaths of three of them.

In the 1981 Irish hunger striker Bobby Sands was the first of ten Irish republican paramilitary prisoners to die. Some of the hunger strikers were elected to both the Irish and British parliaments by an electorate who wished to register their support for them. The ten men survived without food for 46 to 73 days, taking only water and salt, before succumbing. After their deaths, the British government granted partial concessions to the prisoners and the strike was called off.

In February 2012, approximately 1,800 Palestinian prisoners held in Israeli prisons began a mass hunger strike in protest at the practice of administrative detention. At that time Israel was holding 4,386 Palestinian prisoners, of whom 320 were held in administrative detention. The demands of the hunger strikers included the right to family visits for prisoners from the Gaza Strip, the end of the use of extended solitary confinement and the release of those held under the administrative detention laws.

It was announced that the prisoners had agreed to end their hunger strike, having reached a deal with the Israeli authorities, brokered by Egypt and Jordan. Israel agreed to limit administrative detention to six months, except in cases where new evidence against a suspect had emerged; to increase access to family visits; and to return prisoners in solitary confinement to normal cells.

It is clear then that while hunger strikes are not new they are usually used as a non-violent means of protest against political oppression or illegal detention on a wide scale.

• Dana Seetahal is a former

independent senator