Letting Hunger Strikers and other Patients Starve

 

Letting Hunger Strikers and other Patients Starve:

Using the history of medical ethics to understand current controversies

Dr Ian Miller.

Centre for the History of Medicine in Ireland, Ulster University

1800-1930, Thursday the 11th of May.

Edgar Graham Room (MST/02/002), The School of Law, Queen’s University Belfast.

Flyer [.pdf].

Abstract:

The force-feeding of Guantanamo Bay detainees has caused considerable debate. Opponents have depicted force-feeding as brutal; an act that would only be considered as a final resort in clinical practice. Images of patients being restrained and fed against their will clashes with 21st-century ethical sensibilities that privilege dignity and patient autonomy and dignity. Debates on such matters emerged as recently as February 2017 when an American court ruled that an anorexic, who subsequently died, should not be force-fed. However, ongoing debates about the feedings of elderly dementia patients and other anorexic patients suggest that society has developed contradictory and emotionally complex attitudes towards the idea of letting individuals starve to death.

This paper begins by exploring the suffragette hunger strikes of 1909 and 1914 which, for the first time, presented serious ethical questions about the extent to which doctors could intervene in the human body by imposing eating (with force feeding). It then uses less well-known historical evidence (relating to hunger strikes made by convicts, conscientious objectors, Cold War peace protestors and other prisoners) to shed light on questions such as: Is force-feeding therapeutic or coercive?

In 1975, the World Medical Association declared force-feeding as unethical, seemingly ending debates on the matter. However, this paper argues that rather than ending debates on the matter, the introduction of new feeding technologies and ethical dilemmas meant that artificial feeding practices proliferated and diversified since the 1970s. As social attitudes towards starvation (and withholding/withdrawing food in clinical care) are emotionally sensitive, diverse approaches developed in relation to anorexics, prisoners, the elderly demented and the comatose. The paper concludes that, today, doctors and society generally feels more inclined to feed rather than let starve, suggesting that Guantanamo feedings are not in fact as anomalous as they seem and that the historical transition from medical paternalism to patient autonomy was often intricate and fragmentary.

Ian Miller is a lecturer in medical history at the Centre for the History of Medicine in Ireland, Ulster University. He recently published A History of Force Feeding: Prisons, Hunger Strikes and Medical Ethics, 1909-74 with Palgrave Macmillan. His other historical research focuses on areas including the history of stomachs, food, diet and nutrition.