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The links between situations of torture and hunger strikes in the context of imprisonment will also be reviewed, leading to a discussion on the two World Medical Association declarations that specifically deal with hunger strikes. Finally, it will make a case for respecting the informed decision to accept or refuse medical assistance made by prisoners whose fasting is a genuine last resort protest in custodial settings.
The declaration essentially forbids any medical participation whatsoever in any form of torture or cruel, inhuman or degrading treatment. It also states that doctors should not participate in the force-feeding of prisoners.
Defining categories and issues. It has already been said that hunger strikes do not just involve people in custody. Fasting has been used as a visible means of protest in many cultures at least since Roman times. Hunger strikes by protesters not actually in custody can take various forms, but are not the issue here.
It is for people being held in prison, or in any other form of custody, that the issue of hunger strikes takes on an additional dimension. This is particularly true in countries where individual rights, or even human rights in general, are perhaps not fully respected.
Fasting in such cases may become the only means of protesting against, or demanding attention from, the authorities. For doctors working with prisoners or within a prison service, there is also the question of medical monitoring of fasting prisoners, and ultimately - albeit rarely - the issue of medical intervention to stop a hunger strike, mainly by force-feeding.
Before discussing the effects of fasting and its ethical implications, it is first of all necessary to define the very different situations involved. Prisoners and prison authorities know this, and both may use the confusion created by this general and confusing term to their own advantage. Hunger strikes have always been associated with some form of protest.
In early twentieth- century Europe, they were brought into the public eye by the suffragette movement in Great Britain. It was in this context that the controversial medical act of force-feeding was performed for the first time by court order in Hunger strikes by prisoners all over the world are a much more common occurrence than in the past, as any prison governor and the media is well aware. Not all so-called hunger strikes are the same.
Although all involve a certain degree of fasting, they vary greatly in their impact on health and in the ethical dilemmas they may ultimately cause.
To do this, taking account of the various situations in which prisoners stop taking food Real hunger strikes involve actual fasting , which has to be voluntary and has to be pursued for a specific purpose.
Fasting prisoners who are mentally ill or otherwise incapable of unimpaired rational judgement and decision-making cannot be considered real hunger strikers, whatever their own claims. Therefore any patients who, for example, try to starve themselves to death as a result of extreme depression are automatically ruled out.
This is the crucial argument - to be pursued later on — which refutes the frequent assertion that hunger strikes are tantamount to suicide. It should hardly be necessary to state that any form of religious fasting clearly has nothing to do with hunger strikes.
It is mentioned in passing simply because it has sometimes been misconstrued owing to ignorance and cultural differences between captors and captives.
Certainly not. Prisoners who refuse food may be just that - food refusers - and quite distinct from the other category, the real hunger strikers. The two categories represent completely different states of mind and have different aims. Each can be further divided into two sub-categories. It is important, particularly for the medical personnel involved, to differentiate these various types of prisoners from the outset, as the way the situation is approached and handled will also vary greatly in each case.
It is essential to know exactly what the situation is to be able to respond in the most constructive way and avoid making false assumptions. Experience shows that the overwhelming majority of prisoners in this category are male, though no specific data are readily available. This may be because of a refu sed appeal. It may be a local incident, such as a change of cell or cell-mate that the prisoner is unwilling to accept. It may be for a whole variety of reasons, but nearly always concerns only the prisoner himself, and is not part of a more widespread protest.
Many prisoners of this sort fast in protest on numerous occasions during what is often a long career within the prison system. The idea is to drum up sympathy from any available sources, inside or outside the prison system. This will naturally only have a chance of working if it is widely known that he is fasting. Essential to this type of strike is that the prison regime be lenient enough to permit such open displays of protest, and - more to the point - allow news of the strike to circulate outside the prison despite the adverse publicity for the system.
This type of food refuser may indeed decline to take food for some time. He may even be genuinely convinced that he is a legitimate hunger striker. The difference between the reactive food refuser and the real hunger striker is that the refuser has not the slightest intention of fasting to death, or anywhere near death.
Indeed, he has no intention whatsoever of taking serious risks with his health. Consciously or subconsciously, according to context, culture and intellect, he will expect to be taken care of long before there is any danger to his health from fasting. Eventually, the body consumes proteins until it can no longer support vital organs, and they fail.
Without hydration, this takes one to three weeks. With hydration and occasional mineral intake, the body can survive between one and three months. Proper preparation and diet before the strike, along with advice from doctors and experienced hunger strikers, can allow a striker to maintain activity and sharpness for longer and reduce discomfort.
Mary-Pat Hector and her peers planned to ease into their hunger strike, but when news got out, they felt the need to follow through right away. There is a nice soul food restaurant right up the street from campus and they have these lunch specials and you get a discount as a college student.
So I ate baked chicken, macaroni and cheese, and some cabbage. We called a press conference that day, and literally there was little to no preparation. After the first two days, I really did not think about food. I thought I was crazy. I just want to go to class and go lay down. One thing that we wanted to make sure we did was stay together. How long are we willing to go? I think it was around 3 in the morning when they came in and gave us a container of food.
I remember speaking to one of my cellmates and saying I wanted to have pho — or any sort of soup. I remember thinking about margaritas. I did a lot of meditation. I always pictured myself being somewhere else rather than there.
I want to say it was Wednesday. That day I got very sick and I started throwing up. On the 18th of January , we had a hearing — the usual renewal session where we would go to court, a judge comes out and claims he will be listening to our demands, and things end up just the same. Again, I received an extension of detention. It hit me then that this is going nowhere, justice will not be done in an Egyptian court. I decided I would start on the 21st of January, which had no special significance as a day, and I did.
I was at that time with other people in the cell. When it was food time, I just started reading more books, keeping myself busy with other stuff. The first month, it was hard to carry on with the strike, but eventually that hunger feeling faded away.
To be more specific, it was after 40 days. I started becoming numb in terms of being hungry or trying to fill any want for food. At the end of February we had a check from the prison management.
I told them that I wanted to make an official record of my hunger strike. They did and started taking my vitals on a daily basis, but nothing more than that. Only at the beginning of May, when we had a session in court and I told journalists, foreign journalists, that I was a journalist who had been in prison for over nine months and was on hunger strike, did things start to heat up. Al Jazeera was constantly speaking about my hunger strike, and international media was reporting about it, so the Egyptian government sent an official to try to convince me to stop, to tell me I could hurt myself.
A few days later, we were able to smuggle out a picture of what I looked like, which contradicted the story the government told about me, [that] I had secretly been eating my own food sent by my family. After that, they decided that if they transferred me to solitary confinement at the maximum security prison — which they did — there would be no more news about me. My last meal was a piece of bread for breakfast. In my speech in the opening plenary, I said with all due respect to the hosts — so as not to disrespect the hospitality of Poland — that I was commencing a voluntary fast for the climate, in solidarity with my countrymen struggling for food back home and with all communities around the world suffering from climate change.
A lot of people came forward and gave me pointers on how to fast properly: activists who were experts, total strangers, doctors who emailed me. They told me what I needed to do to be able to do it for the two-week duration of the conference, to not just lie down and look pathetic, to do my work at the same level with sleepless nights.
I was given a lot of pointers, including making sure that I warmed my liver every morning with a warm compress. They told me telltale signs on whether my body is acting weirdly or not. It was quite a struggle for the first three days, as you can imagine, like those who are going on detox, the first three days are just crazy.
I was feeling very, very hungry, and then I was getting chills at night, probably because of the food withdrawal and maybe I was also dehydrated.
One of my struggles was that my apartment was one and a half kilometers from the conference venue, and along that road there was an Italian restaurant, a French bakery, a Persian restaurant, a Chinese restaurant. On the fourth day, it was like magic. I did not crave for any food at all. What really drove me was the mere fact that this was a commitment I made very publicly, and I had to honor that. And, of course, during that whole first week the negotiations were not going anywhere.
My brother gave me inspiration — I knew he was still in Tacloban City, still gathering dead bodies. Within a couple of days, more than people [in Warsaw] had joined the fast. There were a number of days when everyone who was fasting would assemble in front of the cafeteria and we just sat down there with empty plates, deliberately showing that we were not eating. The deaths of Bobby Sands and nine other Irish republicans in the Maze Prison hunger strike , which spanned days, are as notorious as they are exceptional.
Like other traumatic experiences, hunger strikes disrupt the basic expectations of daily life. The doctors reminded me that I could not go back to my normal diet just yet. My first, not meal, but first thing that I took in that was not water was orange juice during a party that Sunday evening. Importantly, your organs prefer them over glucose to generate energy. The second trick is that your brain starts using ketone bodies as an energy source as well.
This is an important trick to minimise the loss of muscle mass, by reducing the demand for glucose. Read more: Chemical messengers: how hormones make us feel hungry and full. And we can usually survive until these alternate supplies are depleted. A normal person might last for almost three months without eating if resting; two months is considered a safe bet. An obese person could take much longer to starve, perhaps months, because of the considerably larger fat mass their body can draw on for energy supplies.
However, loss of muscle mass could impair mobility, heart and kidney function. For a person on a hunger strike, the feeling of hunger first increases but then subsides.
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