Will Bioethicists Support Hunger Strike Death?

Last year, I argued against permitting prisoners from harming their health from hunger strikes–by force feeding if necessary. 

The issue has been primarily discussed here at HE in the context of Guantanamo, but there was also advocacy for doctors both helping ease inmate’s hunger strike symptoms and/or refusing to participate in forced feeding.

For example, here is what.bioethicst George Annas said about doctors’ duties to cooperate with the hunger strike by inmates. From my post quoting Annas:

Guantanamo is not just going to fade away, and neither is the stain on medical ethics it represents. U.S. military physicians require help from their civilian counterparts to meet their ethical obligations and maintain professional ethics.

In April the American Medical Association appropriately wrote the secretary of defense that “forced feeding of [competent] detainees violates core ethical values of the medical profession.” But more should be done. We believe that individual physicians and professional groups should use their political power to stop the force-feeding, primarily for the prisoners’ sake but also for that of their colleagues.

Similarly, bioethicist Art Caplan has argued against force feeding prisoners on a hunger strike as a matter of general principle:

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.

Cut to real life: An inmate died recently in Kentucky from what was either a hunger strike or suicide by starvation, and there will be consequences. From the AP story:

Embry, 57, died in January at the Kentucky State Penitentiary in Eddyville after the hunger strike that included a nine-day stretch in which he lost 32 pounds from his six-foot frame, dropping down to just 138 pounds.

Embry’s death of dehydration and starvation, first reported by The AP, prompted an internal investigation by corrections officials and a separate investigation by state police. The case exposed lapses in medical treatment and the handling of hunger strikes, and the local prosecutor is considering whether a grand jury should hear the case.

The state fired the prison’s lead doctor and is pursuing dismissals or disciplinary action against several other staff members.

Exactly right.

Prisoners lose a certain amount of autonomy once they are behind bars. That includes the right to harm themselves, either by hunger strikes or otherwise, regardless of the reason for engaging in the self-destructive behavior.

But if Annas, Caplan, and the AMA position quoted above, are correct, the prison doctor and officials should be cheered for honoring the man’s autonomy rather than being under investigation.

What about it bioethicists? Here’s a real death of a prisoner who was allowed to refuse sustenance. What say you?