WMA condemns all forced feeding

The World Medical Association has strongly reiterated its view that the forced feeding of hunger strikers is unethical, and is never justified.

At its annual General Assembly in Sun City, South Africa, the WMA amended its guidance to physicians on the management of hunger strikers to make it absolutely clear that force feeding constitutes a form of inhuman and degrading treatment.

The new guidance in the revised Declaration of Malta, clarifying existing WMA policy, says that respect for patient autonomy must be weighed against medical interventions, which may or may not be in the hunger striker's best interests. The final decision to intervene must take into account the hunger striker's informed decision and must lie with the physician and not with any non medical authority.

Dr Otmar Kloiber, secretary general of the WMA, said:

• This new guidance makes it absolutely clear that physicians should never be used to break hunger strikes through acts such as force feeding.

• The clarification was necessary because there had been erroneous interpretations of the Declaration, making it seem to allow force feeding in the best interests of the patient, even when he had expressed wishes to the contrary. This interpretation appeared to contradict another WMA policy, the Declaration of Tokyo, which specifically stipulates that prisoners on hunger strike who have made an informed refusal of food shall not be artificially fed.

• In clarifying this policy, delegates at the WMA Assembly emphasized that doctors working in prisons or the armed forces have exactly the same ethical obligations when treating prisoners as they do when caring for other autonomous patients.

• Hunger strikes can differ from one country and one culture to another and raise very complex issues. The specific issue of force feeding has come to the fore again recently. So to help physicians deal with these problems, the WMA has produced a background document and glossary to accompany our amended Declaration, which are available on the WMA's website.