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The awkward case of 'his or her'. 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. The reactive food refuser is relatively common only in countries where the basic rights of prisoners are largely respected.
In tolerant systems, they may tax the patience of both the prison authorities and the prison doctor. Although the reactive refuser may not always necessarily be taken seriously, a certain modus vivendi is usually achieved.
Prison doctors in relatively benign systems will carry out whatever medical duties are prescribed in such cases. Seasoned prison doctors, who have spent whole careers working in prison environments, will be best at handling such prisoners, carefully balancing respect for the patient with a firm approach on what they can and should do from a medical point of view.
The second type of food refuser is the determined food refuser. This type of prisoner can be male or female. The motive behind the refusal of food is completely different from that of the preceding category, as is also the way in which it is carried out. This type of refuser is generally the opposite of the reactive type.
The masculine gender will be used exclusively from here onwards to lighten the text. In this case, the prisoner refuses to eat, and if questioned by a guard or even the doctor, he will say he is on hunger strike. In fact the dividing line between conscious protest and the onset of actual depression may be very hard to establish.
Another crucial difference is that, unlike the reactive type, the determined refuser makes little if any noise about his hunger strike. Comparisons with suicide, usually unjustified, occur frequently in discussions about hunger strikes.
Doctors should be attentive to patients of this sort, as they may well be medical cases that require medical attention they do not actually ask for.
Distinct from the food refusers are the actual hunger strikers, i e prisoners who undergo a substantial period of voluntary total fasting for a specific purpose. The reasons for a hunger strike are obviously as varied as the situations in which they take place. There may be specific demands concerning prison conditions or the judicial process.
Whatever the cause, several factors have to be considered when dealing with real hunger strikers. In this they resemble fasting by reactive refusers. If, however, there is reason to believe that the fast really is serious, there are several issues that any doctor involved has to consider. One has to know whether the fast is genuinely voluntary, and not being imposed by certain prisoners on others. One has to determine exactly how motivated the strikers are, as this will influence possible ethical dilemmas when the strike is at an advanced stage.
There is also a need to know whether there are any medical contraindications to fasting among the prisoners who undertake the strike, who then have a right to know of any negative implications for their health. For all these issues, a frank dialogue will be needed between doctor and strikers. This may be difficult or even impossible for the prison doctor himself.
A climate of trust is obviously essential here, as in any doctor-patient relationship. Any advice they give may be interpreted by the hunger strikers as a ploy by the authorities to dissua de them from fasting. As hunger strikes often occur among prisoners protesting in countries affected by conflict, ICRC doctors are often confronted with hunger strikers.
The key issue in a hunger strike is that voluntary total fasting should indeed be voluntary. Unlike the food refuser category, in which prisoners generally fast alone - with a lot of publicity, as in the case of the reactive refuser, or in silence, as in the case of the determined refuser - prisoners who go on real hunger strike often fast in groups, or at least have individual volunteers from the group take up a prolonged fast.
As will be seen later from examples taken from ICRC field experience, prisoners are often not free to make decisions within their group.
Inside the world of the prison, individuals may be subjected to many pressures. A doctor from the outside, such as an ICRC doctor visiting prisoners, can arrange to s peak with individual hunger-striking prisoners in private, and thus be in a better position to determine the exact motivation behind the strike. Fasting prisoners will be in the spotlight; their every action will come under observation.
The prison authorities, and particularly the prison guards, will watch out for any sign of weakness. Taunting and baiting by guards may trap a prisoner into an intransigent position, whereas he might otherwise have been willing to compromise.
Finally, if the hunger strike gains attention from the outside, the media will also undoubtedly exert pressure on the situation. All these external factors cannot simply be ignored. They must be taken into due consideration by any doctor who deals with the hunger strikers. If the physician is to act in their best interest, provided they have consented to a proper doctor-patient relationship, then these influences have to be known and discussed.
The motivation behind the strike might appear not to be an issue for the physician. Although this may be true in very politicized contexts, experience shows that there may be misunderstanding and intransigence in the relationship between the parties. If the doctor can gain the confidence of all involved, in some cases a compromise may be reached or an issue clarified through him that can lead to the end of the strike see the example below involving the ICRC in Georgia. Knowing the actual determination of the strikers is also essential, as the medical consequences of a hunger strike will differ according to how seriously the strike is taken.
Medical contraindications to a hunger strike, such as metabolic diseases diabetes, etc. If a hunger striker perforates an ulcer after only a week, the whole purpose of the strike - in addition to his health - will be jeopardized to no avail. Whether hunger strikers abandon the fast or not, they have a right to know about all the implications for their health, including the physiological effects of fasting. The importance of doctors being aware of these effects has recently been stressed in two British Medical Journal articles Kalk et al , Peel Words related to hunger strike fasting.
How to use hunger strike in a sentence Thirty-three people that morning decided to go on a hunger strike. Lavers July 14, Washington Blade. Who Will Save Alexei Navalny? Michael Weiss April 22, Time. Journalists faced new threats in These 10 and countless others deserve justice lbelanger January 4, Fortune. The Red Year Louis Tracy. Gulliver's Travels Jonathan Swift.
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