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Between the Devil and the Deep Blue Sea

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Fasting has been common throughout history . It is the act of willingly abstaining from some or all food, drink, or both, for a period of time. It is often used as a method of non-violent resistance to effect political change. Famous fasts include the forty hour fast by World Vision to bring awareness to poverty and hunger around the world. Mohandas K. Gandhi conducted several prolonged fasts as effective political and social protests.

More recently, India against Corruption held a nine day fast in New Delhi. In response, the Indian government issued threats of forced feeding and hospitalisation.

The Indian government has been known to force feed individuals who are protesting. Examples include Irom Sharmila and Ganga Premi Bhikshu .

From the government's point of view, depending on the situation, it can be argued that in some circumstances where a charismatic popular leader uses a hunger strike to incite his supporters to commit uncontrolled anarchy/violence in his name - the welfare of the average citizen may outweigh the hunger striker and his supporters. That situation would cancel out if the supporters amounted to a sizable majority of the population. Where they are a vocal minority then the rights and interests of the remainder of the population must be a priority. Essentially, there is a situation of balancing the interests of the protestor and the public.

India did not outline any rationale involving a balancing of interests. The main issue of importance is whether the protestor[s] has mental capacity to make decisions. In the event that they do, the problem of balancing conflicts becomes complex. Appearing to violate the basic human rights of a protestor may inflame a politically fiery situation. These are the dilemmas every government will probably face at some point - the public interest versus the individual's rights. Unfortunately, the cynical amongst us will notice that the government's self interest to protect its own reputation [as opposed to public interest] may be prevalent in those who have totalitarian and perhaps psychopathic traits. In the absence of accountability, the risk of abuse of power is high. This is certainly every protestor's argument.

The ethics of force feeding is interesting and it is worth noting the relevant directives.

The Times of India recently wrote:-

"Some section of the medical fraternity is also not in favour of forced feeding. "As per the 1975 World Medical Association Tokyo Declaration, doctors can undertake force-feeding under certain restricted rules and only where a second, independent physician is consulted and agrees to the move," said Dr Arvind Singh. The Tokyo Declaration states: "Where a prisoner refuses nourishment and is considered by the physician as capable of forming an unimpaired and rational judgment concerning the consequences of such a voluntary refusal of nourishment, he or she shall not be fed artificially. The decision as to the capacity of the prisoner to form such a judgment should be confirmed by at least one other independent physician. The consequences of the refusal of nourishment shall be explained by the physician to the prisoner." The World Medical Association revised and updated its Declaration of Malta on hunger strikers. Among many changes, it unambiguously states that force feeding is a form of inhuman and degrading treatment.

The Conflict Resolution of the World Medical Association's (1991) resolves the ethical conflict of the doctor in the following way:

"The ultimate decision on intervention or non-intervention should be left with the individual doctor without the intervention of third parties whose primary interest is not the patient's welfare. However, the doctor should clearly state to the patient whether or not he is able to accept the patient's decision to refuse treatment or, in case of coma, artificial feeding, thereby risking death. If the doctor cannot accept the patient's decision to refuse such aid, the patient would then be entitled to be attended by another physician."

Force feeding in a person who retains capacity to make decisions is potentially unethical. The debate has progressed world-wide. Is it ethical to force-feed prisoners on a hunger strike? discusses the ethics of the situation arising in Switzerland where a protestor on hunger strikes. The Federal Court ruled that he should be force-fed but the doctors have refused to obey this order. The article states

"In a letter published in the Lancet (2006; 367: 811), these doctors have argued that force-feeding prisoners who were on a hunger strike violated established standards in medical ethics, which acknowledge that patients - including detainees - have a right to refuse treatment, even of a life-sustaining kind, provided that they enjoy decision-making capacity (or more briefly, capacity)"

In conclusion, the balance of interests and resolving ethical conflicts is a difficult situation for any government when faced with a defiant protester. Involving the courts may not be a solution for a potentially politically volatile situation. This demonstrates the power of non-violent protests in effecting political change. It places the government in a precarious situation of choosing between the devil and the deep blue sea.