On the Force-Feeding of Prisoners on Hunger Strike

HEC Forum. 2019 Mar;31(1):29-48. doi: 10.1007/s10730-018-9365-4.


Roughly 80,000 U.S. prisoners are held in solitary confinement at any given time. A significant body of research shows that solitary confinement has severe, long-term effects, and the United Nations has condemned the practice of solitary confinement as torture. For years, prisoners have been organizing hunger strikes in order to protest solitary confinement. But such action is not without consequences, and some inmates have suffered serious injury or death. The question I raise in this paper is whether we ought to force-feed hunger striking prisoners when serious harm is imminent. Both the World Medical Association and the American Medical Association have denounced the practice of force-feeding prisoners on hunger strike, and yet, the practice is common. Such prevalence is likely a result of the tension between the person-as-patient and person-as-prisoner and cannot easily be resolved. Instead, we must take seriously the complaint that solitary confinement is inhumane and avoid placing health professionals in the position where they must choose to force-feed the prisoner against his will or not. I argue that a conventional bioethics debate centering on polarizing principles of prisoner autonomy and a duty-to-protect the prisoner from harm is an inadequate framework for this complex issue. Instead, we must examine the prisoner's intent and his right to freedom of speech. I argue that when the prisoner's intent is to raise awareness and communicate with others, his hunger strike is a form of speech. Protest-as-speech is constitutionally protected-even for prisoners-and remains a minimum ethical obligation for society to uphold.

Keywords: Freedom of speech; Hunger strike; Prisoner autonomy; Prisoner rights; Solitary confinement.

MeSH terms

  • Enteral Nutrition / adverse effects
  • Enteral Nutrition / ethics*
  • Enteral Nutrition / methods
  • Fasting*
  • Humans
  • Moral Obligations
  • Personal Autonomy
  • Prisoners / legislation & jurisprudence*
  • Prisoners / psychology
  • United States