Force-feeding a prisoner

A sigh of relief was heaved when Sunderlal Bahugana, the eminent environmentalist, ended his forty-nine-day-old fast. His health was rapidly deteriorating by then, with falling blood pressure and acetone in the urine.

The authorities had arrested him and taken him to the All India Institute of Medical Sciences, New Delhi, ostensibly to save his life. Bahugana, an advocate of naturopathy, refused modern medical care. On the basis of his decision, the court ordered that he be shifted out of hospital.

What is the role of the doctor in such a situation? If the doctor in charge feels that the life of a fasting leader is in danger, can the latter be force-fed or given intravenous fluids and electrolytes against his wish? What should guide the action of the medical professional – the wishes of the patient or the threat to his life?

Many feel that the doctor’s action should be guided by the Geneva Declaration (the modified version of the Hippocratic oath) which says that the health of the patient should be the first consideration of the doctor. If this guideline be followed, the doctor is justified in force-feeding the fasting individual.

In fact, the doctor’s action should be guided by the Declaration of Tokyo adopted by the 29th World Medical Assembly in October 1975. Clause V reads: “Where a prisoner refuses nourishment and is considered by the doctor as capable of forming unimpaired and rational judgement 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 judgement should be confirmed by at least one other independent doctor. The consequences of the refusal of nourishment shall be explained by the doctor to the prisoner.”

Fortunately for the medical profession such a dilemma was avoided when Bahugana ended his fast but a similar situation can arise in the future.