Emedinews:Insights on Medicolegal issues:Forceful/Artificial feeding and hunger strike: What is the role of doctor?

It has been observed that generally the hunger strikers do not wish to die but it cannot be ruled out that some may be prepared to do so to achieve their aims. The doctor needs to ascertain the individual's true intention, especially in collective strikes or situations where peer pressure may be a factor. An ethical dilemma for the doctor arises when hunger strikers who have apparently issued clear instructions/consent not to be resuscitated or even any medical intervention reach a stage of cognitive impairment. The principle of beneficence urges physicians to resuscitate them but respect for individual autonomy restrains physicians from intervening when a valid and informed refusal has been made. An added difficulty arises in custodial settings because it is not always clear whether the hunger striker's advance instructions were made voluntarily and with appropriate information about the consequences. I too have faced this dilemma during the case of Medha Patekar hunger strike at Jantar Mantar in Delhi. Such situations are resolved in India by the police by arresting the hunger strikers under section 309 IPC for committing suicide. The doctor treats the person to save his life as a legal obligation with ethical precaution that it should be restricted and limited only for life saving.