Siegal Gil, Glick Shimon, Offer-Stark Irit, Steinberg Avraham
Ono Academic College, Israel.
Ben Gurion University of the Negev, Beer Sheva, Israel.
Harefuah. 2018 Jan;157(1):38-41.
Force feeding of fasting hunger-striking prisoners is the subject of considerable controversy in Israel and elsewhere, posing a direct conflict between two basic ethical values: that of human life and respect for autonomy. The Israel Medical Association, as well as the World Medical Association, has taken the position that force feeding of such prisoners is an act of torture and is therefore unethical. However this paper presents an opposing view, which recently became the law in Israel, that, whereas the rights of prisoners to decree a hunger strike as a form of protest should be respected, if the prolongation of the strike reaches a stage of clear and present danger to the life and health of a prisoner, the saving of the prisoner's life must take precedence over considerations of autonomy. The paper present the steps that should be taken, including extensive and empathic efforts to persuade the prisoner to end his/her fast; gaining the approval of a hospital's ethics committee; and gaining the approval of a district court judge; the feeding is to be carried out in the most humane and sensitive manner as befitting a lifesaving procedure for any patient. This position is consistent with Israel's Basic Law: Human Dignity and Liberty, Israel's Patient Rights Law, Israel's "Do not stand idly by your fellow man's blood" Law, with several Israeli court decisions and in keeping with the dominant Israeli culture. Finally, instructions for physicians who object to such measures are discussed, ascertaining the freedom of conscience as well as preserving the life of the hunger-strikers.
对绝食抗议的囚犯进行强制喂食在以色列及其他地方都颇具争议，这引发了两种基本伦理价值观之间的直接冲突：人的生命价值与对自主权的尊重。以色列医学协会以及世界医学协会都认为，对这类囚犯进行强制喂食是一种酷刑行为，因此是不道德的。然而，本文提出了一种相反的观点，该观点最近在以色列成为法律，即虽然囚犯有权以绝食作为抗议形式，但如果绝食持续到对囚犯的生命和健康构成明显且紧迫的危险阶段，挽救囚犯生命必须优先于自主权考量。本文介绍了应采取的步骤，包括广泛且富有同理心的努力以说服囚犯结束绝食；获得医院伦理委员会的批准；获得地方法院法官的批准；喂食应以最人道和体贴的方式进行，这才符合对任何患者的救命程序。这一立场与以色列的《基本法：人的尊严与自由》、以色列的《患者权利法》、以色列的“不可袖手旁观他人流血”法一致，也与以色列的几项法院判决相符，并与占主导地位的以色列文化相符。最后，讨论了反对这类措施的医生的相关指示，确定良心自由以及保护绝食者的生命。
