Lederman Zohar
Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Assuta Samson Hospital, Ashdod, Israel.
Theor Med Bioeth. 2018 Aug;39(4):321-334. doi: 10.1007/s11017-018-9439-y.
Several bioethicists have recently advocated the force-feeding of prisoners, based on the assumption that prisoners have reduced or no autonomy. This assumed lack of autonomy follows from a decrease in cognitive competence, which, in turn, supposedly derives from imprisonment and/or being on hunger strike. In brief, causal links are made between imprisonment or voluntary total fasting (VTF) and mental disorders and between mental disorders and lack of cognitive competence. I engage the bioethicists that support force-feeding by severing both of these causal links. Specifically, I refute the claims that VTF automatically and necessarily causes mental disorders such as depression, and that these mental disorders necessarily or commonly entail cognitive impairment. Instead, I critically review more nuanced approaches to assessing mental competence in hunger strikes, urging that a diagnosis of incompetence be made on a case-by-case basis-a position that is widely shared by the medical community.
几位生物伦理学家最近主张对囚犯进行强制喂食，其依据是囚犯的自主性降低或丧失这一假设。这种自主性的缺失被认为是认知能力下降的结果，而认知能力下降又被认为是由于监禁和/或绝食所致。简而言之，监禁或自愿完全禁食（VTF）与精神障碍之间以及精神障碍与认知能力缺失之间建立了因果联系。我通过切断这两个因果联系来回应支持强制喂食的生物伦理学家。具体而言，我反驳了VTF必然会自动导致抑郁症等精神障碍，以及这些精神障碍必然或通常会导致认知障碍的说法。相反，我批判性地审视了评估绝食者心理能力的更细致入微的方法，敦促应逐案进行无行为能力的诊断——这是医学界广泛认同的立场。
