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Hunger Strikes and Other Controversial Cases

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Guantanamo and Other Cases of Enforced Medical Treatment

Part of the book series: SpringerBriefs in Ethics ((BRIEFSETHIC))

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Abstract

In order to substantiate the claim made in Chap. 3, the attention of this book will now shift towards a further two controversial cases relating to the [mis]use of the notion of autonomy. The first case relates to the forced treatment of a burns victim desirous of death, and despite dating back nearly three decades, it remains very topical, raising important questions pertinent to the current study.

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Notes

  1. 1.

    Given the extent of literature produced on this case, this book can only pay attention to some specific aspects of the numerous controversial issues raised by it.

  2. 2.

    For the sake of intellectual honesty it must be underlined that at that time the Texan approach to allowing competent patients to refuse treatment had just changed in favour of a less permissive attitude towards the patient’s will. Donald Cowart was particularly unfortunate in this respect also.

  3. 3.

    In relation to this point see the three conditions provided by Michael Gross and listed in Chap. 3.

  4. 4.

    There are different interpretations of the reason for this choice, but what is common to all of them is that the name change was directly related to the accident.

  5. 5.

    When describing the Dax case (referred as Mr. G), Robert Burt writes: “It may seem that some new label should be devised to categorize Mr. G’s confusion -perhaps ‘temporary incapacity’—that would not tar him with the mental illness brush.”(Burt 1979, p. 13).

  6. 6.

    Engelhardt (1989 p. 96).

  7. 7.

    Concern for Dying: Dax’s Case, videotape, 1985, Unicorn Media, New York.

  8. 8.

    The words “proportionate” and “disproportionate” are not in the text of the report, but they do appear in a footnote on the same page as the abovementioned conclusion, in a citation from the Vatican’s Declaration on Euthanasia (June 26, 1980) which is reprinted in an appendix to the report. While there are subtle differences between the Vatican’s concept of proportionate care and the Commission’s conclusion, there is a common theme: a treatment is not morally obligatory when, in the patient’s view, it produces greater burdens than benefits. See President’s Commission on Ethical Problems in Medicine and Biomedical and Behavioral Research, Defining Death: A Report on the Medical, Legal, and Ethical Issues in the Definition of Death (Washington, D.C.: U.S. Government Printing Office, 1981), p. 89 as quoted in Jonsen (2003, p. 260).

  9. 9.

    Jonsen (2003, p. 260).

  10. 10.

    “Please Let Me Die”, transcript of videotape available in Areen et al. (1984).

  11. 11.

    See footnote 17 below for a more specific reference.

  12. 12.

    Zaner (1989, pp. 43–44). My emphasis.

  13. 13.

    White (1989, p. 18).

  14. 14.

    Here I refer to the definition of autonomy given by Ronald Dworkin and highlighted in Chap. 1.

  15. 15.

    Burt Op. Cit., p. 3.

  16. 16.

    Childress and Campbell (1989, p. 23).

  17. 17.

    Ibid., p. 32.

  18. 18.

    See, amongst others: Foster (2009), Gillon (2003, pp. 307–312), O’Neill (2002) and Harris (1994).

  19. 19.

    See, amongst others: La Repubblica, 9 September 2009, available at: http://ricerca.repubblica.it/repubblica/archivio/repubblica/2009/09/09/sciopero-della-fame-detenuto-muore-pavia.html [accessed on 18 January 2010], Il Corriere della Sera, 9 September 2009, available at: http://archiviostorico.corriere.it/2009/settembre/09/Pavia_morto_detenuto_tunisino_che_co_9_090909040.shtml [accessed on 4 January 2015], http://www.adnkronos.com/AKI/English/Security/?id=3.0.3746339292 [accessed on 4 January 2015], http://news.bbc.co.uk/2/hi/europe/8335092.stm [accessed on 4 January 2015].

  20. 20.

    Available at: http://www.senato.it/japp/bgt/showdoc/frame.jsp?tipodoc=Resaula≤g=16&id=00431236∂=doc_dc-allegatob_ab-sezionetit_icrdrs&parse=no [accessed on 4 January 2015].

  21. 21.

    For the sake of the current discussion, the reader should consider a definition of the sanctity of life very much in line with that described by Ronald Dworkin (1993). However, when analysing the specific Italian context, it is appropriate to take into account the deep influence that Roman Catholicism still plays in bioethical controversies, with a resulting attitude that tends to see life as something to be preserved under any circumstances, no matter how extreme. However, we shall later discover that -due to their biopolitical value- some exceptions have been made to this normally intransigent way of portraying sanctity of life.

  22. 22.

    World Medical Association. Declaration of Malta on Hunger Strikers (adopted by the 43rd World Medical Assembly in Malta, November 1991 and revised at the 44th World Medical Assembly in Marbella, Spain, November 1992). Geneva: WMA, 1992. The document has been revised again in the 57th General Assembly in Pilanesberg, South Africa, October 2006.

  23. 23.

    Kenny et al. (2004, pp. 237–240).

  24. 24.

    Brockman (1999, pp. 451–456).

  25. 25.

    Kalk et al. (1993, pp. 391–394).

  26. 26.

    Koçan and Öncű (2006, pp. 349–372).

  27. 27.

    See, for example: http://news.bbc.co.uk/2/hi/europe/1722075.stm, and footnote 29 below.

  28. 28.

    Sevinç (2008, pp. 655–659).

  29. 29.

    It should be noted that in order to ensure the “successful” preservation at all costs of the lives of prisoners, Turkish authorities, through the utilisation of the Army, ended up producing a shocking number of casualties during the process of force-feeding. See, for example: http://news.bbc.co.uk/2/hi/europe/1739041.stm.

  30. 30.

    Ho (2008, pp. 193–207).

  31. 31.

    McLean (2010, p. 19).

  32. 32.

    Kluge (2005, pp. 295–304).

  33. 33.

    Notice that this is also relevant for cases of Anorexia Nervosa, as patients suffering from it do not want to die, they just prioritize the importance of their body image over death.

  34. 34.

    See, for instance: http://edition.cnn.com/2010/WORLD/americas/02/23/cuba.dissident/index.html, http://news.bbc.co.uk/2/hi/8540162.stm [accessed on 4 January 2015].

  35. 35.

    See, for example: http://news.bbc.co.uk/2/hi/south_asia/5348414.stm, http://www.dnaindia.com/opinion/comment_irom-sharmila-s-10-year-fast-is-ignored_1323405 [accessed on 4 January 2015].

  36. 36.

    Nevmerzhitsky v Ukraine (2005) 43 EHRR 32 (ECtHR). Available at: http://sim.law.uu.nl/SIM/CaseLaw/hof.nsf/d0cd2c2c444d8d94c12567c2002de990/34464f8568936e2ec1256fd900316fca?OpenDocument [accessed on 4 January 2015].

  37. 37.

    Foucault (2010).

  38. 38.

    Foucault, ibid., p. 91.

  39. 39.

    Foucault, ibid., p. 97.

  40. 40.

    The widely publicised case of Eluana Englaro is probably the best example in recent years. See, amongst others: Englaro, B. and Nave, E., Eluana—La Libertà e la Vita, Rizzoli, 2008; http://news.bbc.co.uk/2/hi/europe/7880070.stm [accessed on 4 January 2015]; Bock et al. (2007, pp. 1041–1042); http://news.bbc.co.uk/2/hi/6186347.stm [accessed on 4 January 2015].

  41. 41.

    Williams (2001, pp. 285–296).

  42. 42.

    See, amongst other cases: Commonwealth of Pennsylvania, Department of Public Welfare, Fairview State Hospital v Joseph Kallinger (1990) 134 Pa Cmwlth 415, 580 A 2d 887). Despite being recognised to be competent -and thus entitled to refuse nutrition- the Court felt that Kallinger was trying to use the system to his advantage and therefore the Court opted for enforcing treatment on him for the sake of State interests.

  43. 43.

    Foucault, ibid., p. 44.

  44. 44.

    Foucault, ibid., p. 34.

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  1. The Edmond J. Safra Center for Ethics, Tel Aviv University , Tel Aviv , Israel

    Mirko Daniel Garasic

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Garasic, M.D. (2015). Hunger Strikes and Other Controversial Cases. In: Guantanamo and Other Cases of Enforced Medical Treatment. SpringerBriefs in Ethics. Springer, Cham. https://doi.org/10.1007/978-3-319-22653-8_4

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