Abstract
This contribution addresses some bioethical and medico-legal issues of the opinion formulated by the Italian National Bioethics Committee (CNB) in response to the dilemma between the State’s duty to protect the life and health of the prisoner entrusted to its care and the prisoner’s right to exercise his freedom of expression. The prisoner hunger strike is a form of protest frequently encountered in prison and it is a form of communication but also a language used by the prisoner in order to provoke changes in the prison condition. There are no rules in the prison regulations, nor in the laws governing the legal status of prisoners, that allow the conscious will of the capable and informed subject to be opposed and forced nutrition to be carried out. However, this can in no manner make therapeutic abandonment legitimate: the medical doctor should promote every action to support the patient. In the recent opinion formulated by the CNB it was remarked how self-determination is a central concept in human rights and refers to an individual’s ability to make autonomous and free decisions about his or her life and body.
Data availability
Not applicable.
References
Aitchison, G. 2022. Fragility as strength: the Ethics and Politics of Hunger strikes. Journal of Political Philosophy 30: 535–558.
Alempijevic, D., S. Pavlekic, D. Jecmenica, A. Nedeljkov, and M. Jankovic. 2011. Ethical and legal consideration of prisoner’s hunger strike in Serbia. Journal of Forensic Science 56(2): 547–550.
Annas, G. J. 2017. Force-feeding at Guantánamo. Journal of Medical Ethics 43(1): 26.
Annas, G. J., S. S. Crosby, and L. H. Glantz. 2013. Guantanamo Bay: a medical ethics-free zone? New England Journal of Medicine 369: 101–103.
Arda, B. How should physicians approach a hunger strike? 2002. Bulletin of Medical Ethics 181: 13–18.
Bendtsen, K. 2019. On the Force-Feeding of prisoners on Hunger Strike. Hec Forum 31(1): 29–48.
Cannovo, N., R. Scendoni, M. M. Fede, F. Siotto, P. Fedeli, and M. Cingolani. 2021. Nursing home and vaccination consent: the Italian perspective. Vaccines (Basel) 9(5): 429.
Caredda, M. 2015. La salute e il carcere. Alcune riflessioni sulle risposte ai bisogni di salute della popolazione detenuta. https://www.costituzionalismo.it/costituzionalismo/download/Costituzionalismo_201502_519.pdf. Accessed December 29, 2023.
Carta, M. C. 2020. The humanitarian principle of punishment and the protection of prisoners within the european legal space. University of Economics and Human Sciences Press. https://vizja.pl/wp-content/uploads/2021/06/The%20Humanitarian%20Principle%20of%20Punishment%20and%20the%20Protection%20of%20Prisoners%20within%20the%20European%20Legal%20Space.pdf.pdf. Accessed July 20, 2023.
Charter of fundamental rights of the European Union. 2000. https://www.europarl.europa.eu/charter/pdf/text_en.pdf. Accessed July 20, 2023.
Comunicato stampa CNB n. 2/. 2023. 6 March 2023. https://bioetica.governo.it/media/4800/comunicato-stampa-n-2-2023-con-allegato.pdf. Accessed March 15, 2023.
Constitution of the Italian Republic. 2023. Fundamental principles. https://www.senato.it/documenti/repository/istituzione/costituzione_inglese.pdf. Accessed July 20.
Council of Europe. 1999. Convention for the protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine (ETS No. 164). https://www.coe.int/en/web/conventions/full-list?module=treaty-detail&treatynum=164. Accessed July 20, 2023.
D’Agostino, F., and L. Palazzani. 2013. Cos’è la bioetica. In Bioetica. Edited by F. D’Agostino e L. Palazzani, 28–36. Brescia: La Scuola SEI.
De Micco, F., and R. Scendoni. 2024. Three different currents of thought to Conceive Justice: legal, and Medical Ethics reflections. Philosophies 9: 61.
Delbon, P., F. Maghin, and A. Cont. 2021. Medically assisted suicide in Italy: the recent judgment of the Constitutional Court. Clinical Therapeutics 172(3): 193–196.
European Court of Human Rights. 2022. Guide on Article 2 of the European Convention on Human Rights. https://www.echr.coe.int/documents/d/echr/Guide_Art_2_ENG. Accessed December 29, 2023.
European Court of Human Rights. 2002. Case of Pretty v. The United Kingdom, Application no. 2346/02. https://hudoc.echr.coe.int/fre?i=001-60448. Accessed December 29, 2023.
European Court of Human Rights. 2018. Case of Yakovlyev V. Ukraine. https://hudoc.echr.coe.int/fre?i=001-221265. Accessed July 20, 2023.
FNOMCeO. 2023. Federazione Nazionale degli Ordini dei Medici Chirurghi e degli Odontoiatri. https://portale.fnomceo.it/codice-deontologico/. Accessed July 20.
Garasic, M. D. 2015. Guantanamo and its specific Biopolitical Charge. In Guantanamo and other cases of Enforced Medical Treatment. SpringerBriefs in Ethics, Cham: Springer. https://doi.org/10.1007/978-3-319-22653-8_5.
Garasic, M. D. 2017. Guantanamo and other cases of Enforced Medical Treatment-A Biopolitical Analysis. Journal of Medical Ethics 43(1): 22–23.
García-Guerrero, J., and E. J. Vera-Remartínez. 2015. Hunger Strike in Prison Study Group. Episodes of voluntary total fasting (hunger strike) in Spanish prisons: a descriptive analysis. Journal of Forensic and Legal Medicine 34: 182–186.
Gétaz, L., J. P. Rieder, L. Nyffenegger, A. Eytan, J. M. Gaspoz, and H. Wolff. 2012. Hunger strike among detainees: guidance for good medical practice. Swiss Medical Weekly 142: w13675.
Gulati, G., B. D. Kelly, D. Meagher, H. Kennedy, and C. P. Dunne. 2018. Hunger strikes in prisons: a narrative systematic review of ethical considerations from a physician’s perspective. Irish Journal of Psychological Medicine 35(2): 135–142.
Il Sole 24 Ore. 2023. Cospito, chi è e perché è diventato un caso. https://www.ilsole24ore.com/art/cospito-chi-e-e-perche-e-diventato-caso-AEakWqeC. Accessed December 29.
Il Post. 2023. Il caso dell’anarchico Alfredo Cospito, dall’inizio. https://www.ilpost.it/2022/12/28/alfredo-cospito-pena. Accessed December 29.
Italian Constitutional Court. 2023. Judgment of 24 June-28 July 1993 n. 349. https://www.cortecostituzionale.it/actionSchedaPronuncia.do?anno=1993№=349#. Accessed July 20.
Italian Constitutional Court. 2023. Judgment of 15 November 2000 n. 526. https://www.cortecostituzionale.it/actionSchedaPronuncia.do?param_ecli=ECLI:IT:COST:2000:526. Accessed July 20.
Italian Constitutional Court. 2023. Judgment of 24 September 2019 n. 242. https://www.cortecostituzionale.it/actionSchedaPronuncia.do?anno=2019№=242#. Accessed July 20.
Italian Republic. 2023. Decreto Legislativo 22 giugno 1999, n. 230. https://www.gazzettaufficiale.it/atto/serie_generale/caricaDettaglioAtto/originario?atto.dataPubblicazioneGazzetta=1999-07-16&atto.codiceRedazionale=099G0305&elenco30giorni=false. Accessed June 2.
Miller, I. 2017. Starving to death in medical care: Ethics, food, emotions and dying in Britain and America, 1970s–1990s. BioSocieties 12: 89–108.
National Bioethics Committee. 2023. La salute dentro le mure. 27 settembre 2013. https://bioetica.governo.it/media/1825/p113_2013_salute-dentro-le-mura_it.pdf. Accessed December 29.
National Bioethics Committee. Risposta al Quesito posto dal Ministero della Salute. 2023. https://bioetica.governo.it/it/pareri/pareri-e-risposte/. Accessed June 2, 2023.
O’Keeffe, T. 1984. Suicide and self-starvation. Philosophy 59(229): 349–363.
Obegi, J. H. 2023. Death by hunger strike: suicide or not? Psychiatry Psychology and Law. https://doi.org/10.1080/13218719.2023.2175069.
Oguz, N. Y., and S. H. Miles. 2005. The physician and prison hunger strikes: reflecting on the experience in Turkey. Journal of Medical Ethics 31(3): 169–172.
Pallocci, M., M. Treglia, and P. Passalacqua et al. 2023. Informed consent: Legal Obligation or cornerstone of the Care Relationship? International Journal of Environmental Research and Public Health 20(3): 2118.
Peters, A. K. 2014. Force-feeding is in the interests of the state, not its prisoners. Nursing Standard 28(50): 35.
Porteri, C., G. Ienco, E. M. Turla, C. Petrini, and P. Pasqualetti. 2022. Italian law n. 219/2017 on consent and advance directives: survey among Ethics committees on their involvement and possible role. BMC Medical Ethics 23(1): 114.
Shah, N. 2018. 7. Feeding Hunger- Striking Prisoners: Biopolitics and Impossible Citizenship. In Biocitizenship: The Politics of Bodies, Governance, and Power, edited by K. Happe, J. Johnson & M. Levina, 155–177. New York, USA: New York University Press.
Travaini, G. V., F. Pacchioni, S. Bellumore, M. Bosia, and F. De Micco. 2022. Machine learning and criminal justice: a systematic review of Advanced Methodology for Recidivism Risk Prediction. International Journal of Environmental Research and Public Health 19(17): 10594.
Travaini, G. V., F. De Micco, and F. Biscella et al. 2023. Stereotypes and prejudices in nursing prison activities: a reflection. Healthcare (Basel) 11(9): 1288.
United Nations General Assembly. 2023. Universal Declaration of Human Rights, 10 December 1948, 217 A (III). https://www.refworld.org/docid/3ae6b3712c.html. Accessed December 29.
World Health Organization. 2023. Management of Mental and Brain Disorders Team & International Association for Suicide Prevention. 2007. Preventing suicide in jails and prisons. World Health Organization. https://apps.who.int/iris/handle/10665/43678. Accessed July 20.
World Health Organization European Region. Status report on prison health in the WHO European Region 2022. https://iris.who.int/bitstream/handle/10665/365977/9789289058674-eng.pdf?sequence=1. Accessed December 29, 2023.
World Medical Association. Declaration of Malta on hunger strikers. 2017. https://www.wma.net/policies-post/wma-declaration-of-malta-on-hunger-strikers/. Accessed July 20, 2023.
World Health Organization. Preventing suicide: a global imperative. 2014. https://www.who.int/publications/i/item/9789241564779. Accessed July 20, 2023.
World Health Organization Europe. 2007. Health in prisons A WHO guide to the essentials in prison health. http://www.ristretti.it/areestudio/salute/zippati/oms_linee_guida_inglese.pdf. Accessed December 29, 2023.
Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Author information
Authors and Affiliations
Contributions
FDM and RS conceived the key points of the manuscript. FDM draft the manuscript. VT verified the method and encouraged to investigate specific elements. RDV and MC verified the structure of the manuscript and updated the bibliography. RS supervised the innovative aspects of this work. All authors contributed to the final manuscript.
Corresponding author
Ethics declarations
Ethical approval
Not applicable.
Competing interests
The authors declare that they have no competing interests.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
De Micco, F., Tambone, V., De Vito, R. et al. The hunger strike in prison: bioethical and medico-legal insights arising from a recent opinion of the Italian national bioethics committee. Med Health Care and Philos (2024). https://doi.org/10.1007/s11019-024-10215-w
Accepted:
Published:
DOI: https://doi.org/10.1007/s11019-024-10215-w