32 Hunger Strike in the Pendulum of Ethics and Law treatment and force-feeding against the will of the prisoner on a hunger strike is prohibited.99 In the USA, the decision is taken through a court decision, and medical interventions, including force-feeding, with respect to a hunger striker is mainly allowed.100 The American Supreme Court finds acceptable the force-feeding that does not infringe the prohibition of ill-treatment and torture and differentiates between those who are at prisons and those who are not in terms of the boundaries of hunger strike.101 b. Medical Ethics and the Turkish Medical Association’s Approach to the Matter In the documents of the universal medical ethics, a hunger striker with deteriorating health is, in any case, regarded merely as a patient, and no distinction is made between those who are and are not placed at prison. For instance, the Malta Declaration treats equally the hunger strikes of free persons and those of the prisoners and puts forward its perspective on this matter as follows: “Hunger strikes occur in various contexts but they mainly give rise to dilemmas in settings where people are detained (prisons, jails and immigration detention centres). There is a physician-patient relationship between the hunger striker and the physician. As is the case for any patient, the physician may conduct the process through recommendations or treatment.” The Declaration advises that individuals’ autonomy should be respected, noting that the decision given by the striker of his own free will when he is fully conscious should be taken into consideration at the subsequent stages. As a result, it is suggested that a convict refusing medical treatment be left to die in dignity, without any restriction, reservation or exception. “The Manual on Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment”, issued by the UN in 1999 (the Istanbul Declaration) took the ethical standards of patient-physician relationship a step further. Accordingly, it is recommended that in case of any contradiction between 99 James Welsh, “Responding to Food Refusal: Striking the Human Rights Balance”, Interrogations, Forced Feedings, and The Role of Health Professionals (eds. Ryan Goodman&Mindy J. Roseman), Harvard University Press, 2009, p. 147. 100 Gordon, p. 348. 101 Gordon, p. 358 et seq.
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