Theoretical Medicine and Bioethics

, Volume 39, Issue 4, pp 321–334 | Cite as

Prisoners’ competence to die: hunger strike and cognitive competence

  • Zohar LedermanEmail author


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.


Autonomy Hunger strike Force-feeding Mental competence Mental disorder 



Dr. Michael Weingarten passed away while this manuscript was being reviewed. I mourn his passing. I thank Mayli Mertens, Voo Teck Chuan, Marcus Labude, and Owen Schaefer for their constructive comments.


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Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  1. 1.Centre for Biomedical Ethics, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
  2. 2.Assuta Samson HospitalAshdodIsrael

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