Prisoners’ competence to die: hunger strike and cognitive competence
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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.
KeywordsAutonomy 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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