The bioethicist Art Caplan has argued against a court order requiring prison authorities to force feed a prisoner named William Coleman, who is on a hunger strike. It is against his autonomy, Caplan opines. From his column:
Recently, he took a turn for the worse. Prison officials, fearing for his life, sought and received a court order giving them the right to force-feed Coleman by giving food and water intravenously. They are wrong. Competent prisoners should not be fed medically against their will.Feeding Coleman or any other prisoner will require a doctor, nurse or other medically-trained prison worker to use restraints while inserting needles carrying artificial nutrition into the body. Feeding of this sort, as the U.S. Supreme Court recognized in the 1990 case of Nancy Cruzan, a young woman in a permanent coma whose relatives wished to discontinue her feeding tube, constitutes medical treatment. And that makes force-feeding any competent adult against their will unethical.I think Caplan is looking at this from the wrong end of the telescope. First, this isn’t a case of a sick or disabled person refusing medical treatment in the usual sense. The harm being ameliorated is self-caused. Would Caplan similarly claim that if a prisoner hanged himself and left a note that authorities were not to revive him, that the direction should be followed? Indeed, would he argue that about anyone who attempts suicide? I would hope not, and it seems to me the only difference is that Coleman’s self destruction is occurring in slow motion, while other forms are generally quicker. Second, Coleman is a prisoner and has hence lost significant autonomy rights. Third, prison authorities have the duty to protect the health and safety of those in their charge—including against self harm. That is surely why the court granted the authorities’ request for the court order. Finally, prison officials also have the duty maintain good order. Imagine the potentially disrupting impact that could arise were prisoners able to kill themselves by self starvation.
Caplan has anticipated some of these arguments, and in response claims that even if Coleman dies, his act would be protest, not suicide:
Some would argue that refusing food and water is an act of suicide and prisons do not have to accept suicides on the part of inmates. But a hunger-strike is not a suicide attempt. It is an act of protest. Coleman himself says he does not want to die, but he is willing to in order to draw attention to what he believes is his unjust conviction. Risking death is a means to an end. The end may be horrific, but even prisoners have the right to refuse medical care to make their point.No they don’t. Prisoners are not free. They don’t have full first amendment rights of protest. Indeed, had Coleman decided to immolate himself as a form of protest—as Buddhist monks did during the Vietnam War—rather than go on a hunger strike, should that also be permitted?
Sometimes Caplan is right—as in his good thinking about the ethics of organ transplantation. But sometimes his pugilistic political liberalism leads him terribly astray. In my view, this is one of those times.
