Wednesday, August 01, 2007

Is force feeding competent patients against their will compatible with professional ethics?

The question is asked in the International Herald Tribune in reaction to a good commentary on the issue in the Journal of the American Medical Association: Hunger Strikes, Force-feeding, and Physicians' Responsibilities

It seems hard to see how it can be, while arguably the physicians are preventing the patients from harming themselves they are doing this directly against the will of a patient who for all intents and purposes appears to be fully competent. This seems blatantly paternalistic at best. In most cases the best interests of the patient are outweighed by their informed choices. And given the further political aspect of thwarting the hunger strikers protest I am sure that from the strikers perspective they themselves believe that they are acting in their own best interests despite the physical harm they are doing to themselves.

It is surprising and disappointing that physicians seem to feel that they are better placed to decide for these prisoners.

4 comments:

Jasper said...

Now, I don't have nearly the reference necessary to post on this blog, but I consider myself as much of a level headed philosopher as I could possibly be at my age, and love new thought, and new challenges to my mind.

In this case, if only to play devils advocate, I disagree that it is a dissapointing thing that these doctors are doing, and furthermore, I don't think that they themselves are making decisions for these hunger strikers who have made themselves this unhealthy. The views of these doctors may not make this okay, but it is unfair to assume that they have not considered this, so here's my argument:

In essence, these prisoners have made the choice to stay alive, if they hadn't they'd surely have been dead before they got to the prison. So in seeing that these people have chosen to be, and by that choice want to be, alive, the doctors are merely maintaining their health until either they get what they want, or their bodies give out. I don't think that these prisoners have made the choice that they no longer want to be alive in this world, but rather they would chose death over the conditions they are living in, whatever those may be. It is an unfair assumption to say that these doctors are not considering that their job is to keep the people alive until they can get to better times and hopefully be freed, and I'd even go so far as to say many of the doctors probably hate the facility and are rooting for the prisoners to be freed; they are being voices of reason, though they were not asked to be.

The question to me boils down to this; if you are a philosopher, you must love life as a human being and examining that life, and by extension love all of the beings around you because they feel like you feel and think like you think and are the only other things like you that you have ever percieved; and if you love life as a thinking human being (that is what you are, of course) you are convinced that if others are to use their minds, there is no intelligence found anywhere in disrespecting what life is and what it has to offer, so if you see someone planning on commiting suicide, you, as a thinking person, can know (in as far as you CAN know) that this person had the will to live at some point and realized what an incredible thing that life is, and you want to help them, whether or not it is conflicting with their free will. Accepting the instances of suicide as a means for change is assinine, the disrespect for life and living it exudes far outweighs the message it sends about the prison, or about the horrible way of life.

Critique. I'd love to hear a more versed voices opinion...

I have a blog, thetimefortrusting.blogspot.com, I'd love for whoever reads this to check it out. I write about sports and popular culture and lots about the negative effects of 'hyper realities' in advertisement and how the nature of sports has strayed so far from appreciation for human physical ability in our environment. Sports is mostly an accessible means to bigger moral issues, please comment - and if you're interested I can give you permissions to post I want to get people reading it...

David Hunter said...

Hi Jasper, anyone is welcome to comment.

Hmm, interesting argument, I quite like it. I'll agree that the prisoners have "chosen" to stay alive. But I would be worried that this choice is the sort of choice that we would take as effectively waiving their right not to be treated , especially given their explicit dissent.

The main issue is that typically an autonomous decision needs to be informed, competent and voluntary. It is difficult to see that the choice to stay alive is really the sort of thing we would view as voluntary in this case, being captured and imprisoned seems to be a clear case of coercion.

But even if this wasn't the case, could they not be changing their mind, by starving themselves? Presumably one opting for life doesn't mean you opt for life forever.

I should say I agree with you that the doctors for the most part are probably motivated by a concern for keeping these people alive, and they are no doubt doing what they think is right in a horrific situation.

I guess I have a different take on the suicide issue, while I agree in general suicide is not a wise move I do think both that sometimes it can be, and that from the outside it is difficult to judge when it is one of those times. (Though it is also difficult from the inside as well)

In this case these people are making a horrific sacrifice, but supposing they are of sound mind, and they consider their cause to be of higher value than their life, I'm inclined personally to think the obligation is try and make them comfortably, but let them do what they want, remonstrating with them of course.

Jasper said...

I can see what you're saying but I find it hard to stray from my position on chosing death over life as a tenable option for others to be supporting. Being a person interested somewhat in the studies of metaphysics and epistemology, I find it hard to get my mind around sacrificing one's life for something one cannot truly know exists. On the other hand, though, you can easily say that without a sense of meaning and reality a person will not survive or have a sense of worth about his life anyway. It's an interesting debate over whether anything can ever be important enough to a thinking person for her or him to end their own life over it; a debate that I'm sure has been well studied. If you know of any essays or books that I can consult on it I'd appreciate it.

On the doctors decision making, though, it must be the decision of government officials and army ranking officers who tell them to maintain these lives, and I suppose the doctors there are ones who are aware of the issues and think that they are correct in their actions.

Although I have a strong opinion on it myself, I also hold an opinion that is stronger yet, and that as long as a person can demonstrate that his thought is his own, and that it was arrived at in an objective and intelligent way - as opposed to that of the all to many americans who chose to belive in whatever moronic pseudo philisophical soliloquy greys anatomy feeds them that week - he deserves the utmost respect for his opinions and others can have no more say than respectful dissent; and I hold that this above all is a key to all human cooperation - the semiotic and epistemical questions about how to achieve ultimate intellectual independence for all peoples then become our concern.

Thanks for responding, I didn't expect to get a real and respectful response until I got better at logical arguments and coherent writing. I really hope you can take some time to check my blog out, I feel like it will be more legitimate with more established and experienced people...

David Hunter said...

Ignore the religious aspects, I think in this case they are just a distraction. The fundamental question seems to be can it be rational to wish yourself dead. The answer seems to be straightforwardly yes, imagine a situation where it was certain you would be dead in 5 minutes, and you have a choice either die now painless or in 5 minutes time after 5 minutes of hellish pain and lack of dignity. It seems to me that opting to die now would not be irrational in that situation. (It is an interesting question whether opting to live would be)

I agree the doctors ought to be allowed to think for themselves, but given that their actions are also interfering with people who may be thinking for themselves I am not sure why we would give them priority?