Hakan Gürvit
Istanbul Medical Faculty, Neurology Department
Turkey

Sebnem Fincanci-Korur
Istanbul Medical Faculty, Forensic Department
Turkey

The role of the physicians during hunger strikes, dual responsibility and medical ethics

El rol de los médicos durante las huelgas de hambre, la responsabilidad doble y la ética medica

Hunger striking is a multidimensional phenomenon, which should be evaluated, in its political, social, jurisprudential, medical, and ethical perspectives. The HS represents a potential route for the physicians to interfere in the process in accordance with their professional roles. Doctor-patient relationship becomes an intensively dynamic process.

The story, dynamics and contradictions of the experience during the HS's, that have been witnessed throughout the years, will be discussed. Literature is quite scarce in this subject matter, where a sound decision in terms of the best interests of the patient is often times rendered impossible due to the circumstances.

It might be difficult to empathize with a striker but force-feeding cannot be accepted for a competent hunger striker. WMA's Tokyo (Article 5) and Malta Declarations, along with other international documents have proved to be effective as guides for professional practice under dire circumstances.

Doctors as independent representatives of the Turkish Medical Association (TMA) took part in the most recent hunger strike from the very beginning till the intervention of the armed forces on December 19th. TMA doctors interviewed and examined the strikers, informed them about probable consequences and medical issues. Informed consents and the medical records of the strikers are kept in individual files. They have been cautious not to interfere in their decisions and not to question their political opinions. A representative of the TMA also participated as a member of a team of conciliators for the purpose of reaching a consensus to terminate the HS.

Patient-doctor relationship is confidential. However, HS needs public attention for increasing the pressure on the authorities. Hence this situation is not a secret confidential relationship. This inevitable transgression of confidentiality gives rise to multidimensional difficulties for all health professionals in charge of the strikers. The independence of the doctors who will take part in the management of the hunger strikers is of utmost importance, since they must be free of any intervention from third parties, hence of dual responsibility.