A heavy moral burden as Palestine Action hunger strikers risk death | Letters

Dr David Nicholl and Dr John Kalk discuss medical ethics in relation to the care of prisoners on hunger strike, and Dr Jonathan Fluxman calls on Labour to act now before the worst happens

We are not involved in the medical management of the Palestine Action hunger strikers, though we have experience of previous such protests (Families of Palestine Action hunger strikers seek urgent meeting with Lammy, 22 December). The ethical issues are well established: respect for consent, confidentiality, assessment of mental capacity and vigilance for coercion within the doctor-patient relationship.

These prisoners have not faced trial, with some dates set as late as 2027. The damaging effects of prolonged remand on mental health are well known. In this context, voluntary total fasting may be perceived as their only means of protest against detention, so a valid advanced directive, which provides instructions for their medical management when they lose mental capacity, would be essential.