Hospital management of voluntary total fasting among political prisoners In 1989 20 political detainees, held without trial for up to 32 months, were admitted, on hunger strike, to the Johannesburg Hospital, South Africa. Most were held under the regulations of the State of Emergency (since revoked) and 5 were held incommunicado under section 29 of the Internal Security Act (still in force). Guidelines for ethical management were based on the Declaration of Tokyo, which included the understanding that such detentions constituted mental torture. Conditions of detention in hospital were complicated by police interference in medical and nursing care, and by the chaining of some prisoners to their beds. Doctors are in a unique position to protest against inhuman treatment of prisoners, and should use this authority. 