The Ethics of Caring for Detained People on Hunger Strike
Authors: Matthew Wynia, Eunice H. Cho, Joanna Naples-Mitchell
Journal: Annals of Internal Medicine (2022)

Ideas and OpinionsMay 2022The Ethics of Caring for Detained People on Hunger StrikeMatthew Wynia, MD, MPH, Eunice H. Cho, JD, and Joanna Naples-Mitchell, JDMatthew Wynia, MD, MPHUniversity of Colorado School of Medicine, Aurora, Colorado (M.W.), Eunice H. Cho, JDAmerican Civil Liberties Union, Washington DC (E.H.C.), and Joanna Naples-Mitchell, JDPhysicians for Human Rights, New York, New York (J.N.).Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M21-4280 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Hunger strikes by immigrants and asylum seekers are constitutionally protected, nonviolent protests of last resort, occurring with remarkable frequency in U.S. Immigration and Customs Enforcement (ICE) detention facilities (1). Their numbers have increased recently, as detained people protested ICE's lack of adequate pandemic precautions: About 2500 detainees participated in a hunger strike during the first 6 months of the pandemic compared with 1600 during a prior 3-year period (1). Given the vulnerability and lack of agency experienced by people in detention, what are the ethical responsibilities of health care professionals when detainees exercise their right to protest via hunger strikes?... References1. Guerrero M. COVID-19 hunger strikes sweep migrant detention centers. In These Times. 1 September 2020. Accessed at https://inthesetimes.com/article/jailed-migrants-hunger-strike-ice-detention-centers-covid-19 on 7 January 2022. Google Scholar2. Cho E. More of the same: private prison corporations and immigration detention under the Biden administration. American Civil Liberties Union; 5 October 2021. Accessed at www.aclu.org/news/immigrants-rights/more-of-the-same-private-prison-corporations-and-immigration-detention-under-the-biden-administration on 7 January 2022. Google Scholar3. Reeves R, Tamburello AC, Platt J, et al. Characteristics of inmates who initiate hunger strikes. J Am Acad Psychiatry Law. 2017;45:302-310. [PMID: 28939727] MedlineGoogle Scholar4. Cho E, Naples-Mitchell J. Behind closed doors: misuse and retaliation against hunger strikers in U.S. immigration detention. American Civil Liberties Union and Physicians for Human Rights; 2020. Accessed at www.aclu.org/report/report-behind-closed-doors-abuse-retaliation-against-hunger-strikers-us-immigration-detention on 7 January 2022. Google Scholar5. Cruzan v. Dir., Missouri Dep't of Health, 497 U.S. 261, 270 and 281 (1990). Google Scholar6. Sessums LL, Zembrzuska H, Jackson JL. Does this patient have medical decision-making capacity. JAMA. 2011;306:420-7. [PMID: 21791691] doi:10.1001/jama.2011.1023 CrossrefMedlineGoogle Scholar7. Wynia MK. The role of professionalism and self-regulation in detecting impaired or incompetent physicians [Editorial]. JAMA. 2010;304:210-2. [PMID: 20628138] doi:10.1001/jama.2010.945 CrossrefMedlineGoogle Scholar8. GEO Group, Clinical Practice Guidelines: Medical Management of Inmate/Detainee/Resident on Hunger Strike, April 2017. Released under the Freedom of Information Act to the American Civil Liberties Union. Available at www.aclu.org/sites/default/files/field_document/foia_2017-icli-0014_selected_documents_1.pdf. Accessed on 7 January 2022. Google Scholar Author, Article, and Disclosure InformationAffiliations: University of Colorado School of Medicine, Aurora, Colorado (M.W.)American Civil Liberties Union, Washington DC (E.H.C.)Physicians for Human Rights, New York, New York (J.N.).Acknowledgment: The authors acknowledge the work of Carl Takei, who filed the Freedom of Information Act request, and Michael Payne for early conversations that influenced the direction of this paper.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-4280.Corresponding Author: Matthew Wynia, MD, MPH, University of Colorado Anschutz Medical Campus, 13080 E 19th Avenue, Suite 201 E, Aurora, CO 80045; e-mail, Matthew.[email protected]edu.Author Contributions: Conception and design: E. Cho, J. Naples-Mitchell.Analysis and interpretation of the data: E. Cho, J. Naples-Mitchell, M.K. Wynia.Drafting of the article: E. Cho, J. Naples-Mitchell, M.K. Wynia.Critical revision for important intellectual content: E. Cho, J. Naples-Mitchell, M.K. Wynia.Final approval of the article: E. Cho, J. Naples-Mitchell, M.K. Wynia.Administrative, technical, or logistic support: J. Naples-Mitchell, M.K. Wynia.Collection and assembly of data: E. Cho, J. Naples-Mitchell.This article was published at Annals.org on 8 March 2022. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics May 2022Volume 175, Issue 5Page: 732-734KeywordsCOVID-19FoodHealth care facilitiesImmigrant healthMalnutritionMedical ethicsMorbidityStarvationTreatment guidelines ePublished: 8 March 2022 Issue Published: May 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...