Avoiding what is essentially daily torture of illegally confined prisoners with no apparent rights.
So, “Let 'em starve”, then. How enlightened.
Which states criminalise suicide?
Incarcerated individuals do not automatically lose their rights by virtue of conviction or incarceration. Inmates generally retain the right to refuse medical treatment - including life sustaining medical treatment as long as they are deemed competent. In the case of suicide, all people (incarcerated or not) are generally considered not to be of sound and rational mind.
An inmate’s loss of privacy (cell searches, stip searchs, etc) or imposed hygiene standards are generally justified by serving a penological interest e.g.* the safety and order of the prison* - not necessarily because the state ‘knows what’s best’ for the individual inmate. That type of paternalism is very problematic, generally considered highly unethical and historically responsible for horrific abuse within our state institutions. The state certainly has a duty to provide for the well-being of the inmate by ensuring inmate safety, access to healthcare, legal recourse, food, etc. But this duty does not at all automatically extend to the state using force in order to provide.
My understanding, (from a bioethical perspective), is generally inmates who hunger strike as a group are not doing so intending some kind of mass suicide, but to protest. Indeed, it is generally their only form of peaceful protest. From a practical perspective, it is likely far easier to commit suicide in prison than to starve to death, ergo, automatically characterising a hunger strike as a suicide attempt is woefully inaccurate. (Though, there have been some individual inmates that strike intending to kill themselves, however it is my understanding these are few and far between and again the intent to suicide invokes the competency and rationality clause).
The arguments I’m most familiar regarding the force feeding of prisoners involve the inmates first amendment rights. In California, where I beleive force feeding involves a court order, the institution must prove that force feeding serves a penological interest, e.g. maintaining the order and safety of the prison, not because the state’s duty to preserve the (competent) inmates life automatically means doing so by force, against their will. And generally speaking, very, very few inmates engaging in a hunger strike have actually had the incredible strength of will to actually kill themselves by starvation. Off the top of my head I can only think of Bobby Sands (though I am sure someone can find more).
Ironically, some of the most compelling (bioethical) arguments I’ve come across that justify force feeding of prisoners on moral and ethical grounds do so *precisely because * force feeding enhances and prolongs the prisoner’s protest.
In the US, attempted suicide will get you locked up and evaluated.
It’s not against the law to succeed at killing yourself, though you probably won’t collect insurance on it.
It’s not just the AMA, but theWorld Medical Association, Declaration of Tokyo, Declaration of Malta and policies from a host of other national and international health organizations that condemn force-feeding at prisons.
Cite for locking up the majority of attempted suicides. Assessed in ER possibly, detained, unlikely. Unless you know better.
That is uncontested, but “follow their wishes” isn’t how prisoners are treated. That’s rather the point of a prison.
Suicide is exactly what we’re talking about here.
[QUOTE=EverwonderWhy]
An inmate’s loss of privacy (cell searches, stip searchs, etc) or imposed hygiene standards are generally justified by serving a penological interest e.g.* the safety and order of the prison* - not necessarily because the state ‘knows what’s best’ for the individual inmate. That type of paternalism is very problematic, generally considered highly unethical and historically responsible for horrific abuse within our state institutions. The state certainly has a duty to provide for the well-being of the inmate by ensuring inmate safety, access to healthcare, legal recourse, food, etc. But this duty does not at all automatically extend to the state using force in order to provide.
[/quote]
Ensuring their safety can’t be squared with letting them starve, now can it? Something has to give. Why should it be the one that entails suffering and death of those in the state’s care?
[QUOTE=EverwonderWhy]
My understanding, (from a bioethical perspective), is generally inmates who hunger strike as a group are not doing so intending some kind of mass suicide, but to protest. Indeed, it is generally their only form of peaceful protest. From a practical perspective, it is likely far easier to commit suicide in prison than to starve to death, ergo, automatically characterising a hunger strike as a suicide attempt is woefully inaccurate. (Though, there have been some individual inmates that strike intending to kill themselves, however it is my understanding these are few and far between and again the intent to suicide invokes the competency and rationality clause).
[/quote]
Protest and suicide are not mutally exclusive. Hunger strikes are protests, and may also become suicides.
At some point during a hunger strike, at some number of days elapsed, surely the intent to suicide is clear? And if you favor intervention in suicide attempts, why not that subset of suicide attempts?
[QUOTE=EverwonderWhy]
The arguments I’m most familiar regarding the force feeding of prisoners involve the inmates first amendment rights. In California, where I beleive force feeding involves a court order, the institution must prove that force feeding serves a penological interest, e.g. maintaining the order and safety of the prison, not because the state’s duty to preserve the (competent) inmates life automatically means doing so by force, against their will. And generally speaking, very, very few inmates engaging in a hunger strike have actually had the incredible strength of will to actually kill themselves by starvation. Off the top of my head I can only think of Bobby Sands (though I am sure someone can find more).
[/quote]
Can you link to some information about California’s system?
[QUOTE=EverwonderWhy]
Ironically, some of the most compelling (bioethical) arguments I’ve come across that justify force feeding of prisoners on moral and ethical grounds do so *precisely because * force feeding enhances and prolongs the prisoner’s protest.
[/QUOTE]
The fact of the protest is separate from the fact of the starvation, and can be considered separately.
Most states have so called “mental health holds”, attempted suicide “may” and probably will fall under that? As far as the majority being detained? I have no stats on that.
In part;
5122.10 Emergency hospitalization.
Any psychiatrist, licensed clinical psychologist, licensed physician, health officer, parole officer, police officer, or sheriff may take a person into custody, or the chief of the adult parole authority or a parole or probation officer with the approval of the chief of the authority may take a parolee, an offender under a community control sanction or a post-release control sanction, or an offender under transitional control into custody and may immediately transport the parolee, offender on community control or post-release control, or offender under transitional control to a hospital or, notwithstanding section 5119.20 of the Revised Code, to a general hospital not licensed by the department of mental health where the parolee, offender on community control or post-release control, or offender under transitional control may be held for the period prescribed in this section, if the psychiatrist, licensed clinical psychologist, licensed physician, health officer, parole officer, police officer, or sheriff has reason to believe that the person is a mentally ill person subject to hospitalization by court order under division (B) of section 5122.01 of the Revised Code, and represents a substantial risk of physical harm to self or others if allowed to remain at liberty pending examination.
According to who? You? Yes, prison is a form of punishment, but also rehabilitation. Prisoners no longer suffer a ‘civil death’ upon incarceration. They still have rights and autonomy, though limited. Justification for limiting these rights should not be left to prison officials to arbitrarily or randomly determine on their own. Indeed, there is a mountain of case law that details this very issue.
No, it is what you are determined to keep talking about by refusing to frame or consider the issue in any other way - despite there being a plethora of arguments and analysis that do so.
The state’s duty is to provide care for prisoners, not to impose it on unwilling recipients. Who are you to determine the suffering of those in state care, explicitly when the inmate in question is deemed of sound mind and competency to make their own decisions? This is the crux of the issue. This is the very type of paternalism that is inherently unethical. You seem to think that force-feeding is justified in order to prevent the inmates suffering despite the inmate’s right to be self-determining in matters of their body integrity and their own suffering. Force-feeding may cause the inmate more suffering than death, as it is an assault on their human dignity.
From the cite lawbuff linked to on the first page of this thread (page 9):
*****emphasis mine
I encourage you to examine the rest of the article as it presents a compelling argument on how force-feeding is not justified in order to prevent the prisoners death, but in order to serve a penal interest e.g. maintaining safety and order in the prison. Force-feeding is justified if it prevents harm to others in the prison.
From page 18-19 of lawbuff’s cite:
I’m not necessarily in favor of intervention in suicide attempts, but only bring it up to present how the ‘competency’ qualifier commonly invoked justifying suicide intervention * is totally absent in hunger strikers*. Indeed, the very definition of a hunger striker is a person of sound and rational mind choosing to refuse nourishment.
From JAMA (2007):
Nuanced? Definitely. Characterizing a hunger strike as a suicide attempt is inaccurate. The intent and criteria are very different, even if the outcome may be the same.
Futhermore, in the more recent Leroy Dorsey case (New York, 2013), as his fast progresses he is interviewed and examined daily by medical staff, he repeatedly explicitly states his intent is NOT to suicide.
If you care to slog through all 45 pages, skipping the procedural issues/jargon, you will find one of the arguments presented regarding the force-feeding order on Mr. Dorsey as necessary in serving a penal interest, maintaining order and safety in the prison.
(~ pages 43-44)
The court had some (justified, IMO) scathing criticism of Mr. Dorsey, but the arguments and case precedents presented in the opinion are quite sound. (It should also be noted after the force-feeding order was granted by the court, Mr. Dorsey accepted nourishment voluntarily.)
The penal interest justification of force-feeding was also cited by the Connecticut Superior Court in the recent William Coleman case. (sorry, don’t have the wherewithal to actually dig up that opinion, so the HuffPo will have to do)
Starting on page 11:
*****emphasis mine
It is my understanding that this case set precedent in California that force-feeding in prisons must be justified by serving a penal interest and typically involves a court order.
Not necessarily, if the protest is expressed by virtue of starvation. Particularly, on the issue of mental competency and how inmates are generally allowed to refuse life-sustaining medical treatment.
TL;DR
States may vary in how they justify force-feeding and SCOTUS has declined to review the issue, but in my opinion justifying force-feeding as an extension of ‘the state’s duty to provide for an inmate’s well-being’ is totally unethical. I strongly oppose that degree of paternalism. The duty to provide for a person’s care during involuntary incarceration does not extend to forcing ‘care’ on a competent, but unwilling recipient. The only argument that works for me,* in some limited circumstances*, is the ‘preventing harm to others’ justification, e.g. serving a penological interest in maintaining safety and order in the prison.
I think we’re talking past each other on this point. Prisoners do, and should, retain many of the rights they’d have outside of prison. That said, a broad mandate to “follow their wishes” isn’t a useful guide. I have a feeling the wish that 99% of them most desire to follow is be released from prison. By their nature, a prison is going to impose curtailment of some rights. Otherwise, it ceases to be a prison.
[QUOTE=EverwonderWhy]
No, it is what you are determined to keep talking about by refusing to frame or consider the issue in any other way - despite there being a plethora of arguments and analysis that do so.
[/quote]
The moral duty I wrote about is to keep prisoners alive. In that light, the prisoner’s reason to end their life is irrelevent.
Hunger strikes that aren’t an immediate threat to the life of the prisoner don’t invoke the moral duty. Force-feeding someone on day 3 of their strike is right out.
[QUOTE=EverwonderWhy]
The state’s duty is to provide care for prisoners, not to impose it on unwilling recipients. Who are you to determine the suffering of those in state care, explicitly when the inmate in question is deemed of sound mind and competency to make their own decisions? This is the crux of the issue.
[/quote]
A moral person, and nothing more or less.
[QUOTE=EverwonderWhy]
This is the very type of paternalism that is inherently unethical. You seem to think that force-feeding is justified in order to prevent the inmates suffering despite the inmate’s right to be self-determining in matters of their body integrity and their own suffering. Force-feeding may cause the inmate more suffering than death, as it is an assault on their human dignity.
[/quote]
You say paternalism, I say a moral duty. If the legal duty is to let the prisoner starve so as to respect their right to self-determination, so be it. Much that is morally wrong is legal. It doesn’t affect the moral duty, which is what this thread is about; “is it wrong” is purely a moral question.
[QUOTE=EverwonderWhy]
From the cite lawbuff linked to on the first page of this thread (page 9):
*****emphasis mine
[/quote]
I place a great deal of stock in Mill, but I see prisoners of the state as an exception, as previously articulated.
[QUOTE=EverwonderWhy]
I encourage you to examine the rest of the article as it presents a compelling argument on how force-feeding is not justified in order to prevent the prisoners death, but in order to serve a penal interest e.g. maintaining safety and order in the prison. Force-feeding is justified if it prevents harm to others in the prison.
From page 18-19 of lawbuff’s cite:
[/quote]
I don’t assert a general societal interest, but rather a moral duty.
[QUOTE=EverwonderWhy]
I’m not necessarily in favor of intervention in suicide attempts, but only bring it up to present how the ‘competency’ qualifier commonly invoked justifying suicide intervention * is totally absent in hunger strikers*. Indeed, the very definition of a hunger striker is a person of sound and rational mind choosing to refuse nourishment.
From JAMA (2007):
Nuanced? Definitely. Characterizing a hunger strike as a suicide attempt is inaccurate. The intent and criteria are very different, even if the outcome may be the same.
[/quote]
The outcome, not the process, is all that need concern a moral duty to intervene.
[QUOTE=EverwonderWhy]
Futhermore, in the more recent Leroy Dorsey case (New York, 2013), as his fast progresses he is interviewed and examined daily by medical staff, he repeatedly explicitly states his intent is NOT to suicide.
If you care to slog through all 45 pages, skipping the procedural issues/jargon, you will find one of the arguments presented regarding the force-feeding order on Mr. Dorsey as necessary in serving a penal interest, maintaining order and safety in the prison.
(~ pages 43-44)
The court had some (justified, IMO) scathing criticism of Mr. Dorsey, but the arguments and case precedents presented in the opinion are quite sound. (It should also be noted after the force-feeding order was granted by the court, Mr. Dorsey accepted nourishment voluntarily.)
The penal interest justification of force-feeding was also cited by the Connecticut Superior Court in the recent William Coleman case. (sorry, don’t have the wherewithal to actually dig up that opinion, so the HuffPo will have to do)
[/quote]
That is a lengthy piece, I’ll try and find the time to read it.
[QUOTE=EverwonderWhy]
Supreme Court of California
Starting on page 11:
*****emphasis mine
It is my understanding that this case set precedent in California that force-feeding in prisons must be justified by serving a penal interest and typically involves a court order.
[/quote]
As legal reasoning, that’s perfectly fine. The law and morality are quite distinct.
[QUOTE=EverwonderWhy]
Not necessarily, if the protest is expressed by virtue of starvation. Particularly, on the issue of mental competency and how inmates are generally allowed to refuse life-sustaining medical treatment.
[/quote]
Point was, one can discuss the state’s duty or lack thereof to intervene and save the life of those in their care, without considering the qualifier of a formal, declared protest. Either that duty exists, or it does not. Legally, it does not. Morally? Under my moral code, it does.
A diabetic prisoner refuses insulin. Do you pin the prisoner down and inject insulin each time it is warranted?
Yes.
(Meaning that a moral duty exists to do so, not that this duty should supercede a duty to obey the law).
So, a prisoner serving a life sentence who is a brittle diabetic and refuses to inject himself with insulin decides to hunger strike.
You are OK with forcibly capturing and restraining the prisoner three or more times each and every day to force feed, take blood samples, and inject an appropriate dose of insulin?
If so . . . Wow.
Yes.
You are OK with standing by while the prisoner slowly dies?
If so…wow.
I feel my stand is more humane.
You feel your stand is more humane.
Define slowly. The diabetic will not be around all that long without insulin.
There are things worse than death. If I were the prisoner, I would hope for a warden like me.
That seems to sum it up.
Will they not? I know very little about diabetes. The slowness of death is just a detail, though, it doesn’t affect my core judgment.
I’d want the one like me. Thus, my view accords with the Categorical Imperative, and is moral on that basis.
And yet, for you, my position violates said Imperative. This is the subjective mess that Kant was trying to avoid, but as we see, he did so imperfectly, as all morals are ultimately subjective, even Objectivism.
And I’ll add this: when the guards were holding down the screaming prisoner for his feeding or insulin, I bet I’d feel pretty shitty about things.
When the guards were wheeling out the corpse of the prisoner, I bet you’d feel pretty shitty about things.
It’s a situation where there is no “good” outcome, just a choice between which sort of bad outcome is more tolerable.
You keep repeating this type of emotionally charged rhetoric. No one stands by without intervening. Hunger striking inmates in medical crisis are attended and counseled on their condition every day. The intervention stops short of assaulting their person and assailing their human dignity. That assault on a person’s human dignity is what some us find more morally depraved than allowing a competent and fully informed person to be self-determining in the matter of their body integrity and suffering.
Why don’t you inform yourself of what the WMA advises physicians and healthcare providers to do in their treatment of huger strikers? After all, their guidelines are not legally binding, but actually rooted in ethics and their moral duty to the patient supersedes their duty to the state. And in many places such as the UK and Canada that do not force-feed, physicians following the WMA guidelines have actually quite successfully de-escalated many situations in a manner that preserves the patient’s human dignity.
Also:
Hunger Strikes, Force-feeding, and Physicians’ Responsibilities
No one is saying that an ‘inmates wishes should be followed 99% of the time’, except you, in what only can interpreted as a repeated attempt of arguing a strawman of your own invention. An inmate’s rights are limited during incarceration, no question, but curtailment of these rights should be morally/ethically justified. Not totally arbitrary or simply hand waved away as ‘well, that’s the point of a prison, duh!’ As** Little Nemo** pointed out, searches are carried out in different ways and authorized for different reasons. Not because officials can arbitrarily do whatever they want - it must be justified - and typically this justification centers around a penal interest.
You are being disingenuous here. If you are familiar with Mills and the concept of ‘moral duty’ in the context of philosophical ethics, you should also be familiar with Paternalism, as a core concept. To override a competent person’s fundamental right to be self-determining, particularly in matters of body integrity and their own suffering, there must be a serious and compelling moral justification for doing so. You seem to think preservation of life is enough - despite the same moral duty you espouse not existing outside of incarceration. That is paternalism.
I disagree, preventing harm to others’ is the only acceptable moral justification.
By all means, please articulate without going back to your cop out that ‘an inmates wishes don’t have to be followed because they are in prison, duh!’ If an inmates rights are curtailed by virtue of incarceration (a point no one is disagreeing), the curtailment of these rights must be justified. What criteria do you use that justifies the curtailment of these rights? My position is that the curtailment of an inmates rights should serve a penal interest.
The moral duty to preserve life, stems from the concept of human dignity. Intuitively, some think that preserving life is always warranted, because it promotes human dignity and failing to prevent unnecessary death cheapens the value of life. I would tend to agree, but preventing unnecessary death can not be morally justified by assaulting a competent person’s human dignity and denying their right to be self-determining in matters of body integrity and suffering. Indeed, preserving human dignity promotes respect for the sanctity of life far more than simply preserving life (through unethical means.)
Actually, ethics 101, remember ‘the ends don’t justify the means’ concept? An unethical outcome can not be prevented by use of unethical means.
You are the one who asked for the link and then you totally hand wave away the moral/ethically reasoning employed in the decision? Just because it is a legal opinion (which you asked for), does not preclude moral reasoning. But I am sure you know this.
Yes, this is where we fundamentally disagree. The state’s moral duty to intervene and preserve the life of those in it’s care does not extend to forcing care on a competent and unwilling recipient - *without a serious and compelling reason, e.g. preventing harm to others, maintaining the order and safety in the institution. *