Hopefully neither of us will ever find ourselves on either side of the situation.
It’s fine if you disagree with me, but try and be fair about it. “Repeating” was exactly what I did, I repeated the emotionally-charged rhetoric of another poster to make the point that either outcome is a bad one. Forcibly capturing and restraining someone for an insulin shot is a bad thing…as is allowing a person in your care to die. Emotional appears can be made to support either as the least-worst outcome.
[QUOTE=EverwonderWhy]
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.
[/quote]
I understand that this is your view. But refusing to undertake the intervention that would save the prisoner’s life can fairly be characterized as standing by while they die. If that phrasing makes you uncomfortable, then you might not be as firm in your beliefs as you think.
[QUOTE=EverwonderWhy]
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
[/QUOTE]
Those illustrate a key distinction: the moral duties facing the doctors and the prison authorities are very different. I’m addressing on the duty of the latter, as they are the ones in a position to order force feeding, or not to so order. If medical ethics forbid force-feeding, causing doctors to refuse to perform it, then that satisfies the prison official’s duty to see to his charges’ safety to the best of his ability.
Again I ask you to be fair. I never made such an argument. Pjen wrote:
I noted that this was an insufficient policy for a prison, as following their wishes is incompatible with imprisonment. You then chided me about suggesting that prisoners losing all their rights, which I never wrote, nor did I write anything than can reasonably be construed as that. If there’s a strawman here, it is yours.
[QUOTE=EverwonderWhy]
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.
[/quote]
I am familiar with paternalism, but this isn’t an example of it. I don’t suggest that force-feeding should be done because the state knows best, or for the good of the prisoner; it benefiting the prisoner is a side-effect. It should be done because, having removed the prisoners from society and placed them in a situation where they are at the mercy of the prison officials and unable to see to their own care without said prison officials, a moral duty is created to care for the prisoners. This is independent of the rights of the prisoners, and must be weighed against it as competing duties: caring for one’s charges, and refraining from violating their rights. In this particular situation, the former is more compelling.
Let’s see, “strawman”, “disingenuous”, and “cop out”, all in a row. What a delightful exchange this is turning into.
I articulated the source of the moral duty before, and did so again in the paragraph above.
In general, sure, but in the specific case of prisoners, the moral duty stems from having created the prison and locked people in it against their will.
Again, there are two duties in play here: the duty to care for prisoners, and the duty to respect the rights of others. We both seem to recognize both duties. When balanced against one another, I suggest that the duty to care is more compelling for a prison official, but of course it’s a close thing, the best of two bad choices.
? The fact that the outcome of a hunger strike and a suicide are both voluntary, preventable death means that they can be treated similarly. That is what I meant, the fact that one is a protest and the other not doesn’t make much difference to a prison official, again with the caveat that only force-feeding that is necessary to save a life is justified.
You gave me 60 pages of material, which I appreciate, but I’ll have to carve out some time to read it all. Bear with me; I have a job and other matters to attend to. I tossed out a general point, and will follow up after the weekend when I’ll have time to read it.
That’s another question, actually: is the death of one or more prisoners from self-induced starvation likely to destablize the prison, and lead to unrest, riots, etc? I don’t know the history of hunger strikes in prisons well enough to say, but it’s a plausible argument on its face.
On that we can certainly agree.
Perhaps, it can be fairly characterized that way by those who are uninformed, which is why I encourage you to read the link from the WMA where in addition to detailing medical guidelines for provider intervention, also provides a historical context, defines different types of hunger-strikers (or food- refusers), their varying fasting behavior (a total fast or ‘dry fast’ would result in death in a matter of days and is rarely undertaken since the point of fast is to protest by prolonging the process in order for their demands to be heard) and how these type of stand-offs with prison authorities can be better addressed and de-escalated without resorting to the use of force.
If the situation can be diffused with interventions that preserve the inmates life without a forceful assault on their person - while not requiring prison authorities to totally capitulate to the inmates demands - would that not be the most moral outcome of all? Now, it might not work in every circumstance, but it seems to have worked well in other countries that don’t force-feed in prisons as a matter of moral ethics. It is this type of intervention I advocate, which is not ‘just standing by and watching the inmate die.’
The type of black and white thinking you justify as the state’s moral duty, is not the most moral course of action at all. In fact, I think it not only escalates the issue, but perpetuates the problem. The use of force allows the inmate to become a martyr and galvanizes the protest.
Not quite, the WMA article, in particular, details the role ‘custodial officials’ play in the crisis. While I agree with the distinction of duties facing medical providers and prison authorities, there is a decent argument coming from many in the medical community that feel it is unethical to ever ask physicians/nurses to compromise their professional ethics (in the case of forcing a medical procedure on a competent unwilling recipient. Intervening up until that point if totally ethical); second, by asking physicians to participate in force-feeding, prison officials are sort of passing the buck, i.e. a medical solution to a political problem. If it’s the state’s moral duty to preserve life by force, then the state should carry it out. Not involve a third party to do its dirty work.
Yes, you sort of did. In your response to me when I pointed out that prisoners don’t lose all rights upon incarceration, they are limited by serving a penal interest:
Which “follow their wishes” is not at all what I said, so I responded:
To which you responded with:
‘The broad mandate to" follow their wishes" as guide’ you are arguing against is entirely your own. In fact, you seem to refuse to articulate upon what justification should a prisoner’s rights be curtailed in respect to free persons. While I stated my position pretty clearly: inmates do not lose all rights and autonomy upon incarceration, these rights are limited in order to maintain order and safety (and cited case law that supports this.) The complete opposite of ‘the broad mandate’ of your counter argument. I have no idea what you are arguing against on this point,* but yet* you keep responding to this one point by arguing points that no one is claiming (other than perhaps, Pjen, who I think you misunderstood, but is no longer responding, anyway.)
However, all this does center around a valid argument:
If non-incarcerated individuals have the right to refuse life-sustaining medical interventions, and if an inmate’s rights can only be curtailed to serve a penal interest (as case law suggests) then an inmate’s right to refuse life-sustaining medical intervention can only be justified if it serves a penal interest. You may disagree, but it is a pretty sound argument, not easily disproven by your counter argument that ‘the point of the prison is not to follow an inmates wishes.’
They are not entirely independent when they directly conflict . That’s the whole basis of the ethical dilemma and moral reasoning. The duty to care for someone generally does not extend to force, force is generally regarded as quite the opposite of care. And generally, in any other context or circumstance, assaulting a competent person’s body integrity by performing an involuntary medical procedure - is not morally justified. Which is why I find it baffling that you cite Kant’s ‘Categorical Imperative’ as justification. There is no universal maximum that as a moral rule justifies forcing a medical procedure on competent, unwilling recipient in ALL circumstances. Indeed, in almost any circumstance it does not. That’s the whole basis of the ‘Categorical Imperative’, a rule that is ALWAYS true. If non-incarcerated people are allowed to refuse life-sustaining medical treatment and even incarcerated individuals are allowed to refuse to life-sustaining medical intervention (as case law supports) , how does one apply a universal maxim that justifies involuntary medical treatment on competent people to preserve life in ALL circumstances? You can’t.
I gave you those other cites as a bonus to counter your other claims (e.g. hunger strikers being suicide attempts, etc), nor did I expect you to read them unless you cared to, as I stated when I linked them.
Now, you did specifically request the California Prison system link, here:
which I responded by providing a cite and quoting the pertinent parts:
Which is where I took issue, as you summarily dismissed as legal reasoning:
Which yeah, I found a bit astounding. Since you requested legal reasoning (which I dug up and even quoted for you) and then dismissed it outright with zero consideration on the basis it was a legal opinion. :dubious:
Very few hunger strikes in recent history in the US have ever led to death (that I am aware of). The legal reasoning used for the ‘penal interest’ justification seems to come from case law, where a hunger striker’s protest disrupted the prison order by leading to copy cat strikers who then endanger their own lives.
It’s important to notice that Thor was a Whose Life Is It Anyway? situation, i.e., a paralyzed inmate declining food. The California Supreme Court expressly disclaimed any application of its decision to hunger strikes. See footnote 16:
As is evident from my earlier posts, I’m sympathetic with hunger strikers. But I accept that the California Supreme Court in Thor didn’t recognize any such right.
My point in bringing up the case was not that inmates have an absolute right to refuse life-sustaining medical intervention in all circumstances (indeed, that is not my contention at all), but that the reasoning in this case (which vacated a lower court order to continue to force-feed Mr. Andrews) justifies allowing the inmate to refuse life-sustaining medical intervention,* because it did not find sufficient evidence that doing so presented disruption to the safety and order of prison.*
Ergo, the state’s duty to preserve the life of the inmate by non-consensual medical intervention is not absolute, as Human Action asserts. It would seem to very much depend on circumstance (in this case,* in part*, to the quadriplegia of Mr. Andrews - which is not necessarily considered a terminal illness by any means, just brings into question quality of life) and the disruptive effect it has on the safety and order of the institution.
DANIEL THOR, Petitioner, v. THE SUPERIOR COURT OF SOLANO COUNTY,
Respondent; HOWARD ANDREWS, Real Party in Interest.
No. S026393
SUPREME COURT OF CALIFORNIA
From page 2:
California Penal Code 2600 (from page 4 of the opinion)
Also, the preceding context (on page 11) to the footnote you cited:
****** emphasis mine*
What the case did establish was “under California law a competent, informed adult has a fundamental right of self-determination to refuse or demand the withdrawal of medical treatment of any form irrespective of the personal consequences.” And that the curtailment of this fundamental right under Penal Code 2600 must provide sufficient ‘evidence demonstrating a reasonable and necessary disruption to prison safety and order.’
Which is essentially what I asserted here:
And the language of the decision did not necessarily ‘expressly disclaim any application in hunger strikes.’ But “Under the facts of the case we [the court] have no occasion to address, and therefore do not decide, any related issues …”
The ruling in Thor, is NOT a blanket ruling to vacate all force-feeding orders. Each order is evaluated on it’s own merit, but Thor did recognize the fundamental right of competent people to be self-determining in the matter of their medical treatment and places a higher burden on the state to provide evidence of a reasonable and necessary penal interest sufficient to override this fundamental right.
It should also be noted, that Mr. Andrews is responsible for causing his own paralysis by falling or jumping off a wall while in the state’s custody.
Choosing to discontinue medical treatment
is not
Refusing emergency medical treatment
Prison can tube feed somebody as an emergent measure, then later allow the prisoner to decline insulin treatment with no moral conflict.
And I wasn’t equivocating them 
The prison can provide emergency medical treatment, until a court has time to review the force-feeding order. Indeed, not every state requires a court order, but some jurisdictions do.
The other issue in emergency medical treatment is the presence of an advanced directive. Once the patient’s intent about life-sustaining medical treatment is known, the burden for overriding that intent is greater. In a California (and Georgia and Florida too, perhaps) prison system, the burden for curtailing a person’s fundamental right to be self-determining in the refusal or discontinuation of life-sustaining medical treatment hinges upon evidence of a necessary and reasonable penal interest.
Obviously, force-feeding during hunger strikes is still permissible in California (I have never contended otherwise). In the 2011, the CA prison commissioner threatened to seek a court order for force-feeding, but the onus for doing so would be based on the evidence of a necessary and reasonable penal interest. The hunger strike ended before an order was sought from the court and prison officials promised to review the issue of indefinite solitary confinement. It would not be that hard to prove that 30,000 inmates participating in a hunger strike represents a significant disruption in safety and order within the prison. Indeed, I don’t think that providing evidence of the effect of an individual inmate’s hunger strike on prison security would be all that difficult. What I vehemently disagree with, is the state’s absolute right to force life-sustaining medical treatment on a competent and informed person. NO, the state needs to provide evidence of a sufficient penal interest that justifies curtailing an inmates fundamental right to be self-determining in matters of their body integrity. Which again is not all that hard. Strip searches and body cavity searches are justified quite simply by serving a penal interest.
I don’t agree with this argument. The medical staff in a prison are just as much employees as the security staff are. Their job is to provide medical services to the prisoners. It’s not “passing the buck” to expect them to perform a medical procedure.
In the regular context of performing a medical procedure on a consensual patient, I would agree with you.
However, my contention is not that asking ‘medical personnel to perform a medical procedure is passing the buck.’ It’s that in the context of performing a medical procedure on a competent, but unwilling recipient, a physician or nurse,* unlike a regular custodial employee of the state*, are faced with a dual loyalty. Duty to their employer (the state) and duty to uphold the medical ethics of their profession, where performing a medical procedure on a competent unwilling patient - even if it is in the patient’s best interest - is strongly condemned. (The medical community also condemns the participation of physicians in capital punishment for a very similar reasoning.)
Which brings up another issue: in the case of hunger strikes, it is highly recommended that an independent physician/nurse be brought in to intervene. Inmates are more likely to voluntarily resume nourishment if the medical provider intervening on their behalf is not an agent of the state. Seems to work well to de-escalate the crisis in other countries (Canada, the UK, etc) where force-feeding in prisons is NOT permissible.
You’re being overly literal. “Standing by” needn’t mean literally standing near the prisoner and doing nothing at all, it refers, as a I specifically noted, to refraining from undertaking a life-saving force feeding. For a force-feeding to be necessary, all other measures must have failed.
Of course. Violence is always a last resort.
Whether a moral duty exists or not is a black and white question, as it can only be answered with a yes or a no. The shades of gray come into play when it must be weighed against other moral duties.
If other sorts of intervention can be tried, then morally, they must be, with force-feeding, if it is to be used, as a last resort.
That’s another moral duty that state must weigh in its calculation, then. The issue becomes yet more complex.
You must have missed “That is uncontested”. That meant I was agreeing with what you wrote, but explaining why I’d written what I did: it was in response to Pjen. That is the sum of the arguing against a position of “follow their wishes” that I did. My response to you was not a counter-argument; those rarely begin by accepting everything in the argument as being correct, which “That is uncontested did”.
Again, that was not a counter-argument.
The universal maxim is a duty to care for those whom you’ve made utterly dependent on you, be it a child or an inmate. The bounds of that duty, and what is or isn’t care, can of course be debated, as we are doing, but the duty exists, we seem to agree on that.
That was not a claim of mine. Hunger strikes that persist until the person dies are suicides, though, I don’t know what else you would call it. It’s certainly an act of intentionally causing one’s own death. A political suicide, perhaps, but a suicide. Which is why I wrote that a hunger strikes “may also become suicides”.
Well, sorry.
Yes. Having an outside physician speak to the prisoner would be one of the options tried. You’d also have him speak with clergymen and psychiatrists and family members.
Whether or not it’s wrong to force feed an idiot who wants to starve himself, it IS wrong to expect it. If you want to starve yourself it’s not anyone else’s responsibility to protect you from being an idiot.
Assuming they’re mentally sane and capable of reasoned judgement of course.
Damn, it’s a catch 22.
I am old enough to remember when it was the Soviets who did this and it was universally condemned by the West. We knew they were evil because they did these things.
It was the Soviets who
- Had secret lists of people and secret proceedings
- Sent people to prisons without fair trials
- Tortured them
- If they went on hunger strike they force fed them
- If they rebelled they would be sent to psychiatric “hospitals” (because they were obviously crazy)
All these things were universally condemned by western countries. Solzhenitsyn was the hero of the West for denouncing these things. In The Gulag Archipielago he compares force feeding of prisoners with rape.
How times have changed. Now it is America doing all these things and wants us to believe they are acceptable.
The American Government tortures people and drives them insane and when they want to end it all the Government declares them unfit to make their own decision.
I guess I am old fashioned because I still believe all those things are evil and what America is doing is evil.
All states justify their wrongdoing by saying it is “for the people” but that does not make it right.
Never in my younger years could I have imagined America could or would sink so low and so bad. The fact that so many Americans support all this evil makes it so much worse in my eyes.