Sanctity of life and the right to life: Force feeding hunger strikers

In a seminal article from 1997 entitled "Unlimited human autonomy: A cultural bias?" Shimon Glick laid out his support for force feeding hunger striking political detainees. [1] Following recent hunger strikes by inmates at US facilities in Guantanamo Bay, Cuba, and in Israel and Turkey the question is again high on the public agenda. The World Medical Association and Israel Medical Association are quite specific and categorically prohibit the force feeding of competent hunger strikers under any conditions and only permit the artificial feeding of incompetent patients who have not expressed clear wishes to refuse treatment. [2, 3] In most cases, the argument that forbids medical personnel from feeding hunger strikers against their express wishes and allowing them to die is anchored in respect for autonomy. The International Committee of the Red Cross expressed the point succinctly: "The ICRC is opposed to forced feeding or forced treatment; it is essential that the detainees' choices be respected and their human dignity preserved. Given the preponderance of respect for autonomy in contemporary bioethics, it is not surprising that this principle is rarely questioned. It was, however, Glick's incisive argument that vigorously confronted what might be called the ?tyranny? of autonomy, that excessive obsequiousness to a principle that trumpets human choice and freedom but which just might allow healthy patients to die. Glick is not the first to take on autonomy, but his argument turns on the sanctity of life and, in this sense, differs significantly from those bioethicists who appeal to the right to life and concomitant duty of the state to protect life when they reappraise respect for autonomy. The sections below first describe the recurring phenomenon of hunger striking and the dilemma that it poses for medical care and bioethics. The sections immediately thereafter, take up those arguments that moderate if not refute respect for autonomy.