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Legal and ethical implications of medically enforced feeding of detained asylum seekers on hunger strike

Med J Aust 2004; 180 (5): 237-240.

Summary

  • The current practice of non-consensual medical treatment of hunger-striking asylum seekers in detention needs closer inquiry.

  • An Australian Government regulation empowers the Department of Immigration and Multicultural and Indigenous Affairs (DIMIA) to authorise non-consensual medical treatment for a person in immigration detention if they are at risk of physical harm, but there are doubts about whether the regulation would withstand legal challenge.

  • Authorisation by DIMIA does not compel medical practitioners to enforce treatment if such action is contrary to their “ethical, moral or religious convictions”.

  • The World Medical Association has established guidelines for doctors involved in managing people on hunger strikes. The Declaration of Tokyo (1975) and the Declaration of Malta (1991) both prohibit the use of non-consensual force-feeding of hunger strikers who are mentally competent.

  • If called upon to treat hunger strikers, medical practitioners should be aware of their ethical and legal responsibilities, and that they should act independently of government or institutional interests.

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  • Mary A Kenny1
  • Derrick M Silove2
  • Zachary Steel3

  • 1 School of Law, Murdoch University, Murdoch, WA.
  • 2 School of Psychiatry, University of New South Wales, and Centre for Population Mental Health Research, South Western Sydney Area Health Service, Liverpool, NSW.

Correspondence: 

  • 1. Human Rights and Equal Opportunity Commission. Those who’ve come across the seas: the report of the Commission’s Inquiry into the detention of unauthorised arrivals. Canberra: HREOC, 1998. Available at: www.hreoc.gov.au/pdf/human_rights/asylum_seekers/h5_2_2.pdf (accessed Jul 2003).
  • 2. Ruddock explains decision to restart refugee claims process. Australian Broadcasting Corporation. The 7.30 Report 2002, 24 Jan. Available at: www.abc.net.au/7.30/s465903.htm (accessed Aug 2003).
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  • 5. World Medical Association. Declaration of Malta on hunger strikers (adopted by the 43rd World Medical Assembly in Malta, November 1991 and revised at the 44th World Medical Assembly in Marbella, Spain, November 1992). Geneva: WMA, 1992.
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  • 8. Silove D, Steel Z, Watters C. Policies of deterrence and the mental health of asylum seekers in Western countries. JAMA 2000; 284: 604-611.
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  • 10. Steel Z, Silove DM. The mental health implications of detaining asylum seekers. Med J Aust 2001; 175: 596-599. <MJA full text>
  • 11. Commonwealth of Australia. Migration Regulation 5.35(6).
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  • 14. Leigh v Gladstone (1909) 26 TLR 139.
  • 15. Secretary of State for the Home Department v Robb [1995] 1 All ER 677 at 681, referred to with approval in R (On the Application of Wilkinson) v. The Responsible Medical Officer Broadmoor Hospital [2001] EWCA Civ 1545 (22nd October, 2001); Re W (adult: refusal of medical treatment) 24 April 2002 by Dame Elizabeth Butler-Sloss P in the Family Division of the High Court.
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  • 19. World Medical Association. Guidelines for medical doctors concerning torture and other cruel, inhuman or degrading treatment or punishment in relation to detention and imprisonment. Adopted by the 29th World Medical Assembly, Tokyo, Japan, October 1975. Geneva: WMA, 1975.
  • 20. Silove D. Management of asylum seekers on hunger strike. Fellowship Affairs (Royal Australasian College of Physicians) 1993; 12(4): 9-10.
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  • 23. Prison Health Care Practitioners. Medical ethics in the prison context. Available at: www.prisonhealthcarepractitioners.com/Topic_2.shtml (accessed Jun 2003).

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