adequately monitored. The methods used to execute force‑feeding should not be unnecessarily painful and should be applied with skill and minimum force. Force‑feeding should infringe the physical integrity of the hunger striker as little as possible. Treatment of sexual ofenders in prison The treatment of patients with paraphilias, irrespective of which method of treatment is used, has always been undertaken through a minefeld of clin‑ ical and ethical dilemmas. The major ethical issues regarding sex ofenders, including paraphilias, may refect the need for public safety and even a pro‑ fessional orientation towards punishment rather than treatment, even when the treatment is appropriate and efective.29 The CPT has addressed the issue in its several reports.30 Its recommendations could be summarised as follows. X Measures taken to counter re‑ofending should never be based on efcacy alone. Narrow focus on lowering re‑ofending rates may pave the way to serious human rights abuse. Diferent treatment options are available, based on psychotherapy (including group therapy), pharmacotherapy (including the use of anti‑androgens) or a combination of the two; X Before starting any medical treatment, the free and informed written consent of the person concerned should be obtained before the start of pharmacotherapy (including anti‑androgen treatment), allowing for the consent to be withdrawn at any time. The prisoner in question should be given a detailed explanation (including in writing) of the purpose and possible adverse efects of the treatment, as well as the consequences of refusal to undergo such treatment. Anti‑androgen treatment should always be based on a thorough individual psychiatric and medical assessment and such treatment should be on purely voluntary basis. A comprehensive and detailed procedure should be devel‑ oped, including additional safeguards: inclusion and exclusion criteria for 29. Bowden P., “Treatment: use, abuse and consent”. Criminal Behaviour and Mental Health 1 (1991), 130‑41; Berlin F., “Sex ofender treatment and legislation”. Journal of the American Academy of Psychiatry and the Law 31 (2003), 510‑13; Ward T., Gannon T. A. and Birgden A., “Human rights and the treatment of sex ofenders”. Sex Abuse 19/3 (2007), 195‑204; Elger B. S., “Research involving prisoners: consensus and controversies in international and European regulations”. Bioethics 22 (2008), 224‑38. 30. CPT/Inf (2009)8; (2011)20. Psychiatric care and treatment plans Page 45