respect the autonomy of the individual needs to be addressed, in accordance with medical ethics and also with the legislation of the particular country. The European Court of Human Rights has in its ruling X v. Germany stated that, when a detained person maintains a hunger strike, this may inevitably lead to a confict between an individual’s right to physical integrity and the contracting party’s obligation under Article 2 of the Convention – a confict which is not resolved by the convention itself.26 However, the Court has considered that a situation where repeated force‑feeding is not prompted by valid medical reasons but rather aims to force the applicant to stop the protest, and is performed in a manner which unnecessarily exposes the prisoner to great physical pain and humiliation, amounts to torture.27 The CPT has refected upon this issue in one of its visit reports.28 State authorities have a duty of care with respect to persons in their custody. This duty of care includes the protection of a detained person’s life, including the prevention of suicide and of any other act by the person concerned likely to cause death or irreversible physical damage. Therefore, a decision to feed against his will a prisoner on hunger strike can in principle be justifed in order to prevent the prisoner from sufering irreversible physical damage or death. On the other hand, the majority of national legislations in Europe, as well as relevant inter‑ national medical ethical codes, today consider that a competent adult may choose to refuse medical treatment even if it could save his life. Consequently, the authorities involved in the management of a hunger strike by a prisoner may often be faced with two potentially conficting values: their duty of care to safeguard a life and the prisoner’s right to physical integrity (including the right not to have a treatment imposed on him). CM Recommendation No. R (1998) 7 defnes the basic principles of addressing the hunger strike issue. X Hunger strikers should be given an objective explanation of the harmful efects of their action upon their physical well‑being, so that they understand the dangers of prolonged hunger striking. X Clinical assessment of a hunger striker should be carried out only with the express permission of the person, unless he or she sufers from serious mental disorders which require the transfer to a psychiatric service. 26. Case of X v. Germany (1984) 7 EHRR 152. 27. Ciorap v. Moldova 12066/02, Nevmerzhitsky v. Ukraine 54825/00. 28. CPT/Inf (2007)10. Psychiatric care and treatment plans Page 41