X If, in the opinion of the doctor, the hunger striker’s condition is becoming signifcantly worse, it is essential that the doctor reports this fact to the appropriate authority and takes action in accordance with national legislation and professional standards. The WMA Declaration on Hunger Strikers goes further in detail when address‑ ing this issue. Stating that genuine and prolonged fasting risks death or permanent damage for hunger strikers, it also reveals the fact that hunger strikers usually do not wish to die but some may be prepared to do so to achieve their aims. WMA gives clear guidance to the physician how to act in case of a hunger strike. X Physicians must assess individuals’ mental capacity. This involves verifying that an individual intending to fast does not have a mental impairment that would seriously undermine the person’s ability to make health‑care decisions. Individuals with seriously impaired mental capacity cannot be considered to be hunger strikers. They need to be given treatment for their mental health problems rather than allowed to fast in a manner that risks their health. X As early as possible, physicians should acquire a detailed and accurate medical history of the person who is intending to fast. The medical implications of any existing conditions should be explained to the individual. Physicians should verify that hunger strikers understand the potential health consequences of fasting and forewarn them in plain language of the disadvantages. Physicians should also explain how damage to health can be minimised or delayed by, for example, increasing fuid intake. Since the person’s decisions regarding a hunger strike can be momentous, ensuring full patient understanding of the medical consequences of fasting is critical. Consistent with best practices for informed consent in health care, the physician should ensure that the patient understands the information conveyed by asking the patient to repeat back what they understand. XA thorough examination of the hunger striker should be made at the start of the fast. Management of future symptoms, including those unconnected to the fast, should be discussed with the hunger strikers. Also, the person’s values and wishes regarding medical treatment in the event of a prolonged fast should be noted. X Sometimes hunger strikers accept an intravenous saline solution transfusion or other forms of medical treatment. A refusal to accept Prison health care and medical ethics Page 42