Report on the Performance of Activities of the National Preventive Mechanism for 2015 Furthermore, contrary to the instruction of the COPSD, in some cases the prisoners were denied the right to use all the benefits they had previously enjoyed as a consequence of mere initiation of a disciplinary proceeding, even though they had not yet been found guilty by that time. Certain shortcomings in the implementation of disciplinary proceedings, which are held in accordance with the CPA, were caused by the fact that in some penal institutions they are conducted by persons without legal education. The lack of education of persons who hold disciplinary proceedings is certainly a problem, and considering frequent amendments of the CPA and inconsistencies between the EPSA and the CPA, such education is necessary and it would certainly result in a higher level of respect for the rights of persons deprived of their liberty. A special problem is failure of competent courts to act upon proposals made by heads of prisons with regard to pronouncing of a disciplinary measure. Specifically, out of 58 proposals submitted in 2015, in as many as 37 cases the competent court failed to issue any decision, which in some situations makes the maintenance of order and security difficult. Hunger strike Pursuant to the World Medical Association’s Declaration of Malta on Hunger Strikers (hereinafter: Declaration of Malta), a hunger striker is a mentally healthy individual who has declared his/her decision to start a hunger strike and who refuses to take food and/or liquid for a significantly long time. In 2015, as many as 226 persons in the prison system went on a hunger strike, mostly for a period of several days. Although this is a form of expressing one’s dissatisfaction that can seriously harm one’s health and that poses two basic, mutually contrary conflicts of values – the obligation to respect life and the duty to respect the patient’s autonomy, there are no clearly written rules about how to treat hunger strikers in the prison system. The situation is made more difficult by the fact that prison physicians, unlike those who work in public service, are government employees employed with the Ministry of Justice, which can have a negative impact on trust, the basis of doctor-patient relationship. The right to refuse examination is generally respected, but physicians regularly warn prisoners who are on hunger strike that their actions are a threat to their health and their life. However, medical records of hunger strikers are imprecise and incomplete, and in some cases their health condition is not monitored on daily basis. This is contributed to by an insufficiently precise normative framework and lack of knowledge of relevant international documents, primarily the Declaration of Malta. Namely, according to EPSA, hunger strikers are treated in accordance with general medical rules, i.e. in accordance with the Act on Medical Practice, the Health Care Act and the Patients’ Rights Protection Act, all of which contain general provisions about the rights and obligations of patients, but fail to regulate the procedure in the event of a hunger strike. The Criminal Procedure Act and the Ordinance on House Rules in Remand Prisons do not contain any provisions about treatment of prisoners on remand who are on a hunger strike. In 16