or punishment. Meanwhile, we recall that according to Article 17 of the Constitution, restrictions
of human rights and freedoms envisaged in this Constitution can be imposed only by law for the
purpose of a public interest or protection of other people rights. The restrictions should be in
proportion to the situation dictating it. These restrictions cannot harm the core of the human
rights and freedoms and in no case should they overpass the restrictions envisaged by the
European Convention on Human Rights and Fundamental Freedoms.
We bring to your attention the fact that regarding the hunger strike, even though there is a legal
vacuum in the rights envisaged by the local laws, there have been approved several international
and regional acts as following:
“Declaration on Hunger Strikers (Malta Declaration of year 1991, revised in 1992)”,
approved by the 43rd World Medical Assembly held in Malta, November 1991, and
revised by the 44th World Medical Assembly held in Marbella of Spain, September 1992,
and revised by 57th World Medical Assembly held in Pilanesberg of South Africa,
October 2006”. According to Article 1 of this Declaration, the hunger strikes are often e
form of protest by people who lack other ways of making their demands known. In
refusing nutrition for a significant period, they usually hope to obtain certain goals by
inflicting negative publicity on authorities. In the guidelines for the management of the
hunger strikers the same Declaration foresees that:
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.
Physicians should talk to hunger strikers in privacy and out of earshot of all other
people, and must respect confidentiality. They should make an examination of the
hunger strike at the beginning of the fast and must explain the consequences and
medical implications deriving from the strike.
Physicians need to satisfy themselves that food or treatment refusal is the individual's
voluntary choice. Hunger strikers should be protected from coercion. Physicians can
often help to achieve this and should be aware that coercion may come from the peer
group, the authorities or others, such as family members. Physicians or other health
care personnel may not apply undue pressure of any sort on the hunger striker to
suspend the strike. Treatment or care of the hunger striker must not be conditional
upon suspension of the hunger strike.
Artificial feeding can be ethically appropriate if competent hunger strikers agree to
it. It can also be acceptable if incompetent individuals have left no unpressured
advance instructions refusing it.
81
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