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When a hunger strike strikes

What should you do when one or more of the inmates in your facility call a hunger strike?

On the surface, hunger strikes may seem fairly easy to manage, but this is hardly the case. Although uncommon in United States prisons and jails, hunger strikes that are not handled appropriately can lead to bad press and dangerous outcomes for both inmates and staff.

A recent hunger strike initiated by a Cleveland inmate provides a good example. In that instance, the inmate decided to fast after being denied what at the time was considered unnecessary medical care. The story made it into the press, making the prison look like the ‘bad guy.’ An early response may have diffused the situation before the public became aware of it.

Other, more serious instances of hunger striking can lead to medical jeopardy and create an ethical dilemma for management and health care providers. In the most serious cases, facilities may be left with no other choice but to force-feed hunger striking inmates — a thorny ethical situation which will likely draw outside attention.

What should you do when one or more of the inmates in your facility call a hunger strike? First, find out the reason for the strike. Hunger strikes are often caused by a misunderstanding about facility policy or resentment about a recent change or lockdown situation. In these instances, a clarification of policies and rules may sufficiently resolve the situation.

Next, evaluate the seriousness and extent of involvement in the protest. As noted in the World Medical Association (WMA) guidelines for hunger strikes, not all declarations of hunger strikes are what they seem. Reactive hunger strikers, — the most common type of person refusing food — are unlikely to continue voluntary total fasting to the point of physical harm. These individuals are likely just protesting to create sympathy for themselves or their cause. Reactive hunger strikers — like the Cleveland inmate mentioned above — often desire medical attention and monitoring to further elevate their cause.

Unlike reactive strikers, true hunger strikers take action based on principle — not just to ‘make a scene.’ They are more likely to develop dehydration, muscle wasting, or exacerbation of underlying medical conditions.

Hunger strikes are probably rare at your facility. Consequently one of your first actions at present should be a review of facility policy for dealing with strikes — before one happens! During hunger strikes, make sure everyone on your team is aware of their role and ask your medical unit management to review your facility’s healthcare policy on strikes.

In all cases, strikers should have medical monitoring. Expect these steps to be taken:

• Evaluation of the striking inmate’s mental capacity to discover any mental impairment that might undermine their ability to make health decisions

• A medical evaluation to determine any chronic medical condition that could be exacerbated by fasting

• Full disclosure to the inmate of the health consequences of prolonged fasting — you should document a verbal discussion and provide written materials to the inmate, if applicable

• A private medical visit to determine that there is no coercion behind the striker’s determination to fast

• Regular medical evaluation of the hunger striker

With luck, you will never have to deal with a hunger strike. But if one arises in your facility, be prepared to manage the situation safely and effectively.

Please share your hunger strike experiences in the comments below.

Dr. Schoenly has been a nurse for 30 years and is currently specializing in correctional healthcare. She is an author and educator seeking to improve patient safety and professional nursing practice behind bars. Her web-presence, Correctional Nurse, provides information and support to those working in correctional health care. Her books, Essentials of Correctional Nursing and The Correctional Health Care Patient Safety Handbook are available in print and digital on Amazon.

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